EMUC16: Trends in genitourinary pathology and impact on clinical practice

Thu, 24 Nov 2016 • Joel Vega

Genitourinary specialists and experts took up new trends and recent developments in genitourinary pathology and their impact on current clinical practice during a special 8th European Meeting on Urological Cancers (EMUC16) event held today in Milan, Italy.

A well-attended pre-EMUC event, the EMUC Symposium on Genitourinary Pathology and Molecular Diagnostics (ESUP) took up the various developments and updates in genitourinary pathology particularly new classifications and genetic findings in prostate, kidney, bladder, penis and testis cancers.

Providing two keynote lectures were Jonathan Epstein (USA) and Mahul Amin (USA), with Epstein giving a comprehensive update on new additions in the WHO morphological classifications of genitourinary cancers, and Amin presenting a summary of the forthcoming 8th edition of the TNM staging (AJCC and UICC) of genitourinary (GU) tumours and its implications in clinical practice.

“Between 2004 and 2016 WHO Editions on classification of Tumours of the Urinary System and Male Genital Organs there have been many changes in nomenclature, new entities, and understanding of previously described tumours,” said Epstein.

Epstein mentioned that molecular information on GU tumours is “rapidly expanding,” adding that for the 2016 edition “there are only a few specific examples of incorporating molecular tests into clinical practice (mostly with kidney tumours).”

Among the highlights in his presentation are:

  • Prostate cancer: Intraductal carcinoma of the prostate that has some features of high-grade prostatic intraepithelial neoplasia;
  • Kidney cancer: Clear cell papillary RCC- initially described in end-stage kidneys but now recognized as more commonly seen sporadically and a distinct entity with different morphology and genetics;
  • Bladder cancer: In T1 bladder disease, several substaging strategies have been proposed to improve outcome prediction, but none have been routinely adopted; and
  • Testis cancer: Germ Cell Neoplasia In Situ (GCNIS) replaces ‘intratubular germ cell neoplasia, unclassified (IGCNU).

Meanwhile, Amin spoke on the changes that will appear in the 8th edition of the AJCC Cancer Staging Manual.

“In the 8th edition there are updated staging systems in several chapters, updated content in each chapter, updated illustrations and histologic classifications and updated WHO/IARC histology codes,” said Amin. He also noted that there are seven chapters in the Male Genital and Kidney and Urothelial tract chapters.

Amin gave the following take-home messages:

  • AJCC Prognostic Groups are redefined for all sites;
  • AJCC TNM is transitioning to a more individualized approach;
  • Important additional information on prognostic factors for staging, clinical use, emerging in clinical practice, risk assessment models, for clinical trials; and
  • Summary of prognostic factors collected by registries is outlined in each chapter.

“It is also worth mentioning that Chapter 1 of the manual on general staging rules is important to be familiar with,” he said. Moreover, Amin said that the 8th edition is effective with cases diagnosed from January 1, 2018.

Following the presentations by Epstein and Amin, the meeting also presented a roundtable on kidney, prostate and urothelial carcinomas with both pathologists and urologists providing their views including how recent developments in pathology can translate into clinical practice.