Later this month, the EAU comes to London for the 32nd Annual Congress and to mark the occasion Prof. Chris Chapple, EAU Secretary General, has written the issue’s lead editorial looking forward to the event.
The cover image reflects EAU17’s logo with a view along the river Thames of Tower Bridge, with the Shard in the background.
©istock.com/fotoVoyager
Click here for this issue’s Table of Contents
It is a great pleasure to write this editorial looking forward to the EAU hosting its 2017 meeting in London.
The EAU17 meeting promises to be outstanding, with a record-breaking number of abstracts for poster and video presentations submitted for the upcoming 32nd Annual EAU Congress (EAU17) in London. There were approximately 5000 abstracts submitted from 81 countries across the globe, the majority being from Europe and Asia. The overall acceptance rate of the submitted abstracts for both poster and video sessions was 25.37%; 1171 were selected from the 4625 abstracts submitted for the poster sessions and 89 video presentations were accepted from the 342 submitted for the 11 video sessions. This year the main Plenary Sessions were expanded from four to seven, providing not only theoretical perspectives but also focusing on best clinical practice. This is epitomised by the opening plenary session ‘Sleepless nights: Would you do the same again?’, which critically re-evaluates management decisions for kidney cancer cases from a medico-legal perspective. Undoubtedly, this session will trigger discussion on our practice and alert the audience to the implications of such clinical decisions, emphasising that ‘there is no such thing as brave surgeons just brave patients’.
There will be a strong focus on dynamic interaction, as evidenced by thematic Session 2, with a debate on robotic salvage prostatectomy between Declan Murphy and Axel Heidenreich. Another ‘not-to-miss’ event will include Plenary Session 5, with three debates alternating with three state-of-the-art lectures on the latest evidence-based developments in prostate cancer management. A highlight debate on prostate cancer screening will feature Jonas Hugosson and Gerald Andriole taking opposing views on the risks and benefits of prostate cancer screening. During this ‘head-to-head’ debate, both participants and the audience will re-visit this controversial subject, which has engendered opposing perspectives in Europe and North America.
Latest research will be highlighted, for example, two of the many lectures that will provide up-dates on the latest developments in urological research include: the PROstate MRI Imaging Study (PROMIS) trial results reviewed by Hashim Ahmed and the Prostate Testing for Cancer and Treatment (ProtecT) trial reviewed by Freddie Hamdy (both in Plenary Session 5). Visit https://eau17.uroweb.org/ regularly to stay informed about late breaking news sessions and remember that members of the EAU can reflect further on the meeting by watching all of the plenary sessions online at a later date.
It is clear that European urologists are very active in the fields of clinical and academic research, as evidenced by this edition of BJUI. Nielson et al. [1], review the data from 808 patients in a European registry study of renal cryoablation and comment on the oncological outcomes and complications after laparoscopy-assisted cryoablation. They conclude that the intermediate outcomes are satisfactory, in that 16 patients (3.1%) were diagnosed with residual unablated tumour after a median [interquartile range (IQR)] follow-up of 9.8 (6.0–12.8) months and local progression was diagnosed in 16 patients (3.1%) after a median (IQR) follow-up of 25.3 (18.7–55.8) months. However, they advise that it is important that patients are counselled about potential complications, as these included 47 Clavien–Dindo grade I, 61 grade II, 10 grade IIIa, nine grade IIIb, three grade IVa, one grade IVb, and three grade V complications. There were severe complications (grade ≥IIIa) in 26 patients (3.2%).
Ferro et al. [2] have prospectively evaluated 29 consecutive patients, followed-up for 36 months, after treatment with the Virtue® male sling (Coloplast, Humlebaek, Denmark) for post-radical prostatectomy (RP) stress urinary incontinence (SUI). At 36 months of follow-up, 58.6% used no pads/day. Patient satisfaction remained stable over time, with 25/29 patients reporting a Patient Global Impression of Improvement (PGI-I) score of 1 at 12 and 36 months. I concur with the authors that, whilst this series suggest that the Virtue® sling appears to be an effective treatment option for low-to-moderate post-RP SUI, as evidenced by both subjective (patient satisfaction) and objective measures, larger trials are needed to better evaluate the potential of this sling in real-life clinical practice and to compare it with similar devices, using a randomised comparative design. Furthermore, the introduction of prospective databases for all such implants into routine clinical practice is currently being considered and is long overdue.
Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, The Royal Hallamshire Hospital, Sheffield, UK
Neurogenic urinary tract, sexual and bowel dysfunction is highly prevalent and affects the lives of millions of people worldwide. It has a major impact on quality of life and, besides the debilitating manifestations for patients, it also imposes a substantial economic burden on every healthcare system.
It was a great honour and pleasure to organize the 5th International Neuro-Urology Meeting (INUM), which took place from 25-28 January 2017, in Zürich, Switzerland. We are proud to announce that the International Neuro-Urology Meeting, organized under the umbrella of the Swiss Continence Foundation (www.swisscontinencefoundation.ch), has become the official annual congress of the International Neuro-Urology Society (INUS, www.neuro-uro.org), a charitable, non-profit organization aiming to promote all areas of Neuro-Urology at a global level and whose inauguration was inspired during the last INUMs.
The world’s leading experts in Neuro-Urology provided an overview on the latest advances in research and clinical practice of this rapidly developing and exciting discipline. This unique meeting combined state-of-the-art lectures, lively panel discussions, and hands-on workshops with emphasis placed on interactive components. There were many opportunities to exchange thoughts, experiences and ideas and also to make new friendship.
The Swiss Continence Foundation Award: To promote the next generation of outstanding young researchers and clinicians who represent the future of Neuro-Urology, the prestigious Swiss Continence Foundation Award of 10’000 Swiss francs was awarded to the best contribution from a young Neuro-Urology talent: Marc Schneider from Zürich, Switzerland, convinced the international jury with the presentation of his PhD project “Anti-Nogo-A antibodies as a potential causal treatment for neurogenic lower urinary tract dysfunction after spinal cord injury”. He demonstrated in an animal model that intrathecally applied antibodies against the central nervous system protein Nogo-A which inhibits nerve fibre growth had beneficial effects on lower urinary tract dysfunction in rats with incomplete spinal cord injury by re-establishing a physiological micturition and preventing detrusor sphincter dyssynergia. This effect presumably occurs due to neuronal re-wiring of descending micturition circuits facilitated by the anti-Nogo-A antibodies. Anti-Nogo-A immunotherapy enters currently clinical trials in humans and could become a unique causal treatment option for lower urinary tract dysfunction in patients with incomplete spinal cord injury.
One of many other highlights was the joint presentation of the EAU Secretary General Christopher R. Chapple and the BJUI Editor-in-Chief Prokar Dasgupta on the challenging topic “What should the neuro-urologist learn from the onco-urologist and vice-versa?”
Finally, we are delighted to announce the 6th International Neuro-Urology Meeting to be held in Zürich, 25 to 28 January 2018. Save the date! For details please visit: www.swisscontinencefoundation.ch. We are looking forward to seeing you in Zürich!
Thomas M. Kessler, SCF Chairman and INUS Vice-President
Ulrich Mehnert, SCF Vice-Chairman and INUS Treasurer
The introduction of the daVinci robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) has led to a continuous discussion about the cost-effectiveness of its use. The capital costs and extra costs per procedure for robot-assisted procedures are well known, but there are limited data on healthcare consumption in the longer term. In this issue of BJUI, a retrospective study investigated the NHS-registered, relevant care activities up to three years after surgery comparing robot-assisted, conventional laparoscopic, and open surgical approaches to radical prostatectomy and partial nephrectomy [1].
The robotic system is particularly useful in difficult to perform laparoscopic surgeries, which are easier to perform with the daVinci system due to improved three-dimensional vision, ergonomics, and additional dexterity of the instruments. Because the use of the robotic system is more costly, to justify its use the outcomes for patients should be improved. Therefore, more detailed information about the clinical and oncological outcomes, as well as the incidence of complications after surgery with the daVinci system, is needed.
Lower rates of positive surgical margins for robot-assisted radical prostatectomy (RARP) vs open and laparoscopic RP have been reported [2]. There also is evidence of an earlier recovery of functional outcomes, such as continence. RARP is associated with improved surgical margin status compared with open RP and reduced use of androgen-deprivation therapy and radiotherapy after RP, which has important implications for quality of life and costs. Ramsay et al. [3] reported that RARP could be cost-effective in the UK with a minimum volume of 100–150 cases per year per robotic system.
