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Cutting-edge findings in diagnosis and treatment of prostate cancer at EAU21 Virtual

By Prof. Igor Tsaur

Although the COVID-19 pandemic is still a tremendous burden on humanity, evolution in the healthcare sector is fortunately unstoppable. Even as a virtual convention, the 36th Annual EAU Congress (EAU21 Virtual) drew significant public attention while several cutting-edge findings in the area of diagnosis and treatment of prostate cancer (PCa) were presented. What follows is an overview of these findings.


Tran et al. presented the results of the prospective PEDAL trial comparing mpMRI and 18F-DCFPyL-PSMA PET/CT to detect and localise suspicious prostate lesions in 44 men with suspected prostate cancer. All clinically significant lesions identified by means of mpMRI were visualised on PET/CT while the latter alone detected additional clinically significant lesions as well as metastatic disease. Regardless of availability and cost-related issues, these findings corroborate the value of PET/CT in the diagnosis of localised disease and warrant its further investigation in a large trial.

Stabile and co-authors analysed the outcomes of 313 men in a single-centre cohort with a clinical suspicion of PCa and a positive mpMRI (PI-RADS≥3) with concomitant negative systematic and targeted Bx. Related to the median follow-up of 31 months, males with a negative follow-up biopsy exhibited a two- and three-year diagnosis-free survival for clinically significant PCa in comparison to those with a positive follow-up biopsy, with percentages of 97% vs. 65% after two years and 92% vs. 65% after three years, respectively. This data emphasises that a follow-up mpMRI is advisable to decide whether to repeat a biopsy.

Luiting and collaborators investigated 51 men with intraprostatic recurrence after radiotherapy on PSMA-PET/CT. While the positive predictive value for local recurrence (histologically confirmed or radiological progress on subsequent imaging) of both positive PET/CT and mpMRI (PIRADS≥3) was as high as 92.5%, salvage treatment might be initiated in this case without a biopsy in order to avoid its delay. However, in case the mpMRI is negative and the PET/CT positive, histological evaluation is recommended.

Treatment localised disease

One-year functional and oncological outcomes of performing a Retzius-sparing robot-assisted radical prostatectomy (n=260) in comparison to a standard robot-assisted radical prostatectomy (n=291) were introduced by Umari and co-workers in an analysis from a high-volume centre. Both approaches yielded similar oncological and functional outcomes. Thus, the choice of the method should remain at the discretion of the treating surgeon.

Breu et al. randomised 135 patients to receive either a monofilament bidirectional polyglycolic-polycaprolactone suture with an anchoring system or a braided, double-armoured polydioxanon suture for vesicourethral anastomosis during radical prostatectomy. The use of suture materials did not appear to impact postoperative pelvic pain or anastomotic leakage, so the choice depends on the preference of the surgeon.

Crouzet and co-workers investigated hemi high-intensity focused ultrasound (HIFU) ablation treatment limited to the prostate lobe where the prostate cancer recurred after initial radiotherapy in a prospective cohort of 93 men. At five years, the overall, metastasis-free, androgen-deprivation-treatment-free, and failure-free survival rates were 97.3%, 85.8%, 57.4% and 47.4%, respectively. This study underscores the potential of HIFU as a salvage treatment with curative intent after radiotherapy warranting further intensive research in this area.

Treatment metastatic disease

A multi-institutional study by Scuderi (Watch the webcast of this study) and collaborators assessed 152 patients with oligometastatic prostate cancer treated with cytoreductive radical prostatectomy as part of a multimodal treatment with a median follow-up of 46 months. They demonstrated that surgery does have its role as a part of a multidisciplinary therapy in selected men with oligometastatic PCa and favourable features (grade group 1-3 and absence of locally advanced disease).

Fan and co-authors reported on the genomic profiling of 14 homologous recombination (HR) pathway genes in 55 patients with metastatic castration-resistant PCa who received platinum-based chemotherapy after progression to docetaxel chemotherapy. Men with HR defects experienced a prolonged PSA progression-free survival compared to those without, while males with BRCA2 or ATM mutations benefitted most from platinum-based treatment.

Read the EAU21 abstracts that are mentioned in this editorial:

Preliminary results from the PEDAL trial: A prospective single arm paired comparison of ability to diagnose and locate prostate cancer between multiparametric MRI and 18F-PSMA-PET/CT

How to follow patients with negative targeted prostate biopsy but positive multi-parametric MRI? Results from a large, single institution series

Intraprostatic recurrences on PSMA PET/CT after prostate whole gland radiotherapy. Is histological confirmation necessary?

Retzius-sparing robot assisted radical prostatectomy has similar 1-year functional and oncological outcomes as standard robot-assisted radical prostatectomy: Results from a high volume UK centre

Is postoperative pelvic pain after robot-assisted radical prostatectomy associated with suture material used for sewing the anastomosis? A prospective randomized trial

Focal HIFU treatment of radiorecurrent localized prostate cancer: Long term results

Which patients with Oligometastatic Prostate Cancer should be considered for Cytoreductive Radical Prostatectomy as part of a multimodal treatment? Results from a large, multi-institutional collaboration

Distinct response to platinum-based chemotherapy among patients with metastatic castration-resistant prostate cancer harboring alterations in genes involved in homologous recombination