New evidence signals a shift in prostate cancer diagnosis and treatment

A highlight of the EAU25 Game Changer session was the presentation of the OPTIMUM trial, a large-scale international study comparing micro-ultrasound (microUS) with MRI for guiding prostate cancer biopsies. According to the study results, MicroUS matched MRI in effectiveness, and showed a slightly higher detection rate (4%) for clinically significant cancers.

Conducted across 20 sites in eight countries with over 800 patients, the trial results found that microUS-guided biopsies are not only as accurate as their MRI counterparts but come with a host of practical benefits:

• Cheaper and more accessible, especially in settings with limited MRI availability
• No need for contrast agents like gadolinium
• Can be performed in a single visit, eliminating multiple hospital appointments
• Easier to learn and interpret for trained urologists

“This is game-changing,” said Prof. Laurence Klotz (CA), lead investigator of the study. “We’re talking about a one-stop-shop for diagnosis without the complexity or cost of MRI.”

Prof. Jochen Walz (FR), part of the EAU Scientific Congress Office, added: “MicroUS could make targeted prostate biopsies safer and more accessible - particularly in under-resourced health systems.”

The session also highlighted the results of the RAMPP trial, a German multicentre study prospective randomised controlled trial comparing best systemic therapy (BST) with radical prostatectomy or BST alone in the management of men with pauci-metastatic PCa.

The findings were promising:

• Patients receiving surgery plus systemic therapy had a ~10% improvement in cancer-specific survival after five years compared to systemic therapy alone.
• Surgery was shown to be safe, with low complication rates and improved symptom control, including reduced obstruction.
• The trial aligns with earlier data (e.g., STAMPEDE)

Lastly, the session touched on biopsy technique. New study results from TRANSLATE were presented and suggested that transperineal biopsy offered a 5% higher detection rate for significant prostate cancer compared to the traditional transrectal approach - and with far fewer infection risks.

With growing concerns over antibiotic resistance and post-biopsy sepsis, the transperineal route is quickly becoming the preferred standard, especially under local anaesthesia.