Current trends and future prospects in diagnosing and treating prostate and bladders cancers were examined in the plenary session of the 2nd EAU Baltic Meeting held over the weekend in Riga, Latvia.
The focus of the lectures and discussions in the second plenary session were on clinically insignificant prostate cancer (PCa), histological evaluation of prostate tumours, the role of active surveillance, focal therapy for prostate cancer and a state-of-the-art lecture on bladder cancer.
M. Zarkovski (EE) discussed clinically insignificant cancer, and noted that these type of prostate cancers now account for a large or significant number of newly diagnosed prostate cancers. He also urged physicians to exercise caution in using radical therapies that may only lead to complications and morbidities in patients,
Regarding the use of nomograms, he noted that they can be good prediction tools, but underscored that nomograms need to be validated in unscreened populations.
“Active surveillance (AS) is the only way to reduce overtreatment associated with PSA screening for prostate cancer,” said Zarkovski.
Meanwhile, R. Adomaitis (LT) further looked into the issues of AS, as he emphasized the importance of doctors carefully discussing the option with their patients.
Noting that AS is safe, Adomaitis said the use of multiparametric- MRI would prove valuable in the selection and follow-up of patients. He also urged urologists that when it comes to the issue of AS, they should take the initiative to go beyond current guidelines and publish their own data.
M. Emberton (GB) took up the role of focal therapy in prostate cancer. “Focal therapy has emerged as a new class of therapy which now commands legitimacy,” Emberton said and added that focal therapy has prompted “an order of precision in terms of risk stratification that was hitherto missing.”
Emberton: “Our treatments have, to date, been modifications of existing therapies. The next few years will see the emergence of treatments designed for the task.”
B. Schmitz-Drager (DE) gave a state-of-the-art lecture on bladder cancer, discussing the challenges in identifying better markers.
In his closing remarks, he said that although better markers are desirable the performance of current markers is sufficient. He also recommended that doctors use markers before ultrasound cystoscopies (UC) in the follow-up of high-grade tumours.
“In G1-2 NMIBC, multi-marker panel or multiparameter analysis is necessary,” he said while adding that urologists should conduct prospective (randomized) trials in G1-2 tumours.