The 19th Meeting of the EAU Section of Oncological Urology (ESOU22) will commence in January 2022 in Madrid, Spain. The meeting is where top minds in the field, such as renowned expert Dr. Gianluca Giannarini (IT), will gather and offer delegates vital updates.
In this article, Session Chair Dr. Giannarini offers a preview of what delegates can look forward to during the session “Prostate cancer I – Diagnosis: Where are we now and where are we heading?”. The session will comprise of a case discussion on the pitfalls of imaging in prostate cancer detection, and debates on imaging protocols for the future and on biomarkers and other reflex tests in men with elevated serum PSA.
On the pitfalls of current imaging
According to Dr. Giannarini, the advent of multiparametric MRI (mpMRI) of the prostate has revolutionized the clinical pathway for the detection of clinically significant prostate cancer (PCa). He stated that triage with mpMRI has been repeatedly shown to result in higher diagnostic accuracy when compared to “blind” systematic biopsy; this allows some men to avoid unnecessary biopsy and reduces the risk of detecting clinically indolent disease with its downstream consequences.
“However, there are several potential pitfalls of this sophisticated imaging modality, mainly attributable to quality issues in image acquisition, interpretation, and reporting. The subsequent mpMRI-informed biopsy might also be prone to errors due to targeting issues. A clinical case discussion will cover all these aspects,” said Dr. Giannarini.
Imaging protocols for the future
Dr. Giannarini also offered his expert insights on future advances in imaging-based diagnostic pathways. “The positive predictive value of mpMRI remains low to moderate at 34-68%, still resulting in a non-negligible proportion of men eventually submitted to unnecessary biopsies. Moreover, mpMRI may miss clinically significant PCa in up to 10% of cases. For these reasons, the search for newer strategies is continuous to improve the performance of mpMRI further,” said Dr. Giannarini. With regard to this, he stated that positron emission tomography (PET)/computed tomography (CT) with prostate-specific membrane antigen (PSMA) ligands might represent one of the most promising alternatives to mpMRI.
“While PSMA PET/CT is transforming the staging of both newly-diagnosed and biochemically-recurrent PCa, its role in primary tumour detection is still limited. The pros and cons of this newer imaging modality, and whether it should replace mpMRI or be performed as a reflex triage test after MRI, will be discussed in a debate during the session,” concluded Dr. Giannarini.
“Liquid biopsy” and multivariable risk models
Due to the poor specificity of serum PSA, especially in the range of 3 to 10 ng/ml, several novel blood-, and urine-based biomarker tests have been developed and commercialized over the past years to improve the diagnosis and prognosis of PCa. Thus, facilitating clinicians’ decision-making process as well as patient counselling.
During the debate, presenters will discuss the following:
- Challenges and opportunities in development and large-scale utilization of novel biomarkers
- Ideal characteristics of “liquid” biomarkers of the future
- Strategies to integrate biomarkers with PSA and imaging to improve existing diagnostic pathways
- Clinical value of multivariable risk-stratification and risk-prediction tools
The session will take place from 09:00 to 10:30 CET on Friday, 21 January 2022. Remember to save the date. For more information on exciting updates that ESOU22 will offer, explore its scientific programme now.
Interested in joining the meeting? We would love to welcome you onsite! Register before 6 January 2022 (23:59 CET) to benefit from reduced rates.