Centralisation of complex procedures will not only result in better outcomes, but also facilitate optimal economical usage of expensive medical devices. Furthermore, the skills learned to perform the RARP procedure can be used during other procedures, such as robot-assisted partial nephrectomy (RAPN) and radical cystectomy (RARC). The recent report by Buse et al. [4] confirms that RAPN is cost-effective in preventing perioperative complications in a high-volume centre, when compared with the open procedure. Minimally invasive techniques for complex procedures, such as a RC, take more time to perform, but result in less blood loss. A systematic review by Novara et al. [5] showed a longer operation time for RARC, but fewer transfusions and fewer complications compared with open surgery. However, there is no solid evidence about the cost-effectiveness of this technique to date. The RAZOR trial (randomised trial of open versus robot assisted radical cystectomy, DOI: 10.1111/bju.12699) is likely to provide some answers about differences in cost, complications, and quality of life when the results of the study become available later this year.
Additionally, the robotic system has been shown to shorten the learning curve of complex laparoscopic procedures in simulation models [6]. Recently, a newly structured curriculum to teach RARP has been validated by the European Association of Urology-Robotic Urology Section [7]. The effect of the shorter learning curve on the cost of the procedures has not yet been well studied for cost-effectiveness. However, due to the shorter learning curves, patients have lower risks of complications, which from the patients’ perspective is more important than any increased costs.
The study reported in this issue [1]; however, does not include the ‘out of pocket’ expenses of patients, it does not report on the differences in patient and tumour characteristics, and outcomes such as complications and oncological safety. These issues are all challenges to be addressed in a thorough prospective (randomised) trial on the cost-effectiveness of the use of robot-assisted surgery, including quality-of-life measurements and complications of the surgical procedures. In the Netherlands the RACE trial (comparative effectiveness study open RC vs RARC, www.racestudie.nl) started in 2015 and the results are expected in 2018–2019.
As you may know, we alternate the occasion of the BJUI Social Media Awards between the annual congresses of the American Urological Association (AUA) and of the European Association of Urology (EAU). Our first awards ceremony took place at the AUA in San Diego in 2013, followed by the EAU in Stockholm, and a really fun evening at AUA in New Orleans last year. This year, we descended on Munich, Germany to join the 13,000 or so other delegates attending the EAU Annual Meeting and to enjoy all the wonderful Bavarian hospitality on offer. More about that in our blog posts from #eau16.
On therefore to the Awards. These took place on Sunday 13th March 2016 in the roof garden bar of the beautiful Bayerischer Hof hotel. Over 70 of the most prominent uro-twitterati from all over the world turned up to enjoy the hospitality of the BJUI and to hear who would be recognised in the 2016 BJUI Social Media Awards. Individuals and organisations were recognised across 46 categories including the top gong, The BJUI Social Media Award 2016; awarded to an individual, organization, innovation or initiative that has made an outstanding contribution to social media in urology in the preceding year. The 2013 Award was won by the outstanding Urology Match portal, followed in 2014 by Dr Stacy Loeb for her exceptional individual contributions, and in 2015 by the #UroJC twitter-based journal club. This year our Awards Committee consisted of members of the BJUI Editorial Board – Declan Murphy, Prokar Dasgupta, Matt Bultitude, Stacy Loeb, Mike Leveridge, and Henry Woo, as well as BJUI Managing Editor Scott Millar whose team in London drive the content across our social platforms. The Committee reviewed a huge range of materials and activity before reaching their final conclusions. As befits the fast-moving nature of social media, we decided to omit a couple of previous categories and add two new ones.
One of these was the “Best #EAU16 Selfie” competition which we launched on the eve of this year’s EAU Annual Meeting to encourage some fun among congress attendees.
We had dozens of enthusiastic entries which betrayed the social side of urology conferences today – see examples on our Awards Prezi.
The full list of awardees, along with some examples of “best practice” in the urology social media sphere can be found in the Prezi. The winners are also listed here:
Most of the Award winners were present to collect their awards themselves, including Dr Stacy Loeb who received our top gong for her work in driving the #ilooklikeaurologist campaign. The Awards Committee had identified this wonderful social media campaign from early on as a stand-out example of how social media (Twitter in particular), can be deployed to drive a really important social message. The #ilooklikeasurgeon campaign had already caught the imagination of all of us who identified with the message that female surgeons were undervalued in our specialty, and the #ilooklikeaurologist campaign really brought a welcome focus on our female urology specialists and trainees. The tweet that first used the hashtag was sent by Stacy in August 2015 in reply to a tweet from Rustom Manecksha:
Since that time, over 1000 tweets have been sent using this hashtag, most featuring great pictures of our female urologists at work or at play. See plenty of examples on our Prezi or just search the hashtag #ilooklikeaurologist.
A special thanks to our outstanding BJUI team at the Editorial Office in London, Scott Millar and Max Cobb, who manage our social media and website activity as well as the day-to-day running of our busy journal.
See you all in Boston for #AUA17 where we will present the 5th BJUI Social Media Awards ceremony!
Declan Murphy, Peter MacCallum Cancer Centre, Melbourne, Australia
Associate Editor – Social Media, BJUI
@declangmurphy
Das bringt mich weiter! While the sun was shining in Munich, the 3rd day of the 31st EAU Annual Congress continued with very well attended plenary and poster sessions. And that is no wonder because the EAU Scientific Committee had created such an attractive program, including amazing plenary sessions during the morning and a plethora of informative poster sessions in the afternoon.
Professor Hendrik Borgmann (@HendrikBorgmann) has already covered highlights of the opening days 1 and 2 of this year’s Congress in his BJUI blog. We will give you some highlights of Day 3 and highly recommend you to take a look on EAU congress website, Day 3, which has archived a huge amount of material to allow you to catch up on sessions you may have missed. Indeed, lots of webcasts are available!
We focused on non-oncology plenary morning sessions and oncology poster sessions afternoon. Here are some of our highlights:
SURGERY IN THE ELDERLY – As our urological patients become older and older, surgery for octogenarians, or even nonagenarians, is increasingly common. The morning session covered various aspects on diagnosis and treatment of benign prostatic hyperplasia and other urological conditions in the ageing patient.
Professor Cosimo De Nunzio began the morning with “Highlights” on lower urinary tract symptoms and prostatic disease presented during this year’s EAU congress. Also this year, as many as every third abstract was on either prostate cancer or prostatic hyperplasia.
Indeed, the plenary session on Day 3 also covered prostatic disease.
Professor Alexander Bachmann talked about surgery for BPO in the elderly. He pointed out that in elderly (high-risk) patients we do not need a complete anatomical tissue removal, we do not need a (very) long-term follow-up and that we do not need tissue for prostate cancer diagnosis. Instead, we need a safe and efficient operation with individual adaptation of the technique and preferably feasibility in an ambulatory setting or local anaesthesia.
Professor Bachmann further emphasized that it would be preferable if surgery for the elderly would be performed by experienced surgeons, and that age per se is not a reason to not operate. There are several new minimally invasive operations available, and especially for elderly less is often more.
HOW AND WHEN TO STOP ANTICOAGULATION – Managing perioperative thromboprophylaxis for patients who already receive anticoagulants remains a challenge. Associate professor Daniel Eberli and Professor Per Morten Sandset covered many of these aspects in their helpful presentations.
Dr. Eberli told us that bridging therapy (options for stopping or not stopping anticoagulation in the above figure) is eminence-based, as no papers exist showing benefits. He also presented data from the recent NEJM trial (BRIDGE study; see Table below), which showed that stopping anticoagulation without bridging was non-inferior to perioperative bridging for the prevention of arterial thromboembolism and decreased the risk of major bleeding.
Dr. Eberli gave us all a take home message to discuss and question our local bridging guidelines as new evidence is very likely not supporting them (concluding slide below).
Professor Sandset recommended that during the perioperative period only use aspirin in high-risk patients, that is, those with recent thrombotic event or extensive coronary heart disease. He also informed us that stopping antiplatelet therapy 5 days before surgery (figure below) is often the way to go, and agreed with Dr. Eberli regarding bridging therapy statements.
Professor Sandset also gave helpful information regarding use of direct oral anticoagulants (DOACs) in urological surgery:
There were numerous poster sessions available on Day 3, as usual, many of them on prostate cancer. We have selected some of the highlight abstracts presented.
PROSTATE CANCER – On Day 3, prostate cancer presentations dominated once again in a number of poster, abstract and thematic sessions but also kidney, bladder, testicular and penile cancer sessions, which provided new interesting data.
