Tumour characteristics and patient profile: Crucial issues in PCa treatment

Despite advances in diagnostic tools and imaging technologies, prostate cancer (PCa) management remains a challenge to many experts due to extensive variability in tumour characteristics and individual patient profiles which complicate the delivery of an optimal treatment plan.

“There are two crucial aspects at the time of diagnosis in prostate cancer. The first is the (expected) characteristics of the tumour, and the second is the characteristics of its host,” said Prof. Monique Roobol (NL), who will take part as faculty speaker in the new EAU Update on Prostate Cancer (PCa17) to be held in Vienna on September 15 and 16. Roobol will speak on PSA screening and its role in PCa management during the first day of the two-day meeting which aims to provide a practical and more in-depth educational assessment of current and prospective PCa therapies.

“Staging and grading the tumour is becoming more and more accurate with the availability of magnetic resonance imaging (MRI) and more detailed pathology review including, for example, cribriform growth patterns,” added Roobol who is affiliated with the Department of Urology of the Rotterdam-based Erasmus Medical Centre.

New research shows that cribriform growth in some PCa forms such as those in Gleason grade 4 is a strong prognostic marker for distant metastasis and disease-specific death in patients with Gleason score 7 prostate cancer, following radical prostatectomy. Another challenge that Roobol underlined is the assessment of a patient’s life expectancy.

“Assessing life expectancy remains a challenge but is crucial in determining who should be screened and what treatment should be applied after diagnosis,” she said.

With the goal to deliver a more interactive update and assessment of management strategies in PCa, the meeting will feature breakout sessions with each session preceded by “focused” updates on the whole range of issues in PCa such as patient selection, local and systemic treatments and future perspectives, among other topics. A total of 16 sessions will take place over two days to pinpoint management dilemmas and best practices.

Roobol will speak on the modern use of PSA during the session on screening. “I would highlight three things in my lecture. First, the downstream negative consequences of PSA is perhaps not so much the poor test characteristics, but rather the lack of adherence to guidelines emphasizing ‘smarter’ approaches; for example, the overuse of the PSA test when not indicated, and sub-optimal management of screen-detected tumours,” she explained.

She would also examine the set of recommendations recently issued by the U.S. Preventive Services Task Force (USPSTF). “Another point I would look into is the changed USPSTF recommendation and the reasons why, in combination with the previous point. This in my view is a strong message: while there was a lot of critique towards the D recommendation it was perhaps necessary since the PSA test was misused. Hopefully, the C recommendation will result in a comeback of PSA screening (of which I am sure it has a benefit) but only in those men that actually can benefit,” according to Roobol. The C recommendation selectively offers PSA screening or providing it to individual patients based on professional judgment and patient preferences.

Another point Roobol noted was the need to compare biopsy outcome prediction tools. “I would emphasize the need for a head-to-head comparison of biopsy outcome prediction tools. A European-based study addresses the fact that in the EAU guidelines risk calculators are mentioned but no preference is given on which one to use due to a lack of head-to-head comparisons,” she said.

“After consultation with the guideline committee, we identified several data sets across Europe and tested to RCs. At the moment, the manuscript has been presented at EAU/AUA and will be submitted soon,” noted Roobol.

Regarding active surveillance (AS), she pointed out that a further refinement of AS strategies would go a long way in offering better treatment options. “Working in the field of early detection and knowing that a lot of low-risk prostate cancers are still being detected remains a challenge. Refining active surveillance strategies is also an issue. That is what we try to do within the GAP-3 Movember initiative having global data now of approximately 15,000 men with low-risk prostate cancer initially treated with AS,” she added.

Practical and compact programme

With a compact programme that stresses practical insights, the PCa17 event is a unique format and is the latest meeting initiative from the EAU. Besides a comprehensive update on core topics, results from current research and experience from expert centres will be examined by the resource speakers.

“The format is highly interactive and will bring much benefit to participants,” said Roobol regarding PCa17. “Instead of passively listening to presentations the participants have to think and join the debates or discussions. This can only lead to an increase of knowledge of what is currently the state- of-the-art in prostate cancer diagnosis and treatment,” Roobol said.

To know more about the aims of PCa17 and details on the Scientific Programme, speakers, registration and other information, visit the meeting website.