PCa management essentials opens EMUC’s 10th year

09 November 2018


Throughout a decade, the European Multidisciplinary Congress on Urological Cancers (EMUC) has established its reputation as the leading platform where multidisciplinary specialists with expertise in urological malignancies come together. This year, EMUC commences in Amsterdam, The Netherlands.

The programme launched with Plenary Session 01 “Prostate cancer management: Implementation without good evidence?” which was chaired by Prof. J. Oldenburg (GB), Prof. Dr. Kerstin Junker (DE), Prof. James N’Dow (GB) and Dr. Bradley Pieters (NL).

In his lecture “Functional imaging for recurrent disease”,  Dr. Stefano Fanti (IT) emphasised the relevance of performing more randomised and multi-centre studies to produce and procure more quality and robust data.

As he showed the model of the levels of the evidence pyramid, he said “You don’t have to take into account only  expert opinion;  you have to go through systematic reviews, randomised control trials, multi-centre trials as these are absolutely fundamental.”

As an example, he stated that data from his team’s study “PET/CT with 11C-choline for evaluation of prostate cancer patients with biochemical recurrence: meta-analysis and critical review of available data” was incorporated into the EAU Guidelines. “It’s not only the matter of the final diagnostic accuracy but the fact that study has robust, validated data and better than the competitors’,” said Dr. Fanti. “We provide good images, as well as, good evidence.”

Digital slides
“Information, diagnostic and therapeutic approaches resulting from Digital GU Pathology can be more accurate with less uncertainty when sources are evaluated separately and/or individually. It requires knowledge of previous studies that contributed to the current utilisation and role of virtual slides and quantitative tissue analysis. An ability to integrate data from diverse tests will be required,” stated Prof. Rodolfo Montironi (IT) in his lecture “Digital GU pathology”.

Digital Pathology, also known as whole slide imaging (WSI), refers to the high-resolution digitization and storage of entire glass slides as digital (virtual) slides. The advantages of using these include image sharing, interactive publication, quantitative image analysis, and information fusion.

Image sharing can be used for teaching, consultation, remote interpretation, and quality assurance. A digital pathology platform allows instant sharing of WSI in review cases, as multiple pathologists can review the same case in parallel.

With regard to interactive publication, Prof. Montironi said “When we submit data to a journal, we like to include the images of the histology. So we upload the virtual slides. This means that the readers that can see the slide and all the details.”

Quantitative image analysis (computational pathology) is used for prostate cancer detection and grading; location and identification of High-Grade Prostatic Intraepithelial Neoplasia (HGPIN); malignancy-associated changes; and biomarker expression in individual cells.

Information Fusion is direct integration with data derived, for instance, from surgery and other imaging techniques, such as mpMRI.

Prof. Montironi also stated that the performance of digital pathology is equivalent to glass slide microscopy [Snead, et al 2016].

Sequencing of novel therapies
In his lecture “Sequencing of novel therapies in urogenital malignancies”, Dr. Sergio Bracarda (GB) stated that at present, Abiraterone (ABI) or docetaxel (DCT) plus androgen deprivation therapy (ADT) are the new standards of care for cases presenting with high-risk metastatic castration-sensitive prostate cancer (HR-mCSPC), but which is better is not yet known. He added that radiotherapy may be evaluated in cases presenting with LV (oligometastatic?) disease.

Dr. Bracarda said that immediate sequencing between ABI and Enzalutamide (ENZA) should be discouraged, while AR-V7 possibly remains only a prognostic tool; and asked about the relevance and role of Radium-223 (Ra-223).

He foresees that non-androgen receptor (AR) novel targeted therapies such as P13K/AKT or poly-ADP ribose polymerase (PARP) inhibitors, and other new agents, such as checkpoint inhibitors will enter the prescription (Rx) scenario. “These new agents, after being tested in biologically designed Phase III studies, will modify the actual clinical sequencing in a genome-based, step-by-step verified sequencing. The future is here!”

To know more, access the EMUC18 Resource Centre.