EAU 2019 Prostate Cancer

EAU 2019 Prostate Cancer

EAU 2019: Academic and Scientific Activity of European Urology Residents During their Training

Barcelona, Spain (UroToday.com) The authors of this study note that most urologic residency training programs in Europe lacks a specific academic, scientific and research curriculum. As such, the authors of this study aimed to determine the current status of academic and scientific involvement of resident/trainees and urology departments in Europe, followed by an assessment of the predictors were associated with a higher involvement among European urology residents.

EAU 2019: Overall Adverse Events in Patients Treated with Radium-223 for Metastatic Castration Resistant Prostate Cancer: Registry Study and Analysis of Real-Life Data from EudraVigilance

Barcelona, Spain (UroToday.com) Radium 223 is a targeted alpha therapy that demonstrated a significant overall survival (OS) benefit and a favorable safety profile in patients with castrate-resistant prostate cancer (CRPC) and bone metastases in the ALSYMPCA trial. 1 The PARABO trial (NCT02398526) is an ongoing prospective observational, non-interventional, single-arm study, which aims to evaluate pain and bone-pain related quality of life in patients with metastatic CRPC receiving Radium 223, who were enrolled in a routine clinical practice setting in Germany between March 2015 and December 2017, over a follow-up period of 5 years (study design shown in Figure 1).

EAU 2019: Comparison of Docetaxel and Androgen Receptor Axis Targeted (ARAT) Agents mCRPC Patients with Intraductal Carcinoma of the Prostate

Barcelona, Spain (UroToday.com) Intraductal carcinoma of the prostate is recognized as a poor prognostic risk factor. However, there are no data available on the optimal sequence of multiple new agents for metastatic castrate-resistant prostate cancer (mCRPC). The authors of this study aimed to investigate the efficacy of docetaxel and androgen receptor axis-targeted (ARAT) agents in mCRPC patients with intraductal carcinoma.

EAU 2019: Risk of Dementia Following Androgen Deprivation Therapy of Prostate Cancer

Barcelona, Spain (UroToday.com) Androgen deprivation therapy (ADT) is one of the cornerstones of treatment for men with a high-risk, locally advanced, or metastatic prostate cancer. ADT is associated with a variety of side effects, such as cardiovascular disease, osteoporosis, and metabolic syndrome. There is an ongoing controversy with conflicting evidence on the link between ADT and dementia, as well as depression. In this study, the authors aimed to establish the association between ADT and dementia in men with histologically confirmed localized and locally advanced principal diagnosis of prostate cancer.

EAU 2019: Trainee Burnout in the United States and Europe: A Multi-National Comparative Study

Barcelona, Spain (UroToday.com)  Physician burnout is an increasingly recognized and rapidly growing concern in the medical community, particularly in the United States. Beyond its impact on the system, it has severe consequences for both the physician and the patients they treat – and if not recognized, can have dire consequences. Defined by most sources as a combination of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, burnout has reached greater than 50% amongst some specialties. Indeed, according to the 2019 Medscape “National Physician Burnout, Depression & Suicide Report 2019,” urology tops the list of specialties with burnout! Topping the list of reasons for burnout include: “too many bureaucratic tasks,” such as charting and paperwork, and spending too many hours at work.

EAU 2019: Higher Free Testosterone Predicts Faster Potency Recovery After Robot-Assisted Radical Prostatectomy

Barcelona, Spain (UroToday.com) Hypogonadism and sexual dysfunction are closely related, such that men with low testosterone are at increased risk of erectile dysfunction. In a cohort of men undergoing radical prostatectomy and in consideration of its attendant side effect of decreased sexual function, preoperative low testosterone is of significant concern. 

EAU 2019: Switching from GnRH Agonists to Antagonists for Castration-Resistant Prostate Cancer as a Second-line Hormonal Therapy: A Multicenter Prospective Study

Barcelona, Spain (UroToday.com) LHRH agonists are the most frequently used drugs for androgen deprivation therapy (ADT) in prostate cancer. Using these drugs and achieving castrate testosterone levels lower than 20 ng/dl correlates with improved disease-specific survival in advanced prostate cancer patients. The testosterone levels may rise above castrate levels between administrations, especially if it is delayed.  

EAU 2019: A Multi-Institutional Randomized Controlled Trial Comparing Novel First Generation High-Resolution Micro-Ultrasound with Conventional Frequency Ultrasound for Transrectal Prostate Biopsy

Barcelona, Spain (UroToday.com) In this study, the authors compared first-generation high frequency 29 MHZ transrectal micro-ultrasound (micro-US) with conventional low frequency 7-12 MHZ transrectal ultrasound (conv-US) for the detection of clinically significant prostate cancer.

A total of 1676 men referred for prostate biopsy with no history of prostate cancer were randomized either to micro-US or conv-US guided biopsy at 5 different sites, including Johns Hopkins, Urology of Virginia, Calgary, UHN/Princess Margaret Cancer Center, and Universite Laval.  

EAU 2019: Long-Term Mortality in Patients with Positive Lymph Nodes at Radical Prostatectomy

Barcelona, Spain (UroToday.com) The management of node-positive prostate cancer is rapidly changing. Historically, men with a clinically node-positive disease at the time of radical prostatectomy (RP) often had an aborted RP and were treated with androgen deprivation therapy (ADT) alone. Men who were found to have a microscopic node-positive disease at the time of final pathology, based on the strength of the Messing data,1 were treated with ADT alone.

