BJMO - 2019, issue Special, march 2019
C. Artigas MD, prof. dr. Piet Dirix
PSMA is a type II transmembrane glycoprotein that is highly expressed in almost all prostate cancer (PCa) cells, with only 5–10% of primary PCa not having PSMA expression. The recent development of radiotracers directed against PSMA has taken things to a new level. There is now a solid body of evidence for the performance of 68Ga-PSMA PET/CT in secondary staging (i.e. at PSA rise after primary treatment), with an ability to accurately detect small volume disease at far lower serum PSA levels than with bone scan or even choline PET/CT. As a result, the use of 68Ga-PSMA PET/CT as a diagnostic adjunct is becoming increasingly mainstream. In addition to this, radioligand therapy is emerging as a new therapeutic strategy in PCa. In the final presentation of the 2019 annual BMUC meeting, dr. Carlos Artigas discussed the potential of PSMA-PET in staging and assessing biochemical recurrence in prostate cancer (PCa) patients after which dr. Piet Dirix listed up some critical notes with respect to the use of PSMA in the evaluation of biochemical recurrence.
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Prof. dr. Silke Gillessen
Over the last decade, the prostate cancer (PCa) treatment landscape changed dramatically. During her second lecture at BMUC 2019, Prof. dr. Silke Gillessen summarized the recent evolutions regarding systemic therapy across the PCa disease spectrum.
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S. Van Bruwaene MD, PhD, B. Engels MD, PhD, B. Sautois MD, PhD
In line with the tradition, the BMUC scientific committee asked a urologist, a radiation oncologist and a medical oncologist to summarize the top stories that were presented during the large urology and oncology meetings of the past year.
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Brian Chapin, MD
Radical treatment of the primary tumour in patients with metastatic prostate cancer (PCa) has been debated for several decades. The concept of combining systemic therapy with primary tumour cytoreduction has been attempted in different malignancies and recent data also suggest a potential benefit of this strategy in PCa. This include an improved local tumour control, but there are also data indicating that local treatment might alter the natural course of metastatic disease. In his presentation, Prof. dr. Brian Chapin (MD Anderson Cancer Centre, Houston TX, United States) discussed the rationale, the available data and ongoing trials regarding local treatment in patients with (oligo) metastatic PCa.
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Prof. dr. Karim Fizazi
For several decades the standard of care in patients with poor-risk non-seminomatous germ-cell tumours (NSGCT) has been 4 cycles of bleomycin, etoposide and cisplatin (BEP). However, there are data to support that in patients with an unfavourable decline in tumour markers after a first cycle of BEP, a high-dose chemotherapy regimen should become the standard of care. Dr. Fizazi also insisted on the importance of centralisation of care and provided some new insights for the treatment of patients with germ-cell tumours (GCT) following a relapse.
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N. Martínez Chanzá MD
Although non-metastatic muscle-invasive bladder cancer (MIBC) can potentially be cured with a trimodal approach in well-selected patients, radical cystectomy remains the reference treatment to date. However, there is a significant rate of recurrence after a radical cystectomy. This risk of recurrence is highly stage dependent and recurrences are commonly seen under the form of distant metastases.1 The predominant cause for these recurrences is the presence of occult micrometastases at the time of cystectomy. For this reason, there is interest in combining definitive surgical or radiotherapeutic treatment for localized disease with systemic chemotherapy for occult metastases. In this respect, several randomized controlled trials (RCTs) assessed the efficacy of peri-operative chemotherapy in the management of MIBC. During the 2019 annual BMUC meeting, dr. Nieves Martínez Chanzá reviewed the available peri-operative treatment landscape in MIBC and discussed emerging data on checkpoint inhibitors and predictive biomarkers in this setting.
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Prof. dr. Karim Fizazi
More than half of the patients who ultimately die from prostate cancer (PCa) are patients who already have metastases at the time of their diagnosis (de novo metastatic patients).1 Until recently, the treatment of M1 PCa patients consisted of androgen deprivation therapy (ADT). In recent years this treatment paradigm changed following the publication of convincing clinical data demonstrating a significant survival advantage of adding docetaxel or abiraterone acetate (AA) to ADT.2–8 During BMUC 2019, Prof. dr. Karim Fizazi (Institut Gustave Roussy, Paris, France) gave an overview of the latest developments in treatment of M1 PCa patients.
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