ESO Conference: Making cancer treatment personal
12 Nov 2015 - Joel Vega
The European School of Oncology (ESO) Interdisciplinary Conference “Personalized approach to prostate cancer management” in Barcelona, Spain took up the various issues that needs resolution to enable physicians to provide optimal care to prostate cancer patients within the context of so-called individualized treatment.
Three speakers in the second plenary session approached the question of extending tailored PCa treatment from the perspective of active surveillance, surgery and radiotherapy. ESO co-chairman Prof. Ricardo Valdagni (IT) spoke on the various points in active surveillance such as the role of Gleason score and imaging technologies.
"How reliable is our detection of Gleason 3+3 disease with random biopsies?" Valdagni asked at the start of his presentation. "Mounting evidence suggest that true pathologic Gleason 3+3 disease, while possessing the ability to grow and extend locally has an exceedingly low, if any, metastatic potential," he said.
He added that it remains to be fully clarified whether some Gleason 3+3 disease has the capacity over time to transform and acquire a metastatic phenotype. Valdagni also noted that the 3+3 entity should not be labelled as malignant cancer, but should instead be differentiated from benign entities, and thus underlining one of his main messages.
He also pointed out that although the use of mpMRI targeted biopsies can significantly improve the detection rate of GPS > 4, it should not, at the present time, substitute random biopsy. He came to his last point, that what is needed in active surveillance are non-invasive indicators of tumour progression, adding that it is also of value to promote and develop large databases ad real-time analysis.
Dr. Alberto Briganti (IT) tackled the progress that needs to take place in surgical management for PCa patients. “What do need in surgery? We need randomized clinical trials, but how? We need to individualized treatments through better imaging and predictions,” said Briganti. “The other thing we want to have if we can reduce recurrent disease, is that we need more accurate imaging modalities which only picks up advanced metastatic disease.”
Briganti also underscored the role of quality control in surgery that will assess whether the surgery is good or not. He cited the work of the Michigan Urological Surgery Improvement Collaborative (MUSIC) which is designed to evaluate and improve the quality and cost efficiency of PCa care for men in Michigan.
“We need to decrease treatment related side effects and we need more training programmes, and we had to have individualized treatments and predictions,” added Briganti.