Molecular markers, genomic profiling and individualized risk and treatment assessments were presented and discussed in poster session 58, and summarized by Stacy Loeb (@LoebStacy). Further advances in prostate cancer biomarkers in prostate cancer were presented in poster session 84. These new tools are moving from bench to bedside and urologists can hopefully incorporate these new tools to cancer care sooner rather than later.
In sessions on prostate cancer diagnostics, more advanced risk profiling tools were highlighted. For instance, STHLM3 test combines history of the patient, clinical parameters, biochemical markers and genetic markers. It was presented earlier in the congress and on Day 3 further health, economic and clinical evaluations were presented in Thematic session 12. It is one example of the tests showing promising results to potentially decrease the number of prostate biopsies needed. Other similar risk profiling tools were also presented during the congress. In addition to PSA only, evaluation of the smart use of already available clinical and biochemical parameters and the combination of genetic markers may bring individualized risk assessment of prostate cancer to the next level.
In poster session 62 on Day 3, diagnostic proceedings in prostate cancer with co-morbidity evaluation, biopsy strategies and MRI imaging were presented. A combination of molecular markers and imaging may be the way to proceed in future. These aspects were covered nicely in Thematic session 12.
MRIs have been heavily integrated in prostate cancer diagnostics during recent years. Image guidance in prostate biopsies seem to be making a breakthrough in prostate cancer diagnostics. Targeted biopsies with cognitive or MRI-TRUS fusion imaging were shown to be the way to enhance the results and reliability of biopsies and cut down the number of biopsies. However, as biopsies are still needed in prostate cancer diagnostics, use of the pre-biopsy MRI protocols were suggested to be done only in clinical trial setting. Many aspects of MRI diagnostics of prostate cancer were elegantly summarized in Thematic session 11.
New sophisticated imaging technologies in addition to MRI were present in several sessions during the meeting. Diagnostic enhancement has been seen also in metastatic prostate cancer. PSMA-PET seems to be replacing choline-PET-TT in evaluation of relapsing and metastatic prostate cancer (e.g. Thematic session 10). More reliable diagnostics and imaging of prostate cancer are also enhancing the treatment decision and treatment choice of patients with local prostate cancer. Finding the right patients for the active surveillance protocols is also being helped with advanced diagnostics. Indeed, finding only patients who need treatment for prostate cancer should be the ultimate goal for enhanced diagnostics as discussed in poster sessions 66 and 75 on Day 3. There are also high expectations on focal therapy (e.g. poster session 66), which at the moment is still experimental but will likely be a real option for patients with low volume prostate cancer verified by imaging.
The role of quality of life evaluations and patient reported outcomes measured were heavily discussed during the congress in all treatment modalities of both local and advanced prostate cancer. Survivorship issues are an increasingly important issue when more effective treatments both in local and advanced prostate cancer are available.
In metastatic disease, the use of early chemotherapy in combination with hormonal treatment has been implemented very rapidly to clinical use after the results of the CHAARTED and STAMPEED studies. Further evaluation of early chemo in metastatic disease is still needed and the patient selection needs still clarification. Hormonal therapy still has a very marked role in metastatic prostate cancer and new advances can also be found in new strategies of using castration therapy as presented in poster session 67. Urologists should actively follow the changing landscape of the medical treatment of metastatic prostate cancer and be active in treatment planning and treatment of these patients. At the same time with poster session 62 novel drugs and new forms of isotope radiation therapy in castration resistant prostate cancer were discussed in poster session 61. These open new possibilities for potential treatments.
The clinical and scientific content of the program of the Day 3 was of a very high standard, and reflective of the breadth of contemporary research in many areas within urology. Besides this session, it was our pleasure to meet old and new urological friends worldwide. The annual EAU meeting remains a highly effective method of knowledge translation and provides the opportunity for collaboration between surgeon scientists and other researchers in the field. As always in big congresses, there are so many interesting sessions going on at the same time, that it is hard to pick up and follow everything you would like to. We hope that this report provides some memories and take home messages of the Day 3 to the readers of the BJUI and BJUI blogs.
We look forward to future BJUI and EAU happenings!
Kari Tikkinen
Urology resident, adjunct professor of clinical epidemiology
Helsinki University Hospital, Helsinki, Finland
@KariTikkinen
Mika Matikainen
Chief of urology, adjunct professor of urology
Helsinki University Hospital, Helsinki, Finland
“It is my ambition to say in ten sentences what others say in a whole book.” – Friedrich NietzscheThe EAU guidelines on lower urinary tract symptoms have been published recently. These contain 36,000 words. It was pointed out to me that the American declaration of independence contained 1300 words and The Ten Commandments just 179 words.
The challenge was therefore to write ten commandments for urology in 179 words. The rules I set were that I should write them whilst keeping the spirit of the structure of the decalogue as closely as possible. (It may be worth rereading the original before reading on). So here goes.
1) I am a logical specialty. Thou shall investigate thoroughly prior to undertaking intervention for I am a specialty that avoids surprises.
2) Though interested in the whole of medicine thou will perform no other procedures other than urological.
3) Thou shalt not base intervention on old imaging for the clinical situation could have changed.
4) Remember that 80% of diagnoses can be made with history alone. Thou shalt listen carefully to your patient to this end.
5) Honour sound surgical principles. Urological tissue is forgiving but anastamoses under tension will not heal.
6) Thou shall not ignore haematuria.
7) Thou shall not leave a stent and forget it has been placed.
8) Thou shall not adopt new technology without proper clinical evaluation unless it is part of a trial.
9) Thou shall not fail to see the images yourself in assessing the patient before you.
10) Thou shall not fail to assess the potential for harm before embarking on a surgical procedure. If you would not do it to your family, your neighbour or friends, you will not do it to the patient who is in your clinic.
I put these out for discussion. Other offerings please.
Jonathan M. Glass @jonathanmglass1
The Urology Centre, Guy’s Hospital, London, UK.
Persistent rain throughout this year’s 30th EAU Annual Congress failed to dampen the spirits of over 12,000 delegates who have enjoyed another fantastic congress here in Madrid. The EAU Scientific Committee, led by Arnulf Stenzl, deserve tremendous credit for the work they have done to construct an extremely comprehensive and stimulating programme once again this year. I do recall my last EAU Congress in Madrid 12 years ago and there is no doubt but that the standard of this meeting has risen exponentially during this time. It is not just be Annual Congress of course which has developed in this time; the EAU has seen enormous growth in its global influence through the meteoric rise of European Urology, the activities of the European School of Urology (even beyond Europe), the pre-eminence of the EAU Guidelines, and the introduction of new initiatives such as UroSource. The Annual Congress is the nidus for much of this activity and it has become an unmissable event for many of us (even when based in Australia as I am!).
Rebecca Tregunna and Matthew Bultitude have already covered some of the highlights of the opening days of this year’s Congress in their BJUI blog . I will give you some further highlights and point you towards the excellent congress website which has archived a huge amount of material to allow you to catch up on sessions you may have missed.
Big highlights for me on day 3 and 4 include the following (please forgive my oncology focus):
PSMA PET scanning – there was considerable interest in the early data on PSMA PET scanning for recurrent prostate cancer at last year’s EAU Congress, and this year has seen some very positive data being presented from Munich and Heidelberg and further enthusiasm for this imaging modality. Tobias Maurer (Munich) presented a number of papers showing the high sensitivity in particular for PSMA PET in detecting recurrent prostate cancer at low levels of biochemical recurrence using either PET CT or PET MRI (poster 928).
Many other plenary speakers also highlighted the positive data surrounding PSMA PET and also the possible theragnostic potential of this in the future (poster 675 and Dr Haberkorn plenary lecture). However in the scientific souvenir session which closed the meeting, Dr Peter Albers burst the bubble somewhat by warning that we need much better data (tissue validation in particular), before we all rush towards PSMA. He has a point of course, although I have been extremely impressed with our initial experience using PSMA PET in Melbourne over the past six months and I do expect it to live up to the hype.
CHAARTED data looking good – Nine months after he made world-wide headlines when he presented the overall survival data of the CHAARTED study at ASCO, Dr Chris Sweeney crossed the Atlantic to again present this data to a packed eUro auditorium. This randomised study of 790 men with metastatic prostate cancer, has demonstrated that men who receive six cycles of docetaxel chemotherapy upfront at the time of starting androgen deprivation therapy, have a considerable survival benefit compared to those who receive ADT on its own (the current standard of care). This was especially so for men with high volume metastases who had a 17 month survival benefit (HR 0.61).
