New drugs and emerging technologies have entered mainstream management strategies for urological cancers prompting experts to closely look into the role of imaging, drug combinations and genetic research and how these gains may be employed to optimize current standard practices.
At the 8th European Multidisciplinary Meeting on Urological Cancers (EMUC16) to be held in Milan (IT) from 24 to 27 November, the focus will not only be on controversial diagnostic issues and treatment strategies but also how these developments impact clinical practices, disease progression and the patient’s quality of life.
Besides discussions on malignancies such as kidney and bladder cancers, new imaging technologies on recurrent prostate cancer (PCa) will be among the topics up for discussion during the four-day event. The role of positron emission tomography (PET) and computed tomography (CT), for instance, will be the focus in one of the first-day sessions where experts will attempt to identify the benefits of employing precision imaging techniques.
“A key point is that PET/CT can play a major role in the imaging of prostate cancer patients, especially using the new available tracers. Some indications are already known and scientific literature is rapidly growing (such as PSMA PET/CT in biochemical recurrent prostate cancer),” said Stefano Fanti, associate professor of nuclear medicine at the University of Bologna.
Fanti, who also chairs the European Association of Nuclear Medicine’s (EANM) Oncology Commitment, said there are other indications that are new and emerging, among them the use of PET/CT to evaluate response to therapy in recurrent PCa. New gains in technology and drug developments are eagerly welcomed and awaited but these are paired with challenges and dilemmas particularly with regards drug sequencing and data interpretation. “With respect to biochemical recurrence, it is important to properly restage patients, before the occurrence of a widespread diffusion of the relapse,” Fanti pointed out.
“For example in a patient treated with radical prostatectomy and biochemical recurrence, before planning salvage EBRT (external beam radiation therapy), the possibility of any disease outside the prostatic bed should be excluded and this could be properly done with PET/CT,” he added.
A more inclusive meeting
In the last seven EMUC editions, organisers European Society for Medical Oncology (ESMO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU) aimed to present a scientific programme which not only addressed core topics and emerging trends but also attempts to trigger critical evaluation of widely accepted multidisciplinary approaches. With a gathering of oncologists, urologists, pathologists, radiation oncologists, nuclear medicine physicians, genetic researchers and related healthcare professionals, EMUC examines best practices and evaluates forward-thinking approaches.
This year´s EMUC edition will open on 24 November with the Symposium on Genitourinary Pathology and Molecular Diagnostics which will present updates in guidelines and protocols on urological cancers. Seven sessions during the event will cover the whole range of treatment and diagnostic dilemmas, prospects and developments with plenary meetings, debates, lectures and case discussions.
Fanti said there is still room to further expand multidisciplinary meetings and make it more inclusive. He noted the real challenge is not so much on the composition of multidisciplinary teams but more on material capabilities and technical expertise.
“Imaging experts are not always part of the multidisciplinary team, but the most relevant problem is that most institutions lack specific expertise and facilities for innovative PC imaging. Few centers have available new tracers for PET/CT and multiparametric MRI that are complementary techniques,” he said.
Asked what he expects in terms of treatment breakthroughs in the coming years for prostate cancer, Fanti said there is already a build-up or steady progress in the field.
“There has been dramatic progress in both the treatment and imaging of prostate cancer. Availability of new therapies (especially treatment of CRPC) and imaging methods (new PET tracers) have made possible a major change in patient’s management,” Fanti said.
“Imaging can be the driver to allow the clinicians (either uro-oncologist or radiation oncologist) to decide on the best treatment option for each patient. The time for personalized therapy has also come for prostate cancer. ”