Despite gains in imaging technology and molecular research, pathologists engage in prostate cancer diagnosis are faced with dissimilar reporting systems and the lack of efficient selection criteria that are needed to further improve the accuracy of diagnosing prostate cancer types particularly those that are lethal or aggressive.
“We need to develop a pathology reporting system common to all. At the moment, there is no uniformity among pathology labs in the way specimens are analyzed and evaluated. The other is to better define the selection criteria, and from the morphological point of view to better select patients for active surveillance,” said Prof. Rodolfo Montironi, pathology professor and head of the Genitourinary Cancer Program at the Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region in Ancona, Italy.
Montironi is session chairman and a speaker at the upcoming 9th European Multidisciplinary Meeting on Urological Cancers (EMUC17) to be held in Barcelona from November 16 to 19. EMUC is annually organised by three of Europe’s leading and specialised medical associations- the European Society for Medical Oncology (ESMO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU).
Aggressive prostate cancer is one of the most malignant urological diseases among men, and doctors face challenges in the early detection of lethal types. With the development of new imaging tools, early diagnosis are more attainable than in previous decades but these tools need to be combined with other techniques and more accurate detection methods.
Recent investigations, based on the 2016 publication of the WHO bluebook, have shown that there are four architectural patterns in Gleason pattern 4 such as the cribriform, glomeruloid, fused and the poorly formed types.
“Aggressive forms of cancers can have different architectural patterns, mainly when referring to Gleason pattern 4. Recent investigations, based on the 2016 publication of the WHO bluebook, have shown that there are four architectural patterns in Gleason pattern 4 such as the cribriform, glomeruloid, fused and the poorly formed types,” explained Montironi. “It has been shown that the cribriform architectural pattern is more aggressive than the others, and that intraductal carcinoma of the prostate (IDC-P) is also a marker of prostate cancer aggressiveness.”
New imaging techniques, according to Montironi, are needed to enable doctors identify the cases with a cribriform pattern and IDC-P. “These tools include biomarkers and other molecular techniques to distinguish aggressive diseases. With new research outcomes, physicians are hopeful that diagnosis and therapy can be improved with the entry of more sophisticated technologies,” he added.
Issues with MRI
In recent years, Magnetic Resonance Imaging (MRI) is considered as one of the newer tools that can aid doctors and cancer specialists in diagnostic work, and although there are distinct benefits from this technology and other variants of MRI, Montironi said further work is needed to refine the diagnostic process.
“MRI represents a great step forward in detecting morphologically aggressive forms of cancer. However, some cancer foci of low-grade and high-grade type can be missed by MRI. Further clinico-morphological investigations are needed to improve cancer detection, mainly in those instances of potentially aggressive forms,” said Montironi.
He expressed optimism that given the right tools and with insights from current or still ongoing research studies, there are hopes for key breakthroughs in the coming years.
“We need the addition of molecular testing to the traditional pathology approach. Some of the tests can be applied to tissue obtained from prostate specimens, while others to liquid and urine samples,” said Montironi, whilst underscoring that some prostate cancers with similar characteristics or morphology can behave differently.
Asked to comment on the role of multidisciplinary meetings such as the EMUC, Montironi said events such as the EMUC help link up and inform cancer experts from various fields. “The great advantages of a multidisciplinary meeting are that pathologists, basic scientists and clinicians can discuss findings from their points of view and integrate these in the final evaluation based on different sources or perspectives,” he said.
With a compact three-day Scientific Programme, EMUC17 will address key issues in prostate, kidney and bladders cancers. EMUC will be preceded on 16 November with the EMUC Symposium on Genitourinary Pathology and Molecular Diagnostics (ESUP), providing more focus on specific challenges in pathology and molecular research. A complementary pre-meeting event is the 6th Meeting of the EAU Section of Urological Imaging (ESUI17) with critical discussions and updates on a range of imaging issues and controversies.
The European School of Urology (ESU) will offer courses and Hands-on Training sessions, while the ESTRO is organising a delineation contouring workshop with the topic “Target volume contouring in bladder cancer.” A Uropathology Training Workshop will present practical insights on uropathology procedures and show how various cancer experts can benefit from collaborative work.