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Highlights from the 36th Annual EAU Virtual Congress |
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| Treatment for Metastatic Hormone-Sensitive Prostate Cancer |
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| De Novo Versus Recurrent Metastatic mHSPC: What Is the Role of Modern Imaging? |
| Declan Murphy, MB, BCH, BaO, FRACS, FRCS, Urol |
| At the European Association of Urology (EAU) 2021 Annual Meeting’s plenary session on the treatment for metastatic hormone-sensitive prostate cancer, Declan Murphy presented a state of the art lecture on the role of modern imaging for de novo versus recurrent metastatic hormone-sensitive prostate cancer (mHSPC). |
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| Treatment Options for Recurrent mHSPC - Systemic Treatments: When and How? |
| Christopher Sweeney, MBBS |
| In this presentation, Christopher Sweeney discusses when and how to use systemic treatment for recurrent metastatic hormone-sensitive prostate cancer (mHSPC). Dr. Sweeney notes that the hypothesis is that men with mHSPC have a wide array of prognoses (i) that can be easily defined by clinical variables, (ii) impacts the efficacy of different treatment strategies, and (iii) have broadly distinct underlying biological profiles. |
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| Treatment Options for Recurrent mHSPC: The Role of Imaging-Guided Treatments: Radiotherapy
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| Pierre Blanchard, MD, Ph.D.
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| Pierre Blanchard discussed the role of imaging-guided treatment for recurrent metastatic hormone-sensitive prostate cancer (mHSPC). Dr. Blanchard started his presentation by emphasizing that stereotactic body radiotherapy works. There is currently low level of evidence for metastasis-directed therapy in oligo metastatic recurrent prostate cancer. Despite the level of evidence, metastasis directed therapy is commonly used in clinical practice. It is important to recruit to randomized trials in order to demonstrate a magnitude of benefit, which also provides an avenue for large scale, prospective meta-analyses.
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| Treatment Options for Recurrent mHSPC: The Role of Imaging-Guided Treatments: Surgery |
| Tobias Maurer, MD |
| Tobias Maurer discussed the role of imaging-guided surgical treatment for recurrent metastatic hormone sensitive prostate cancer (mHSPC). Dr. Maurer started his presentation by emphasizing that the most recent EAU guidelines do not favor salvage lymph node dissection, given the lack of high-level evidence for oncological efficacy. Metastasis directed therapy is still outside the current guideline recommendations. If considered, metastasis directed therapy should be based on novel molecular imaging (PSMA-PET). |
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| Phase 3 Study of 177Lu-PSMA-617 in Patients with Metastatic Castration-Resistant Prostate Cancer (VISION) |
| Johann De Bono, MD, MSc, Ph.D., FRCP, FMedSci |
| The European Association of Urology 2021 Annual Meeting’s Game-Changing session included a presentation by Professor Johann De Bono discussing the VISION trial, a phase 3 study of 177Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer. |
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| TheraP Phase 2 Trial of Lu-PSMA-617 vs Cabazitaxel: Results and Contrasts to the VISION Study
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| Michael S. Hofman, MBBS (Hons), FRACP, FAANMS
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| Michael Hofman discusses the phase 2 trial of 177Lu-PSMA-617, TheraP, as well as important contrasts/differences between TheraP and VISION. Dr. Hofman highlights that 177Lu-PSMA-617 improves patient outcomes in men with mCRPC following docetaxel and androgen receptor directed therapy. 177Lu-PSMA-617 is also more active than cabazitaxel in PSMA-avid disease with fewer Grade 3-4 adverse events and improved quality of life.
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| Treatment Options That Offer a Survival Benefit in mCRPC Discussion: The TheraP and VISION Trials |
| Silke Gillessen, MD |
| As part of the game-changing session at the European Association of Urology 2021 Annual Meeting, Silke Gillessen discussed the recently published TheraP and VISION trials. Dr. Gillessen notes that in the metastatic castration-resistant prostate cancer (mCRPC) setting, we now have several treatment options that offer a survival benefit, including abiraterone, cabazitaxel, docetaxel, enzalutamide, radium-223, sipuleucel-T, olaparib, and now 177Lu-PSMA-617. |
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Prostate Cancer: cN+ in Newly Diagnosed Patients
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| Introduction and Setting the Stage: Prostate Cancer: cN+ in Newly Diagnosed Patients
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| Nicolas Mottet, MD, Ph.D.