Although the French GETUG study has not shown the same benefit, Sweeney and others have proposed rational explanations for why this might be so. While the final paper has not yet been published (will be submitted this week), very many of us have already embraced the CHAARTED as the new standard of care for men presenting with high-volume metastatic prostate cancer. A proper landmark study.
Metastatic castrate-resistant prostate cancer (mCRPC) – still more questions than answers. What an amazing few years for this disease area! Five years ago, urology trainees only had a handful of “essential reading” papers in the world’s top journal, the NEJM, that we could cite to support evidence-based practice. It is now difficult to keep up with all the landmark trials in NEJM and other top journals reporting overall survival advantage for a variety of agents targeting mCRPC. Enzalutamide has already joined the ranks of these blockbuster drugs and this year’s EAU saw more data illustrating the powerful activity of enzalutamide in the pre-chemo mCRPC space. In the Breaking News session on the final day, Dr Bertrand Tombal presented the final analysis of the PREVAIL study which confirmed the overall survival advantage of patients receiving enza pre-chemo when compared with placebo. The HR of 0.77 was strongly significant (p=0.0002) and the therapy was well tolerated.
However as pointed out by discussant Dr Maria de Santis, we have still a way to go to figure out which patient will benefit from which therapy and when. The sequence and combination of therapies is still being worked out, and while the potential of predictive biomarkers such as AR7 is certainly exciting, we are still bereft of data and tools (and funding), to figure out the best pathways.
Robot vs open surgery – cystectomy is the new battleground. As Alberto Brignati pointed out in his outstanding souvenir session on localised prostate cancer, it appears that the old debate of robotic vs open prostatectomy is no longer of interest. Despite the lack of prospective randomised data, there appears to be little doubt that robotic prostatectomy is the standard of care in many regions. A large number of posters and plenaries demonstrated convincing data of excellent outcomes in robotic prostatectomy series, including data from a multicenter randomised study (REACTT, poster 622) led by Dr Stolzenberg which demonstrated improved potency outcomes for robotic prostatectomy (not the primary endpoint).
The same cannot yet be said of robotic cystectomy. Despite my own enthusiasm for and publications on robotic cystectomy, it is hard to get away from some of the cautionary language being expressed about the role of robotic cystectomy at the moment. An excellent plenary featuring giants in the field of bladder cancer (Dr’s Bochner, Wiklund, Studer, Palou), debated the issue in the main eUro auditorium and the following day’s newsletter summed it up nicely:
This provoked much discussion on Twitter with some prominent names chiming in from the US. Dr Khurshid Guru got involved to reassure us that the International Robotic Radical Cystectomy Consortium which he leads will provide the answer.
Well said @khurshidguru!
On a non-cancer note, it is clear that some of the most popular session and courses at EAU15 were focused on uro-lithiaisis. Stone surgeons are also very active on Twitter and although I did not attend any stone sessions, I was pleased to see that standardization of terminology is also important to the “pebble-ologists”:
Finally, #EAU15 was truly a social experience, not just in the wonderful bars and restaurants of Madrid, but also through Twitter and other social media channels, strongly supported by the excellent communications team at EAU. We recently published a paper in the BJUI documenting the growth of social media at major urology conferences and at EAU in particular. Between 2012 and 2014, the number of Twitter participants increased almost ten-fold, leading to an increase in the number of tweets from 347 to almost 6,000 At #EAU14, digital impressions reached 7.35 million with 5,903 tweets sent by 797 participants.
(From Wilkinson et al BJUI 2015)
As might be expected, #EAU15 has continued this trajectory with almost 8000 tweets sent by 1220 participants.
One of the only criticisms I have of EAU15 is that the scientific program is now so large that it is impossible to get to all the sessions I am interested in. There did seem to be a lot of prostate cancer running simultaneously but I am not sure how much the Scientific Committee can do to avoid such clashes. Thankfully, the EAU meeting website www.eaumadrid2015.org contains a huge amount of material including webcasts, interviews, posters etc which allows delegates and EAU members to catch up on some of the outstanding content.
Another big attraction of the EAU Annual Congress is of course that it takes place in Europe’s most wonderful cities. EAU16 heads to Munich – put the date in your diary 11-15 March 2016.
Declan Murphy, Urologist, Melbourne
Associate Editor – Social Media, BJUI
@declangmurphy
Click here for Declan Murphy’s disclosures
