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HIGHLIGHTS FROM THE 2024 EUROPEAN ASSOCIATION OF UROLOGY ANNUAL MEETING |
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| Rapid-Fire Debates: Common Problems and Controversies in Bladder Cancer |
| Is There Any Role for Urinary Markers Other than Cytology in Era of Modern Cystoscopy in Surveillance of Patients? What About to Decrease Frequency of Cystoscopy?
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| Joan Palou MD, Ph.D., Eva Comperat, MD, Ph.D., and Tahlita Zuiverloon, MD, Ph.D.
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| Joan Palou, Eva Comperat, and Tahlita Zuiverloon debated the role of urinary markers in surveillance of bladder cancer patients, particularly in comparison to cystoscopy. Palou highlighted the challenges and limitations of cystoscopy and cytology, while Comperat argued for the reliability and specificity of urinary cytology. Zuiverloon advocated for the use of urinary markers as potential alternatives to reduce costs, discomfort, and frequency of cystoscopies, especially for patients with low-grade disease.
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| How Do We Manage a Patient with Frequent Recurrence of LG Papillary Tumours in the Bladder Despite Intravesical Chemotherapy and BCG Therapy? No Clinical Trial Available |
| Marek Babjuk, MD, Ph.D., Kenneth Chen, MBBS, MCI, MRCS (Edin), FRCS (Glasg), FAMS, and Philippe Spiess, MD, MS |
| This debate focused on managing patients with recurrent low-grade papillary bladder tumors despite intravesical chemotherapy and BCG therapy. While some argued for continued aggressive approaches with TURBT and additional intravesical therapy due to the high risk of recurrence and progression in patients with high-risk index tumors, others advocated for surveillance and therapy de-escalation, considering guidelines supporting less aggressive management for low-risk disease and the economic burden associated with frequent surveillance. |
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| Healthy Patient with T1HG Micropapillary NMIBC - What Is the Best Treatment Option? What If Mixed Histologic Subtypes in Addition to Micropapillary? |
| Paolo Gontero, MD, Benjamin Pradere, MD, MSc, and Ashish Kamat, MD, MBBS |
| This debate centered on the optimal treatment for a healthy patient with T1HG micropapillary NMIBC, further complicated by mixed histologic subtypes. While some advocated for intravesical therapy as the best option, others argued in favor of upfront radical cystectomy based on evidence suggesting superior outcomes with cystectomy, especially in patients with variant histologies like micropapillary subtype, known to have worse prognoses. |
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| Patient with MIBC After Radical Cystectomy – Can We Use ctDNA to Guide Decisions on Adjuvant Chemo/IO? What About utDNA for Bladder Sparing After NAC?
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| Andrea Necchi, MD, Peter Black, MD, and Jørgen Bjerggaard Jensen, MD, DMSc
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| Andrea Necchi, Peter Black, and Jørgen Bjerggaard Jensen discussed the utility of ctDNA and utDNA in guiding treatment decisions for MIBC patients post-radical cystectomy. Professor Black argued against their use, citing insufficient evidence, while Professor Jensen supported their use, emphasizing ctDNA's prognostic value and potential for personalizing treatment. While ctDNA shows promise for guiding adjuvant immunotherapy decisions, utDNA's role is less established, with future research needed to clarify its utility.
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| The Age-Old Debate – What Is the Best Treatment – Oncological and QOL – for Young Healthy Patient With MIBC? What About Health Care Related Costs?
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| J.A. Witjes, MD, Alison Birtle, MRCP, FRCR, MD, and James Catto, MBChB, PhD, FRCS(Urol)
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| A rapid-fire debate was held regarding the optimal treatment for young healthy patients with MIBC, considering both oncological outcomes and QoL, as well as healthcare costs. While Professor Fred Witjes presented radical cystectomy and trimodality therapy as viable options based on the EAU 2024 guidelines, Professor Alison Birtle argued for TMT, meanwhile, James Catto advocated for radical cystectomy.
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| Patient With Non-Invasive, High Grade Upper Tract Disease in Setting of Prior Radical Cystectomy – What Is Optimal Management? What if GFR ~ 50 Instead of 80?
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| Morgan Rouprêt, MD, Ph.D., Sarah Psutka, MD, MSc, and Arnulf Stenzl, MD
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| This rapid-fire debate discussed the optimal management of patients with non-invasive, high-grade upper tract disease after prior radical cystectomy. Morgan Rouprêt presented a case advocating for a conservative approach, considering patient factors and risks associated with radical nephroureterectomy, particularly in those with lower kidney function. Sarah Psutka argued for radical nephroureterectomy based on oncological guidelines, Arnulf Stenzl supported radical nephroureterectomy as the standard of care
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| Game-Changing Session – Prime Time for Adjuvant Treatment in Locally Advanced Bladder Cancer |
| Clinical Outcomes in Patients with High-Risk, Post-Cystectomy Muscle-Invasive Bladder Cancer with Persistent ctDNA- Status on Serial Testing: Surveillance Analysis from the IMvigor011 Study
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| Thomas Powles, MBBS, MRCP, MD
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| Thomas Powles presented clinical outcomes from the IMvigor011 trial at the EAU 2024 annual meeting, focusing on patients with high-risk, post-cystectomy muscle-invasive bladder cancer with persistent ctDNA-negative status on serial testing. The analysis included 286 ctDNA-negative patients, with 17 disease-free survival events over a median follow-up of 16.3 months.
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| Extended Follow-up from CheckMate 274 Including the First Report of Overall Survival Outcomes |
| Matthew Galsky, MD |
| Matthew Galsky presented extended follow-up data from the CheckMate 274 trial at the EAU 2024 annual meeting, including the first report of overall survival outcomes. The study evaluated adjuvant nivolumab versus placebo for high-risk muscle-invasive urothelial carcinoma after radical surgery. Extended follow-up demonstrated continued benefits of nivolumab in terms of disease-free survival, non-urinary tract recurrence-free survival, and distant metastasis-free survival compared to placebo. |
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| Upper Urinary Tract Cancer: Risk Stratification and New Treatment Modalities |
| Head-to-Head Comparison of the American Urological Association and European Association of Urology Risk Stratification Models of Upper Tract Urothelial Carcinoma |
| Giuseppe Basile, MD |
| Giuseppe Basile presented a comparative study at the EAU 2024 annual meeting, evaluating the American Urological Association (AUA) and European Association of Urology (EAU) risk stratification models for upper tract urothelial carcinoma. The study analyzed patient data from a tertiary care institution between 2015-2022, categorizing patients into low and high-risk groups based on both models. |
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