EAU 2019: Pathological Findings at Radical Prostatectomy of Biopsy Naïve Men Submitted to MRI-targeted Biopsy Alone without Standard Systematic Sampling

Barcelona, Spain (UroToday.com) There is data coming from prospective randomized trials endorsing the use of mpMRI as a triage test for prostate cancer diagnosis in biopsy naïve men. The PRECISION trial1 assessed the superiority of mpMRI-targeted biopsy over systematic biopsies for the detection of clinically significant prostate cancer. 

EAU 2019: Which Patients with Clinically Node Positive Prostate Cancer Should Be Considered as Candidates for Radical Prostatectomy as Part of a Multimodal Treatment? The Impact of Nodal Burden

Barcelona, Spain (UroToday.com) The management of node-positive prostate cancer is rapidly changing. Historically, men with a clinically node-positive disease at the time of radical prostatectomy (RP) often had an aborted RP and were treated with Androgen Deprivation Therapy (ADT) alone. Men who were found to have a microscopic node-positive disease at the time of final pathology, based on the strength of the Messing data,1 were treated with ADT alone.

EAU 2019: The Impact of Surgical Experience on the Risk of Surgical Margins and Biochemical Recurrence after Robot-Assisted Radical Prostatectomy: A Learning-Curve Study

Barcelona, Spain (UroToday.com) There is a known learning curve with any surgical procedure, which has been established in both the general surgery literature and in the urology literature. Prior papers, in fact, have already demonstrated better surgical outcomes with increased surgeon experience. Specifically, improved cancer control with increasing surgical experience (the “learning curve”) has been demonstrated for open and laparoscopic prostatectomy. In this manuscript, the authors focus on demonstrating the relationship between surgical experience and oncologic outcomes of robot-assisted radical prostatectomy (RALP). 

EAU 2019: Is mpMRI Enough in Prostate Cancer Diagnosis?

Barcelona, Spain (UroToday.com) The PROMIS trial showed that men with raised PSA might avoid a biopsy if a mpMRI was performed as a triage test.1 The authors of this retrospective study aimed to evaluate the negative predictive value of mpMRI for clinically significant prostate cancer in a “real world” setting. Other outcomes included in this study were the consistency between centers, the added value of PSA density and comparison of biopsy methods.

EAU 2019: Impact of Bilateral Neurovascular Bundle Preservation on Oncological Outcomes in Non-organ Confined Prostate Cancer Patients

Barcelona, Spain (UroToday.com) Sparing of the neurovascular bundle (NVB) at the time of radical prostatectomy (RP) has been established as a predictor of improved functional recovery, particularly as it relates to erectile function. However, sparing the NVB entails a closer dissection to the prostatic capsule, which may carry the risk of positive surgical margins, especially in more locally advanced tumors.  

EAU 2019: There is no way to Avoid Concomitant Systematic Prostate Biopsies in Addition to mp-MRI Targeted Sampling in Men with Positive Imaging

Barcelona, Spain (UroToday.com) It is still considered controversial whether it is necessary to add systematic biopsies to a targeted biopsy in patients with a suspicious prostate mpMRI lesion. In this study the authors attempted to identify patients who can avoid systematic biopsy at the time of mpMRI targeted biopsy, relying on individual patient probability to harbour clinically significant prostate cancer outside the index lesion.

EAU 2019: The Advances in the Treatment of Castrate Resistant Prostate Cancer

Barcelona, Spain (UroToday.com) Dr. Robert Van Soest presented on the recent advances in the treatment of castrate-resistant prostate cancer (CRPC). The current therapeutic options in metastatic hormone-sensitive prostate cancer (mHSPC), and the 1st and 2nd treatment lines of metastatic CRPC are shown in Figure 1.

EAU 2019: The Impact of Sleep-Related Impairment on Burnout in Urologists: Results from a National Consortium Study

Barcelona, Spain (UroToday.com) Physician burnout is an increasingly recognized and rapidly growing concern in the medical community, particularly in the United States. Beyond its impact on the system, it has severe consequences for both the physician and the patients they treat – and if not recognized, can have dire consequences. Defined by most sources as a combination of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, burnout has reached greater than 50% amongst some specialties. 

EAU 2019: Diagnostic Accuracy of Targeted Prostate Biopsies: Results from a Prospective Trial Comparing Micro-Ultrasound with Multiparametric MRI for the Detection of Prostate Cancer

Barcelona, Spain (UroToday.com) Targeted multi-parametric MRI (mpMRI) fusion biopsies are replacing systematic US-guided biopsies as the standard of care. High-resolution micro-ultrasound (micro-US) is a new real-time US-based imaging modality enabling real-time targeted prostate biopsies.

In this study – the authors examined the efficacy of a micro-US as a new diagnostic approach to targeted biopsies. 

EAU 2019: Impact of Putative Chemopreventative Agents on Prostate Cancer Diagnosis

Barcelona, Spain (UroToday.com) The authors of this study leverage the strength of the Canadian nationalized healthcare system (organized at the province level) to help address an important question in prostate cancer survivorship. As a relatively indolent disease in the older male population, often in patients that take medications for other comorbidities, there has long been an interest in the effect of these other medications on prostate cancer development and treatment.  

EAU 2019: Enzalutamide in Men with Chemotherapy-Naïve Metastatic Castration-Resistant Prostate Cancer: Long-term Overall Survival and Safety Analyses of the Phase 3 PREVAIL Study

Barcelona, Spain (UroToday.com) Enzalutamide reduced the risk of death and radiographic progression-free survival vs. placebo in the PREVAIL study of patients with asymptomatic metastatic castration-resistant prostate cancer. The magnitude of PSA decline at 3 months was strongly associated with improved clinical and patient reported outcomes in patients with metastatic castration-resistant prostate cancer (CRPC) treated with enzalutamide in the PREVAIL study.