8 minute read
EMUC21: Multidisciplinary updates from diverse fields
By Erika De Groot and Juul Seesing
With 925 registrants from 49 countries, delegates and 95 faculty members convened from 25 to 28 November 2021 in Athens, Greece for the 13th European Multidisciplinary Congress on Urological Cancers (EMUC21). Through the collaborative efforts of the European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), and the European SocieTy Radiation Oncology (ESTRO), the face-to-face format of the congress enabled and encouraged intensive interaction, which is essential for a truly multidisciplinary congress such as EMUC21, to achieve its goals.
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On 25 November, the 9th Meeting of the EAU Section of Urological Imaging (ESUI21) took place in conjunction with EMUC21. The ESUI21 and EMUC21 scientific programmes comprised lectures interspersed with Hands-On Training courses courtesy of the European School of Urology (ESU), the meeting of the Young Academic Urologists (YAU), the Radioligand therapy session, the EMUC Symposium on Genitourinary Pathology (ESUP), and the Uropathology training workshop.
EMUC21 and ESUI21 were for some delegates the first in-person events they attended after two years. The atmosphere was electric and the audience’s enthusiasm, palpable. Even online, EMUC21 generated buzz with an impressive 3.6 million impressions on Twitter alone.
Esteemed members of the Steering Committee, Prof. Arnulf Stenzl (DE) of the EAU, Prof. Aristotelis Bamias (GR) of ESMO, and Prof. Michael Pinkawa (DE) on behalf of Prof. Peter Hoskin (GB) of ESTRO, brought the congress to a conclusion.
This report collates some take-home messages, information on awards and the recipients, how to access the sessions, and where the next EMUC and ESUI editions will take place.
Take-home messages Being an event with a multidisciplinary nature, the take-home messages were categorised according to diverse fields. Prof. Maurizio Colecchia (IT) delivered the summary on pathology, Prof. Pinkawa on radiation oncology, Prof. Axel Merseburger (DE) on urology, Prof. Raymond Oyen (BE) on radiology, and Prof. Jan Oldenburg (NO) on medical oncology.
Pathology Prof. Colecchia’s first take-home message came from Dr. Gladell Paner’s (US) presentation on the new WHO classification of renal tumours. “This classification includes morphologically-defined and molecularlydefined entities,” Prof. Colecchia said.
Later, Prof. Colecchia referred to Prof. Paolo Gontero’s (IT) presentation in Plenary Session 3 for his pathologic takeaways regarding non-muscle-invasive bladder cancer (NMIBC): “Promising urinary markers for surveillance challenge urine cytology and will likely replace it in clinical practice. No prognostic marker can currently be recommended in clinical practice. Molecular classifications are promising but are not yet ready for routine application.”
Prof. Colecchia ended his summary with his vision for the future: “I have great expectations for the coming years. In particular, the molecular characterisation of uro-metastatic patients and the use of liquid biopsy in the routinary management of these patients will be the gold standard. Other useful tools that will become more prevalent are artificial intelligence and digital pathology.”
Radiation oncology Prof. Pinkawa gave the conclusions on radiation oncology, “There is a lack of data on the treatment outcome of the use of PSMA PET in prostate cancer patients. PSMA PET has clinical importance, which will be further defined in studies over the next years.” He cited Dr. Stefano Fanti’s (IT) lecture, who had said in Plenary Session 1, “The 2022 EAU Guidelines on Prostate Cancer will recommend using PSMA PET or a whole-body MRI in high-risk patients to increase the sensitivity. The guidelines will emphasise the very important limit of the lack of outcome data on subsequent treatment changes.”
On radio-immunotherapy for bladder preservation, Prof. Pinkawa said, “There are studies taking place on bladder preservation with the combination of radiotherapy and immunotherapy. Specifically in the UK, bladder preservation using radiotherapy is considered as a standard method that is more frequently used than a cystectomy, especially now in these times of COVID-19. But currently we don’t have convincing data considering this combination. We have some data that showed increasing toxicity that is not tolerable, and we don’t have convincing results yet that really show an improved disease-specific survival.”
Urology Prof. Merseburger offered trial updates of “Extended vs limited Pelvic Lymph node dissection in prostate cancer”, which was presented by Dr. Jean Lestingi (BR). “In a subgroup analysis, intermediate- and high-risk patients in particular benefitted from extended lymph node dissection (EPLND). EPLND remains the gold standard for lymph node staging. Its oncological role still needs to be defined," stated Prof. Merseburger.
25-28 November 2021 Athens, Greece
ESUI21
25 November 2021 Athens, Greece
Prof. A. Choudhury shares insights in radio-immunotherapy for bladder preservation
Prof. Grange donates prize money to YAU
He reiterated one of the key points of the Trial of Imaging and Surveillance in Seminoma Testis (TRISST) presented by oncologist Dr. Stefanie Fischer (CH) during a multidisciplinary case discussion on active surveillance: MRI is non-inferior to computer tomography, avoids irradiation, and should be recommended.
Radiology Radiologist Prof. Oyen discussed the ESUI21 lecture "The new mpMRI: Biparametric MRI: fast and accurate" by radiologist Dr. Giorgio Brembilla (IT) in Plenary Session 1: The MRI Corner: Faster and cheaper. Prof. Oyen underscored that biparametric MRI (bpMRI) lacks dynamic contrast-enhanced sequence (DCE-MRI) and may lead to greater uncertainty in lesion detection and scoring.
Prof. