EAU 2019

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EAU 2019

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: Adherence to the AUA Penile Prosthesis Antibiotic Prophylaxis Guidelines in Diabetic Patients is Associated with Significantly Higher Risks of Device Infection

Barcelona, Spain (UroToday.com) Perioperative antibiotic prophylaxis and method of delivery is a highly controversial and surgeon-dependent practice. While it is highly recommended that patients undergoing inflatable penile prosthesis implantation are prescribed antibiotics to prevent postoperative infection, there is no agreed-upon standard as to which antibiotics are most recommended.

EAU 2019: Mid-Term Oncologic and Functional Outcomes of Endoscopic Robot-Assisted Simple Enucleation for Renal Tumors: Results from a Tertiary Referral Centre

Barcelona, Spain (UroToday.com) In this abstract, the authors from a single institution in Italy provide their midterm evaluation (oncologic and functional) of Endoscopic robot-assisted simple enucleation (ERASE) procedures for patients with smaller renal masses.

EAU 2019: MUSIC-KIDNEY Collaborative Assesses Patterns of Renal Mass Biopsy

Barcelona, Spain (UroToday.com) Renal tumor biopsy (RTB) for renal cell carcinoma (RCC), especially for small renal masses, is recommended by international guidelines if the RTB pathology will change treatment management – either favoring surveillance or ablative therapy. Yet, its usage remains relatively low and uptake is sporadic. Its accuracy is reported to be quite high in more recent series but can be very institutional dependent.

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: High Frequency for Dusting During Holmium Laser Lithotripsy: Does it Matter?

Barcelona, Spain (UroToday.com) The definition of the dusting technique during laser lithotripsy is the use of low pulse energy (PE) and high frequency to achieve submillimeter fragments. In theory, increasing the frequency can increase fragmentation but it is not understood if there is a threshold at which its effect on lithotripsy is limited.

EAU 2019: Pre-ablative or Peri-ablative Biopsies: A Comparison of Different Diagnostic Strategies in Small Renal Masses Treated with Ablation

Barcelona, Spain (UroToday.com) Renal tumor biopsy (RTB) for RCC, especially for small renal masses, is recommended by international guidelines if the RTB pathology will change treatment management – either favoring surveillance or ablative therapy. Yet, its usage remains relatively low and uptake is sporadic. Its accuracy is reported to be quite high in more recent series but can be very institutional dependent. More important, with regards to focal ablative therapy, RTB can either be done at a separate setting from the actual treatment or at the time of treatment itself.

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: Primary Results from SAUL: A Prospective, Multinational Single-Arm Study of Atezolizumab for Locally Advanced or Metastatic Urothelial Carcinoma of the Urinary Tract

Barcelona, Spain (UroToday.com) Dr. Axel Merseburger presented the preliminary results of the Safety of Atezolizumab in locally advanced or metastatic UrotheliaL and non-urothelial carcinoma of the urinary tract (SAUL) study at the EAU 2019 Breaking News session. Atezolizumab is a humanized monoclonal antibody that targets PD-L1 and inhibits the interaction with PD-L1 receptors. This treatment was approved as monotherapy for patients with locally advanced or metastatic urothelial carcinoma^1-3:

EAU 2019: Lynch syndrome: The Tip of the Iceberg

Barcelona, Spain (UroToday.com) In this last talk of the session, Dr. Zlotta focused on Lynch Syndrome (LS) and its implications in the UTUC forum. This was an overview of the topic and an important plea to urologists worldwide to understand the responsibilities we have to now diagnose and appropriately refer patients with suspected Lynch Syndrome.

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: Radical Nephroureterectomy: How Radical to Go?

Barcelona, Spain (UroToday.com) In this presentation, Dr. Thomas Seisen focused on the radical nephroureterectomy in all its forms: approach, bladder neck cuff, lymph node dissection, etc. I will highlight the main points from his talk.

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: Active Surveillance for Small Renal Masses ≤2cm: Results from an Italian Multi-Institutional Prospective Protocol

Barcelona, Spain (UroToday.com) Active surveillance (AS) for small renal masses has become an established first-line treatment option based on growing evidence of the indolent natural history of the majority of these lesions. Yet, the uptake for AS has been quite low. In general, however, most physicians agree that AS is ideal for an elderly patient with multiple comorbidities, where the competing risks outweigh treatment benefit.

EAU 2019: Active Surveillance vs. Nephron Sparing Surgery for Small Renal Mass in Very Elderly Patients: A Competing Risk Analysis

Barcelona, Spain (UroToday.com) Active surveillance (AS) for small renal masses has become an established first-line treatment option based on growing evidence of the indolent natural history of the majority of these lesions. Yet, the uptake for AS has been quite low. In general, however, most physicians agree that AS is ideal for an elderly patient with multiple comorbidities, where the competing risks outweigh treatment benefit.

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: TERT Promoter and FGFR3 Mutations – A Highly Sensitive and Non-invasive Tool for Bladder Cancer Recurrence Detection

Barcelona, Spain (UroToday.com) Up to 3/4 of non-muscle invasive bladder cancer (NMIBC) patients will endure recurrence during their lifetime. Disease follow up is invasive, costly and long and consists of cystoscopy, cytology, and imaging. The most prevalent non-invasive approach for the diagnosis of recurrence remains urinary cytology, although far from ideal with reduced sensitivity and specificity.

EAU 2019: A Rational Approach to Systemic Treatment of UTUC

Barcelona, Spain (UroToday.com) Dr. Sridhar, a medical oncologist from the University of Toronto, provided a summary of the current status of chemotherapy for upper tract urothelial carcinoma (UTUC).

UTUC accounts for 5-10% of urothelial malignancies, of which 60% are invasive at disease presentation. Radical nephroureterectomy remains the standard of care for localized and invasive disease. The 5-year overall survival for pT2-pT3 disease is <50% and a dismal <10% for pT4 disease. It is important to note that due to a paucity of evidence, the benefit of perioperative chemotherapy is extrapolated from bladder cancer. However, although UTUC histology is similar to bladder cancer, embryonic origin, genomic and epigenomic features, staging and prognosis differ between the two. That being said, urothelial cancers appear to be quite sensitive to chemotherapy. So, in addition to the extrapolation from the bladder cancer world, there is new emerging data and strong rationale for perioperative chemotherapy in UTUC.