Europe’s largest urology event, the 38th EAU Annual Congress, included live surgeries, cutting-edge lectures, case discussions and debates during the four-day scientific exchange. To emphasize the multidisciplinary nature of urology, speakers from patient and nurse care were also asked to share their perspectives. The goal was to advance urologic health care.
In the paper “The role of PSMA mRNA from circulating tumor cells in localized or locally advanced prostate cancer”, we investigated whether circulating tumor cell (CTC)-based prostate specific membrane antigen (PSMA) messenger RNA (mRNA) or PSA mRNA alone can predict biochemical recurrence (BCR) after radical prostatectomy (RP) for localized prostate cancer (PCa). The paper finds that quantified PSMA gene expression in CTC can be used as a useful marker to predict BCR after RP. The CTC count and the detection rate of PSMA mRNA expression increased in advanced PCa.
In addition, men with localized prostate cancer were found to have a high likelihood of good long-term outcomes, regardless of the choice of treatment. This was the conclusion of the large-scale Prostate Testing for Cancer and Treatment (ProtecT) study. 1643 men were randomly assigned to receive either radical prostatectomy, radiation therapy, or active surveillance for this purpose. At a median follow-up of 15 years, no significant differences were observed between treatment groups in either prostate cancer mortality or all-cause mortality rates. In fact, prostatectomy or radiation therapy reduce the incidence of metastases, local progression, and long-term androgen deprivation therapy by half compared with active surveillance. However, this reduction did not lead to differences in mortality. Accordingly, the researchers concluded that it is safe to delay treatment in order to calmly weigh treatment management in terms of its risk-benefit profile.
Risk reduction through plant-based diets
That a plant-based diet combined with physical activity can reduce the risk of prostate cancer progression or recurrence was demonstrated by an American study. Approximately 31.5 months after diagnosis, individuals were surveyed regarding their dietary habits. Depending on the level of plant content in their diet, the men were divided into four groups. Men in the highest quintile group who consumed at least 2.4 servings of fruit, 4.2 servings of vegetables, 2.6 servings of dairy, and 1.2 servings of meat daily had a 52% lower risk of progression and a 53% lower risk of recurrence, which was statistically significant. In comparison, men in the lowest quintile consumed 0.8 servings of fruit, 2.1 servings of vegetables, 3.1 servings of dairy products, and 1.4 servings of meat daily. Results were adjusted for total caloric intake, race, and smoking status. In addition, it was observed that among those who additionally exercised daily – in this case, fast walking more than three times per week – the risk of progression was reduced by 56% and the risk of recurrence by 59% in the highest quintile group.
Benign prostatic hyperplasia
A comparison between robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) was further highlighted in the article “Robot-Assisted Simple Prostatectomy versus Holmium Laser Enucleation for the Treatment of benign prostatic hyperplasia in large (>100 ml) prostates: updated comparative analysis from a high-volume center”. Patients treated with RASP had higher Comprehensive Complication Index (CCI) scores and larger prostates on preoperative imaging. Median operative time for RASP, catheterization time, and length of stay were slightly shorter in the HoLEP group. The rate of transient urge incontinence was higher in the HoLEP group.
Urine test predicts bladder cancer
An international team of researchers had a small sensation in their luggage. According to their results, a simple urine test for genetic mutation can predict urothelial cancer up to 12 years before the first symptoms. The test was performed using a next-generation sequencing assay (UroAmp, Convergent Genomics, San Francisco, Calif.) that identifies mutations in 60 genes associated with bladder cancer. In training and validation cohorts, the uCGP (Urinary Comprehensive Genomic Profiling) test accurately predicted future bladder cancer in 66% of patients’ urine samples, including some collected more than a decade before the test. Even urologists who were not involved in the research are confident that the text has the potential to serve as a cancer screening tool for individuals who are at increased risk for bladder cancer because of genetics, smoking, or exposure to known carcinogens in the environment. It could also help reduce the frequency of unnecessary cystoscopies. However, further studies are needed to validate the previous information.
In up to 40% of non-muscle invasive bladder cancer (NMIBC), recurrence occurs after transurethral bladder resection of the tumor (TURBT), likely due to incomplete removal of malignant tissue. Evidence suggests that resection assisted by photodynamic diagnostics provides better diagnostic accuracy than white light cystoscopy, increasing the likelihood of complete resection and decreasing the risk of recurrence. However, evidence on long-term effectiveness and cost-effectiveness is still limited. To determine whether photodynamic, diagnosis-guided TURBT provides better recurrence-free survival in patients with NMIBC, the PHOTO trial, an open-label, randomized, parallel-group study was conducted at 22 hospitals in the United Kingdom. A total of 209 patients were randomly assigned to photodynamic diagnosis-guided TURBT (PDD group) and 217 to white light-guided TURBT (WL group). Recurrences occurred in 86 patients in the PDD group and 84 patients in the WL group. The 3-year recurrence rates were similar: 57.8% in the PDD group and 61.6% in the WL group.
Testicular and penile cancer
News on Penile Cancer presented research findings from the paper “Penile cancer care in the Netherlands over three decades: increased incidence, centralization of care, and overall survival.” The study demonstrated the beneficial effect of centralized care in patients with penile cancer, with a 30% advantage in overall survival, although patients had a higher disease burden.
The Need for organ preservation in postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) study also showed that there is a tremendous need for more organ preservation, as 40% of all minor organ resections are oncologically unnecessary due to the presence of necrosis/fibrosis (N) only in pathologic specimens. Frozen section analysis should be further explored, and serological or image-based biomarkers for N are needed.
Congress: European Association of Urology (EAU) 2023
InFo ONKOLOGIE & HÄMATOLOGIE 2023; 11(2): 16–17