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| Nicolas Mottet, the chair of this session "Guideline Session II: Prostate Cancer: cN+ in Newly Diagnosed Patients" provided an introduction and set the stage the presenters in this session. He poses two questions, first, Is local treatment needed”? Most available data are for EBRT, as the data for RP are limited. Is there a best local option? Secondly, if systemic therapy is given, do we give the same “old” ADT or intensity ADT (with chemotherapy, oral agents, etc)?
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| cN+ and Systemic Treatment: More than ADT Is Needed as Systemic TTT: Yes!
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| Maria De Santis, MD
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| In the Guideline Session II: Prostate Cancer: cN+ in newly diagnosed patients during the 2021 European Association of Urology meeting, Maria De Santis argues the point of view that more than ADT is required as systemic therapy for patients with clinically node-positive prostate cancer. She notes the challenges of this argument as there is little data, most of which is low-level evidence. However, she feels the goals of treatment intensification will improve the strategies and lives of our patients by utilizing multimodal therapy, providing alternative strategies, and treating the patient earlier.
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| cN+ and Systemic Treatment: Guidelines Point of View More Than ADT is Needed as Systemic TTT: No!
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| Guillaume Ploussard, MD, Ph.D.
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| Guillaume Ploussard, armed with more data, argues against the need for more than ADT as systemic therapy for cN+ prostate cancer. He also provides the guideline point of view on this topic. He provides several take-home messages; 1. There is no overall survival benefit from an intensified systemic therapy, only failure free survival. 2.The first step to initiate intensification should be any distant metastases on conventional imaging. and 3. Risk of overtreating the majority of patients and under treating some locally if you intensify systemic therapy.
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| cN+ and Local Treatment: Guidelines Point of View |
| Thomas Wiegel, MD, Ph.D. |
| Thomas Wiegel reviews the guideline points of view for local treatment in the setting of clinically node positive prostate cancer. He reviews the role of local control, the options of local therapy (RP or EBRT +/- ADT), further potential improvements and the current EAU 2021 guideline position. |
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Treatment Sequencing in Metastatic Prostate Cancer
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| Monitoring and When To Change Treatment In mHSPC |
| Guillaume Ploussard, MD, Ph.D. |
| In this talk in the thematic session focusing on treatment sequencing in metastatic prostate cancer, Guillaume Ploussard provided a summary of key concepts in the monitoring of prostate cancer and when to change management. |
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| An Overview of Systemic Treatment Options for mCRPC
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| Gero Kramer, MD |
| Gero Kramer reviews the systemic treatment options for metastatic castration-resistant prostate cancer (mCRPC) and highlights some recent developments. The landscape for metastatic castration resistance prostate cancer continues to rapidly change. Therapies move forward from CRPC to castration-sensitive prostate cancer. There have been novel targeted drugs for metastatic castration resistance prostate cancer. There’s also new data on the treatment sequence in this disease space.
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| Tumor Molecular Testing: For Whom and When Is It Clinically Useful? |
| Johann de Bono, MB, ChB, FRCP, MSc, Ph.D., FMedSci. |
| Johann De Bono provides us with an overview of prostate cancer molecular testing, along with guidance on which patients and when we should be obtaining them. In his opinion, germline (patient) and somatic (tumor) testing can now be recommended for all men with advanced prostate cancer. This can help inform family cascade testing and treatment selection decisions (ie PARP inhibitors, immunotherapy, etc). However, he understands that not all systems and practices are able to do this regularly.
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| PSMA In Diagnostics and Treatment |
| Karim Fizazi, MD, Ph.D. |
| Karim Fizazi finished off the thematic session of Treatment Sequencing in Metastatic Prostate Cancer with a presentation on the role of PSMA in diagnostics and treatment of metastatic prostate cancer. PSMA is a transmembrane protein that is often highly expressed by prostate cancer cells and not express by most normal tissues (exception = salivary glands). Expression correlates to advanced disease. It is less expressed by liver metastases.
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| To view our full coverage of the 2021 EAU Virtual Congress, visit the Conference Coverage section on UroToday.com
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