PCa18: Experts tackle diagnostic pitfalls in PCa management

14 September 2018

wirth_PCa18

Diagnostic issues in prostate cancer (PCa) management remain a challenging area with topics such as screening, using the right imaging tools and the role of genomics, among others, all having a significant impact on current clinical practice.

With more than 250 participants, faculty and exhibitors, the 2nd EAU Update on Prostate Cancer (PCa18) opened today in Milan with Prof. Manfred Wirth (DE) underscoring the importance of continued updates on major urological malignancies such as prostate cancer.

“The aim of this meeting is to offer a focused and highly interactive meeting that will lead not only to open and critical discussions but also to relevant insights on new strategies,” said Wirth. “Thus, it is important for everyone to join and contribute to the discussions which will cover a wide range of clinical issues and dilemmas.”

With a Scientific Programme that consists of update lectures followed by breakout case discussions in four groups, the two-day compact meeting covers the major issues and latest medical strategies in prostate cancer management, particularly recent developments in diagnosis, staging, optimal patient selection for local treatment, salvage treatment for recurrent disease, technical aspects of open and robotic radical prostatectomy, radiotherapy issues and salvage local treatment, among other topics.

At the opening plenary session, G. Villeirs (BE) discussed the use of MRI in diagnosing PCa examining the recent data on the benefits of mpMRI, W. Everaerts looked into the issue of using fusion, systematic prostate biopsy or both, and W. Oyen tackled the role of PET scanning in the primary diagnosis of prostate cancer.

“The rationale of mpMRI is that if mpMRI is negative, do not biopsy. And if mpMRI is positive, there is a basis for a target biopsy needle towards mpMRI visible lesion,” said Villeirs. He also said in his concluding remarks that prostate mpMRI, after prior negative biopsy and in biopsy-naïve patients, lead to fewer biopsies overall and detects more significant cancers.

In the follow-up lecture, W. Everaerts gave a comprehensive update on the use of fusion, systematic and the role of using both techniques. He noted that target biopsies are more accurate than systematic and combination biopsies in predicting intermediate and high-risk PCa on prostatectomy specimens.

He, however, added that there are known pitfalls of MRI-targeted biopsies such as the variation in quality and interpretation of MRI, the differences in accuracy of MRI-targeted biopsies, the fact that almost all nomograms and risk tables are based on digital rectal examination (DRE) and template biopsies, and that there is a need for a better definition of clinically significant PCa.

“Combined targeted and systematic biopsies can increase the detection rate of clinically significant PCa but come at the cost of more over-detection of insignificant PCa and we still miss significant tumours,” said Everaerts.

W. Oyen (GB) looked into the role of using PET scanning in the primary diagnosis of prostate cancer and gave a background on choline PET/CT use in prostate cancer. “Ga-68-PSMA PET/CT is a major step forward in detecting disease. It shows improved lesion detection and detects lesion sizes down to 4mm,” said Oyen. “The open question, however, is- does earlier and more appropriate diagnosis of small-volume disease improve patient’s outcomes?”’

The first-day continued with case discussions with the rotating faculty group addressing issues and developments in topics such as PSA use, which imaging to use after initial PCa diagnosis, patient selection for biopsy and how to use genomics in PCa.