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BLOG: Highlights from the European Association of Urology Meeting 2021

Chris_McNamara
Community Manager
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Highlights from the European Association of Urology Meeting 2021

By Kalli Spencer

This year’s meeting was held virtually from 8-12th July and in this weeks’ instalment we will highlight three major focus areas presented at the meeting:

  • Novel treatment approaches for de novo Metastatic Castrate Sensitive Prostate Cancer (mCSPC)
  • Future replacement of MRI by PSMA-PET/CT Scan for prostate cancer diagnosis
  • New androgen deprivation therapy (ADT) options

Treatment of De Novo mCSPC

So what is de novo mCSPC? The term refers to prostate cancer that is detected for the first time at an advanced stage where it has spread to parts of the body other than just the prostate. The cancer is, however, still amenable to androgen deprivation (testosterone blocking) therapy and has not developed resistance to treatment yet.

The PROfound trial set out to investigate a personalized medicine approach to managing mCSPC in advanced prostate cancer1. A specialised assay was used to identify alterations in one of 15 pre-specified genes involved in homologous recombination repair. Those participants with alterations in DNA repair genes were considered potentially amenable to immunotherapy agents like the PARP inhibitors(Olaparib) and could be treated with capivasertib where there is a PTEN loss.

Radiotherapy to the prostate is currently the only “personalized” approach for low-burden mHSPC, according to findings by Dr Karim Fizazi of the Universite Paris-Saclay, France. The PSMAddition trial is investigating those with PSMA positive cancer and their potential for treatment with Lutetium-PSMA in the future2.

Other research by Dr Alberto Briganti from the San Raffaele Scientific Institute in Milan reported that surgery may only be a feasible option in highly selected patients with the following criteria:

  • Low volume disease according to CHAARTED criteria/1-3 bone metastases
  • No clinical evidence of nodal disease (cN0)
  • PSA < 60 ng/mL
  • Gleason grade group 3-4 (versus 5)
  • Patients responding to neoadjuvant ADT

He concluded that a cytoreductive radical prostatectomy should primarily be considered as a possibility for men with oligometastatic cancer (<5 metastatic deposits) but within the clinical trial setting.

Early combination therapy is the standard of care, according to Professor Noel Clarke from the Christie Cancer Centre in Manchester. The study reveals that radiotherapy to the primary site may be beneficial in low-burden disease. Systemic treatment is found to be effective regardless of disease burden and chemotherapy with the new hormonal agents (enzalutamide and abiraterone) appears to be equally effective in terms of quality of life and survival. According to Dr Piet Ost from the University of Ghent, Belgium,  radiation therapy to the prostate with ADT (+/- 6 cycles of docetaxel) improved overall survival and failure-free survival in patients with positive lymph nodes only, or <4 bone metastases (+/- lymph node), regardless of location.

PSMA PET/CT

Viet Tran from Melbourne reported the preliminary findings of the Pedal Trial. This trial set out to investigate the accuracy of 18F-DCFPyl-PSMA-PET/CT to detect and localize prostate lesions compared to multiparametric MRI (mpMRI) in men with suspected prostate cancer.

Detection and localization of suspicious prostate lesions were compared between mpMRI, PET/CT, and fused PET/MRI images. Some patients underwent targeted prostate biopsy and radiological findings were correlated with histological findings.

  • Prostate mpMRI detected 35 lesions (PIRADS ≥3), compared to 40 lesions on PET/CT. Twenty-five lesions were detected on both mpMRI and PET/CT, with 15 lesions identified by PET/CT alone.
  • When histology was assessed, prostate cancer was detected in 25 of 34 men who underwent biopsy. On a per-lesion analysis, 17 of 25 (73.8%) lesions with clinically significant prostate cancer (Grade group ≥2) were visualized on both imaging arms. All significant lesions identified by mpMRI were visualized on PET/CT. PET/CT identified 3 (13%) clinically significant lesions that were undetected by mpMRI and diagnosed 11 patients with metastatic disease.

PSMA-PET/CT is therefore able to detect prostate lesions seen on mpMRI prostate, as well as identify additional clinically significant lesions. The ability of PSMA-PET/CT to diagnose metastatic disease also obviates the need for further staging following diagnosis. Further research is needed, but this could alter diagnostic pathways in the future.

ADT for advanced cancer

The outcomes of the TITAN trial were presented by Simon Chowdhury from Guy's and St. Thomas' Hospital, London. In patients with mCSPC, irrespective of disease volume, apalutamide added to ADT significantly improved radiological progression free survival, overall survival, and time to PSA progression. PSA response was rapid and significant following apalutamide treatment, regardless of disease volume. The safety profile in both high- and low-volume disease remained consistent with previous research.

Reza Sari Motlagh from the University of Vienna reported on the new oral GnRH antagonist. The efficacy and safety of relugolix is comparable to that of degarelix, without complications such as injection site-reactions. It would also dispense with the need for regular injections. This data is, however, preliminary, and should be interpreted with caution until large scale direct comparison studies with a longer follow-up are available.

From the above review, it’s evident that many exciting developments which could alter practice in the near future are taking place in the field of prostate cancer research. Watch this space!

References

  1. De Bono J, Mateo J, Fizazi K et al. Olaparib for Metastatic Castration-Resistant Prostate Cancer. N Engl J Med 2020; 382:2091-2102
  2. An International Prospective Open-label, Randomized, Phase III Study Comparing 177Lu-PSMA-617 in Com...
  3. 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. Tran V, Sutherland T, Lee SF, Schlicht S, Corcoran N, Lawrentschuk N, Tarlinton L, Wong LM.
  4. Chi KN, Agarwal N, Bjartell Anders et al. Apalutamide for Metastatic, Castration-Sensitive Prostate Cancer. N Engl J Med 2019; 381:13-24

 

 

 

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About the Author

Kalli Spencer

MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC)

Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality.

Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups.

 

Help is Available
 
If your life has been impacted by prostate cancer, our Specialist Telenursing Service is available to help. If you would like to reach out to the PCFA Prostate Cancer Specialist Telenurse Service for any questions you have about your prostate cancer experience, please phone 1800 22 00 99 Monday - Friday 9am - 5pm, Wednesday 10am-8pm (AEST).
 
PCFA is proud to have a national network of affiliated support groups in each state and territory of Australia consisting of men and women who have a passion for assisting others who encounter prostate cancer. This network is made up of over 170 affiliated groups who meet locally to provide one-to-one support, giving a vision of life and hope after treatment. Call us on 1800 22 00 99 to find your local group.
 
MatesCONNECT is a telephone-based peer support program for men affected by prostate cancer. If you’ve recently been diagnosed with prostate cancer, our MatesCONNECT service can connect you to a trained volunteer who understands what you’re going through. All of our volunteers have been through prostate cancer. Simply call us on 1800 22 00 99 to be connected with a volunteer.
 
Newly diagnosed? or need to find more information -Access the PCFA resources here!
 
Additional Resources:
 
PCFA Funded trial: ProPSMA Pet/CT (Prof Declan Murphy & Prof Michael Hofman)
 
PCFA Webinar - Personalised prostate cancer treatment of the future; brining together imaging, diagnostics, and therapy to stop cancer's spread.

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