Examining new issues and challenges in prostate cancer
13 Nov 2015 - Joel Vega
From precision grading, imaging, genomics to epidemiology, a range of issues that impact prostate cancer therapies were examined by a multidisciplinary team of experts which gathered today in Barcelona for the 7th European Multidisciplinary Meeting on Urological Cancers (EMUC15).
Issues such as Gleason scores, MRI-guided biopsy, worldwide incidence and mortality rates of prostate cancer to genomics were discussed by urologists, radiation oncologists, pathologists and medical oncologists who gathered for the three-day annual event which focuses on multidisciplinary strategies.
“Large global variations in rates reflect differences in both practice (PSA screening) and underlying risk,” said Ahmedin Jemal (USA) of the American Cancer Society in his lecture on prostate cancer (PCa) epidemiology. “Incidence continue to increase in several low-medium income countries and Eastern Europe, which may reflect increased detection as well as changes in risk factors.”
Jemal noted that Lithuania posted the highest increase in incidence in the last 10 years, while mortality rates took a leap in the Philippines for the same period (1998-2007 to 2004 to 2013).
Regarding the issue of the need for a new prognostic grading score in prostate cancer diagnosis, Prof. Riccardo Montironi (IT) examined the new grading recommendations which have been in place in the last five years.
“The new grading provides more accurate stratification of tumours than the Gleason system,” he said. “The classification simplify the number of grading categories from Gleason scores 2- 10 to grades 1- 5. The lowest is 1 not 6 as in the Gleason system, with the poitential to reduce overtreatment of indolent cancer.”
Regarding genomics, Prof. James Catto (GB) gave an overview and provided updates on various biomarkers.He said genomic markers have the role to guide patient choice and as exit triggers for active surveillance, and also to guide adjuvant and salvage treatments.
“Predictive genomic panels exist but direct comparisons have not been performed,” according to Catto. “The most useful clinical setting (active surveillance) has not been directly tested. Although markers may help guide some patients, their additive benefits are unclear over traditional measures.”
Caroline Moore (GB), meanwhile, discussed the role of imagingtechonologies such as multiparametric MRI (mpMRI) which she says works best in combination with other indicators.
“MRI-targeted biopsy, in comparison to standard TRUS biopsy detects at least as much clinically significant disease, and also less clinically insignificant disease,” said Moore.