EAU23 report: Year-on-year progress

By Erika De Groot, Stephanie Fitts and Loek Keizer

The 38th Annual Congress of the European Association of Urology was a momentous occasion in Milan, Italy, earlier this year. An extensive and dynamic scientific programme shed light on ground-breaking research and novel technologies. Attracting over 9,800 delegates from 123 countries, more than 1,700 experts shared their knowledge and latest research findings during 300 sessions that included state-of-the-art lectures, debates, panel discussions and 47 courses (including Hands-on training) organised by the European School of Urology.

Over four days, there were eight plenary sessions, a full day of live surgery, multiple game-changing sessions, 28 thematic sessions, 15 Urology Beyond Europe lectures, poster presentations, prestigious awards, Patient Day, YUORDay and industry sessions. During this time, both the 7th International Congress on the History of Urology, and the annual meeting of European Association of Urology Nurses (EAUN23) took place as well.

This article provides a short summary of some highlights from EAU23, but for the most complete coverage of the congress, you can read the full news reports on www.eau23.org/news.

Day 1: GU cancers and supportive care

In his state-of-the-art lecture “Optimising supportive care for metastatic GU cancers”, Dr. Florian Scotté (FR) cited the findings of the National Cancer Database retrospective study “Considerations for palliative care in urologic oncology” by Bryn Launer, et al. The study showed supportive care is infrequent for patients with advanced urologic malignancies, and outlined the possible barriers, such as misconception about what palliative care is, limited access to the healthcare system and patients’ acceptance.

One of the solutions that Dr. Scotté discussed was derived from the paper “Integration of oncology and palliative care: A Lancet Oncology Commission” by Stein Kaasa, et al. wherein two approaches were combined: tumour-directed approach (focus on treating the disease) and host-directed approach (focus on the patient). He stated that this combination will result in a systematic assessment, improvement in patient-reported outcomes, and active patient involvement in the decisions. As a consequence, there will be better symptom control, improved physical and mental health, and better use of healthcare resources.

Kidney transplantation (KT)

Dr. Javier Sanchez Macias (ES) presented the lecture “Bladder function and Lower urinary tract symptoms (LUTS) after renal transplant”, whereby he provided information on post-operative lower urinary disorders including absence of bladder, low capacity bladder and neurogenetic bladder. “The implementation of new minimally-invasive technologies for the management of patients with LUTS will in the future oblige their daily use in transplant patients. New studies will be necessary to determine whether Rezūm, Aquablation or transurethral HIFU (high intensity focused ultrasound) techniques will replace endoscopic enucleation and TURP (transurethral resection of the prostate)”, stated Dr. Sanchez Macias.

Lively debates followed between Dr. Oscar Rodriguez Faba (ES) and Dr. Romain Boissier (FR) on the topic of “Urological evaluation of the recipient before kidney transplant should be obligatory”. Dr. Rodriguez stressed that a proper urological evaluation of a KT patient is necessary. “Urological complications comprise the second most common adverse event after KT. Pretransplant targeted urological evaluation allows for optimisation of the urinary tract accepting the graft.”

“We are also doing some fascinating translational work comparing pre- and post- tissues to see what effect LuPSMA has on the tumour microenvironment. This work is ongoing and it may give us an idea of how to better select patients for this type of targeted treatment.”

Day 2: Bladder cancer (BCa) sessions

Incontinence and sexual dysfunction are of real concern especially in young women after neobladder surgery but it is a frequently overlooked topic. “Roughly 25% of new BCa patients each year are diagnosed in female patients” stated Dr. Manuela Tutolo (IT) in her lecture ‘Treatment of incontinence and sexual dysfunction after cystectomy’. “Our goal as urologists should be to guarantee optimal urological outcomes together with optimal functional outcomes in these patients. The surgeries are difficult with serious complications that have an impact on quality of life (QoL).”

Phase 3 ZIRCON study

Prof. Peter Mulders (NL) presented the latest results in a game changing session on the use of 89Zr-DFO-girentuximab for PET/CT imaging of clear cell renal cell carcinoma (ccRCC). According to Prof. Mulders, the ZIRCON study exceeded sensitivity and specificity targets, which also included small masses (cT1a <4cm), and had a favourable safety and tolerability profile. “These positive results suggest that 89Zr-DFOgirentuximab improves identification of primary ccRCC compared to cross-sectional imaging. It has the potential to improve management by aiding risk stratification and holds promise to improve staging in ccRCC, therapeutic target (radiopharmaceuticals) or to image other solid tumours.”

Latest OpeRa results

Prof. Marc-Oliver Grimm (DE) delivered an update on the OpeRa study, which compared robotic assisted partial nephrectomy (RAPN) and OPN (open partial nephrectomy) in intermediate/high complexity renal tumours. With RAPN, there was a numerically lower 30-day complication rate (primary endpoint), but with regard to oncologic (R1-rate, TRIFECTA) and functional outcomes (eGFR, ischemia time <25 minutes), there was no difference. There was less intense pain management required with RAPN, less pain reported and a better QoL scored (through POD30).

New robotic systems

One of the best-attended sessions at EAU23 was without doubt the live surgery session “Technology developments never end”. Running continuously from 10:30 to 19:00hrs, the programme featured more than 30 cases, with extra attention for the newest single-use scopes, and Thulium and Holmium laser enucleation of the prostate. The programme also featured less common cases, for instance two pre-recorded presentations on inflatable penile prostheses.

AI and PCa diagnosis

Dr. Maarten De Rooij (NL) presented the study design for 'Prostate Imaging: Cancer Artificial intelligence (PI-CAI Challenge)’, which aims to evaluate the performance of modern AI algorithms at patient-level diagnosis and lesion-level detection of csPCa (clinically significant PCa). “The preliminary results in the reader study arm show that bpMRI (biparametric) has similar csPCa detections to mpMRI (multiparametric) assessments. We have to look into experience, workflow, image quality and protocol familiarity to evaluate future work. We look forward to the next steps in which we will establish the primary endpoint, comparing AI with radiologists”.

Final results of LuTectomy study

Dr. Renu Eapen (AU) shared the concluding results for the prospective study of dosimetry, safety and potential benefit of upfront [177Lu] Lu-PSMA-617 radioligand therapy prior to radical prostatectomy in men with high-risk localised PCa. “We have seen that Lu-PSMA, followed by surgery is safe, it is well tolerated, and it is effective. Radiation dose delivery is high and targeted, but variable. We are seeing some encouraging responses from a biochemical, imaging and pathological point of view. Further research is worthwhile to see if this could be an effective treatment strategy in well selected patients.”

“Radical cystectomy with ONB (orthotopic neobladder) is an attractive treatment option, but it has high rates of voiding/sexual dysfunction. We should treat patients conservatively as much as possible.” In Dr. Tutolo’s opinion, it is important to optimise surgery to preserve sexual function, select patients upfront according to their risks of incontinence or other general complications, and properly inform patients to create realistic expectations. She believes there is a clear need for more prospective studies and a real multidisciplinary approach.

In the afternoon sub-session on robotic surgery, Asst. Prof. Nina Harke (DE) joined Auditorium 1 from Niguarda Hospital in Milan and performed a robotic partial nephrectomy with a highly distinguished panel of moderators: Profs. Alex Mottrie (BE), Henk Van Der Poel (NL) and Alessandro Antonelli (IT). Her demonstration was followed by a Retzius-sparing robotic prostatectomy by Dr. Antonio Galfano (IT), using the new Hugo system, also in Niguarda. The system was installed just three months prior, and the team had performed fewer than 20 cases so far. “We are still exploring the possibilities of the system,” said Dr. Galfano.