Key points and hot topics at ESOU22

By Erika De Groot

Contemporary updates and multidisciplinary insights on genitourinary cancers, the 19th Meeting of the EAU Section of Oncological Urology (ESOU22) delivered these and more when it commenced in Madrid, Spain from 21 to 23 January 2022. Chair Prof. Morgan Rouprêt (FR) spearheaded the hybrid ESOU22 meeting where 1,000 enthusiastic participants convened, a third of whom followed the sessions online. This report provides some of the key points of hot topics addressed during at the meeting, as well as, exciting news to look forward to in 2023.

Some key messages In the state-of-the-art lecture “Molecular advances in risk stratification of localised prostate cancer”, Dr. Daniel Spratt (US) stated, “At present, nearly all treatment decisions in prostate cancer are based on prognosis until we have true predictive biomarkers.” He added that the current standard of care risk-stratification tools such as standard National Comprehensive Cancer Network and D'Amico risk classifications have an “unacceptable performance” as these inherently over- and underestimate the cancer risk and disease aggressiveness for patients and thus, affect their treatment.

Dr. Spratt also stated that gene expression tests have proven to be superior in prognostication, and that he foresees that artificial intelligence with digital pathology and radiomics with magnetic resonance imaging (MRI)-based machine learning may provide more cost-effective solutions.

Dr. Mary-Ellen Taplin (US) presented “Neoadjuvant treatments before radical prostatectomy for high-risk prostate cancer: Developments and challenges” wherein some of her lecture’s key points included that biomarkers suggest favourable response in SPOP-mutated tumours and poor response in p53-mutated and ERG+/PTEN-loss tumours. She added that ongoing correlative analyses are being performed to investigate response and resistance such as single-cell sequencing analysis which may be promising.

During the debate on monitoring patients on active surveillance (AS), Prof. Caroline Moore (GB) offered her insights on the adequacy of MRI, and Dr. Juan Gómez Rivas (ES) offered his as a counterpoint: prostate biopsy is mandatory.

According to Prof. Moore, the EAU Guidelines recommend MRI for all men on AS. She stated that the DETECTIVE consortium affirmed that confirmatory biopsy can be omitted, and that the ASIST study underscored high-quality MRI and accurate reporting are essential. “When an MRI-led approach is used, the majority of men can omit scheduled biopsy and adherence to AS is increased,” said Prof. Moore.

Dr. Gómez Rivas concluded that further data in monitoring disease progressions is needed with regard to the use of MRI instead of prostate biopsy, and that the role of MRI on AS is not yet standardised. He said, “We need protocol optimisation. Additionally, we should use MRI with other clinical parameters such as clinical exam, serum PSA, serial prostate biopsies, urinary markers, and genomic tests.”

In “New tools for the conservative management of UTUC”, Dr. Guido Giusti (IT) advised that in case of a high-grade disease, nephroureterectomy is still the first treatment option, and that kidney-sparing surgery (KKS) should always be offered for lowgrade disease and imperative cases. He emphasised that identifying the grade is of uttermost importance, and a strict follow-up is mandatory.

In her lecture “Future directions of systemic treatment for mRCC: What can we expect in the next 5 years?”, Dr. Laurence Albiges (FR) stated that she expects that the integration of adjuvant therapy into clinical practice will be important, and that there are going to be new combinations tested over the next several years, including a potential role for triplet therapy. New agents are under evaluation (including hypoxia inducible factor [HIF]-2alpha inhibition) and at present, there are insufficient biomarker-driven trials. Dr. Albiges added that new algorithms focusing on PD-1 resistance strategies are needed. Access and (re)view all presentations via the ESOU22 Resource Centre https://resource-centre.uroweb.org/ resource-centre/ESOU22.

ESOU Chair Prof. Rouprêt announces new onco-urological event Majority of participants attended the hybrid meeting onsite

Well-rounded programme This year, the hands-on training (HOT) course "Prostate MRI reading for urologists"; the STEPS (Session To Evaluate ProgresS) programme; the Educational Session organised through the collaboration of the ESOU, European School of Urology (ESU), and EAU Robotic Urology Section (ERUS); and the joint session of the ESOU and European Urology Oncology journal complemented the lectures of the meeting.

Great news for 2023 Although ESOU22 was the last edition of the meeting, a new European onco-urological event awaits in the summer of 2023. "I am pleased to announce that UROonco23 will take place next year! This massive European event will be a fusion of previous specialised meetings, a culmination of onco-urology expertise and developments. Expect a new formula, larger scope, and broader audience!", stated Prof. Rouprêt. More details will follow in the coming months. Stay tuned!

Preliminary ESU programme in Amsterdam

Adrenals • Adrenals for urologists

Andrology • Office management of male sexual dysfunction • The infertile couple – Urological aspects

Female urology • Advanced vaginal reconstruction • Prolapse management and female pelvic floor problems

General urology • How to proceed with hematuria • Ultrasound in urologyUpdate renal, bladder and prostate cancer guidelines 2022, what has changed? • Updates and controversies: Incontinence, bladder / paediatric stones and male LUTS guidelines 2022: What has changed? • Improving your communication and presentation skills • How to write the introduction and methods • How to write results and discussion • Practical aspects of cancer pathology for urologists.

The 2022 WHO novelties

Infections • Dealing with the challenge of infection in urology

Kidney transplantation • Renal transplantation: Technical aspects, diagnosis and management of early and late urological complications Neurogenic and non-neurogenic voiding dysfunction • Chronic pelvic pain in men and women • Practical neuro-urology • Lower urinary tract dysfunction and urodynamics

Paediatric urology • Practical approach to paediatric urology

Penile and testicular cancer • Male genital diseases • Testicular cancer

Prostate cancer • Robot-assisted laparoscopic prostatectomy • Retropubic radical prostatectomy: Tips, tricks and pitfalls • Focal therapy in prostate cancer • Prostate cancer imaging: When and how to use it • Prostate cancer screening and active surveillance –

Where are we now? • Prostate biopsy: Tips and tricks • Metastatic prostate cancer • Oligometastatic prostate cancer • Prostate cancer update: 2021-2022 • Surgery or radiotherapy for localised and locally advanced prostate cancer • Prostate cancer challenges and controversies from guidelines to real-world • Theranostics in prostate cancer

Renal tumours • Advanced course on laparoscopic renal surgery • Treatment of small renal masses • Robot renal surgery Urethral strictures • Advanced course on urethral stricture surgery

Urolithiasis • Percutaneous nephrolithotripsy (PCNL) • Update on stone disease • Flexible ureterorenoscopy and retrograde intrarenal surgery:

Instrumentation, technique, tips, tricks and indications • Metabolic workup and non-surgical management of urinary stone disease • Advanced endourology in the non-standard patients with urolithiasis

Urological surgery • Laparoscopy for beginners • Advanced course on upper tract laparoscopy: Kidney, ureteropelvic junction (UPJ), ureter and stones • Peno-scrotology and basic lower urinary tract endoscopy – Questions you are scared to ask • Prosthetic surgery in urology • Lymphadenectomy in urological malignancies • Practical tips for pelvic laparoscopic surgery: Cystectomy, radical prostatectomy adenomectomy and sacrocolpopexy

Urothelial tumours • Practical management of non-muscle invasive bladder cancer (NMIBC) • How we manage upper tract tumours • Robot-assisted laparoscopic radical cystectomy • Management and outcome in invasive and locally advanced bladder cancer • Nerve-sparing cystectomy and orthotopic bladder substitution. Surgical tricks and management of complications • Perioperative immunotherapy and multidisciplinary management of localized genitourinary cancers

ESU Courses