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EAU20 digital events deliver key PCa updates

Thanks to the efforts of the scientific committee of the European Association of Urology (EAU), the EAU20 Virtual Congress and the EAU20 Theme Week commenced and delivered the latest and relevant developments in urology through lively deliberations, Plenary, Thematic and Game-Changing sessions, to name a few. Prostate cancer (PCa) was a primary topic and found below is a selection of data presented on PCa.

The Europa Uomo Patient Reported Outcomes (EUPROMS) study is the first patient-driven, quality-of-life study that assesses the real effect of PCa treatment (Deschamps A. et al). The study involves almost 3,000 patients from 24 countries. It gives an interesting cross-sectional picture of the PCa population, demonstrating that early PCa detection might have an important role on the preservation of quality of life.

With the advent of transperineal biopsies under local anaesthesia, the TRexit movement is getting more attention, and an interesting evaluation of pain after a modified aesthetic protocol have been reported (Messas A. et al). Various presentations have also highlighted the safety of focal therapy in selected cases, and the acceptable mid-term oncologic and salvage radical prostatectomy outcomes.

In low-risk PCa management, PSA density and genomic scores have been correlated with biopsy upgrading in active surveillance protocols and can be used as predictive tools for patient counselling and monitoring adaptation (Lonergan P.E. et al). In case of residual disease after radical prostatectomy (PSA persistence), the debate between salvage radiotherapy alone or in combination with androgen deprivation therapy is ongoing.

The tolerability results from the GETUG-AFU 22 trial have been presented showing no difference between arms in terms of genitourinary and gastrointestinal and quality-of-life outcomes (Sargos P. et al). Efficacy outcomes will be presented in early 2021.

Treatment of the biochemical recurrence after local treatment depends on various factors, and may be influenced by the increasing use of new generation imaging. In spite of the timely interest for metastasis-directed therapy, systemic treatment remains an option in high-risk cases. Docetaxel has been tested in addition to bicalutamide in a randomized study for non-metastatic disease with a rising PSA (Josefsson A.S. et al). In that study, chemotherapy demonstrated a significant impact on progression, but overall survival benefit was not achieved.

At later stages, the inhibition of steroid sulfatase could have a positive action on tumour growth and could improve response to enzalutamide (Gao A. et al). Its overexpression increases the intracrine androgen synthesis, opening the way to a therapeutic approach by targeting this key enzyme.