6th EMUC: Experts examine strategies in prostate cancer management
Optimising treatment and management strategies in prostate cancer took up the first plenary session of the 6th European Multidisciplinary Meeting on Urological Cancers (EMUC) in Lisbon, Portugal, with experts discussing prospects in imaging, radiotherapy and benefits of medical treatment.
“This year’s meeting has gathered 1,394 participants from 65 countries, and after seven years of holding this congress we have always focused on the central aim to foster education and knowledge in urological cancer and improve diagnosis and treatment through a multi-disciplinary approach,” said EAU Sec. General Per Anders Abrahamsson (SE) in the opening of the 6th European Multidisciplinary Meeting on Urological Cancers (EMUC).
Abrahamsson was joined by co-chairpersons Joaquim Bellmunt (US) of ESMO, Philip Poortmans (NL) of ESTRO, Gertraud Heinz-Peer (AT) of ESUR and A. Lopez-Beltran (PT) of ESP/ESUP.
In the first plenary session, Abrahamsson and Maha Hussein (USA) took opposing views on the issue of intermittent androgen deprivation (IAD) and continuous androgen deprivation (CAD) in the treatment of castration-resistant prostate cancer (CRPC).
In debunking the benefits of IAD, Hussain examined the strengths and weaknesses of major trials, survival outcomes and quality of life (QoL) data, saying that no trial to date has demonstrated overall survival (OS) superiority or equivalence of IAD over CAD. In her concluding remarks, she noted several points, comparing CAD with IAD in various disease settings.
For adjuvant setting where survival can be prolonged with androgen deprivation therapy (ADT) and local therapy, Hussain said CAD has a role. Regarding non-metastatic PSA-only relapse, she said that neither approaches yield added benefit based on current data, but for IAD, she noted: “There is possibly (a role) but a balanced discussion is needed considering the lack of data to support significant outcome impact of either approaches.”
On the issue of metastatic disease, Hussain said CAD has a role based on optimal survival outcomes. “Patients interested in IAD should be counseled regarding potential negative impact on survival and modest impact on QoL,” she said.
On the other hand, Abrahamsson argued for IAD and underscored the discussion basically centres on the question whether “to give more drugs or giving less drugs” while noting that in maximal androgen blockade (MAB) majority of trials are sponsored by industry compared to few trials for IAD, where only a small minority .
“There is no clear evidence for inferiority or superiority of intermittent androgen suppression (IAS) in terms of time to CRPC,” said Abrahamsson, adding that IAD is equivalent to CAD in selected patients.
He added that IAD is effective as contnuous ADT but with better tolerability. “There is Insufficient data to determine whether IAD is able to prevent the long-term complications of ADT,” noted Abrahamsson as he stressed that “more comparative analysis focused on QoL issues is warranted.”
He also quoted from the EAU Guidelines; ‘…IAD is currently widely offered to patients with prostate cancer in various clinical settings , and its status should no longer be regarded as investigational (LE: 2)”
Other topics discussed were optimising imaging for biochemical recurrence given by Jelle Barentsz (NL), understanding the natural history of progressing PCa and whether treatment is always needed by Martin Gleave (CA), curative radiotherapy by M. Van Vulpen (NL), curative surgery for local recurrence and patient selection by Steven Joniau (BE), and optimal treatment for mCRPC by G. Attard (GB).