EAU15: Future of targeted prostate cancer treatment

Sat, 21 Mar 2015

As treatment options become more refined and comprehensive, the tools available to the urologist or clinical oncologist to effectively target this treatment become more important. Systems that give precision on a molecular level are becoming a reality.

A substantial part of the second day of the Annual EAU Congress was devoted to the Section Meeting of the EAU Section of Oncological Urology, which cooperated with EORTC-GUCG, the EUOG, ESSO and ESTRO.

Profs. Freddie Hamdy (GB) and Morten Høyer (DK) gave back-to-back State-of-the-art lectures that together painted a poignant picture of the (very near) future for precisely-targeted treatment: surgical and radiotherapeutic, respectively. Key to both talks was the need for better targeting.

Hamdy showed the novel techniques of a prototype optical system that was developed in Oxford, which combined white-light with infrared in real time. Combined with the use of molecular mini-bodies, very precise surgical procedures can be achieved. He showed the size and scope of the team, which included engineers and radiologists. Hamdy: “We worked with a broad team to realize this project, but it’s the urologist who knows the unmet needs of patients.”

Speaking as a clinical oncologist on behalf of ESTRO, Høyer discussed the inclusion of pelvic lymph nodes in radiotherapy for prostate and bladder cancer. “The efficacy of elective radiation therapy to pelvic lymph nodes in therapy for PCa has not been proven in randomized clinical trials, and results from retrospective cohort studies are diverging. However, this poor efficacy could be explained by insufficient imaging, radiation techniques and dose.”

Speaking after the session, Høyer agreed that the optical system of Hamdy’s team would be very useful, combined with radiation oncology. “Combined, this could be the future of radio oncology and surgical oncology. What we need is better targeting of our treatments, defining volumes that we are treating with surgery or radiation oncology.”

“Although I’m well aware that I’m at a congress for urologists, it’s not a competition, there’s a mission for both of us. For instance, it would be obvious to treat patients with lymphnode metastasis with radiation oncology. That’s because we can treat electively, relatively large margins, which is not possible with surgery. We can boost up, give more intensive treatment of high-risk volumes, or volumes where we know there is metastasis.”

Asked about the multidisciplinary approach that is often mentioned in the treatment of urological cancers, Høyer quipped: “You shouldn’t just talk about it, but live together in the same house! Our new hospital in Aarhus, which opens in 2018, will be a single PCa clinic with every discipline under the same roof. I hope to see clinics like this across Europe in the near future!”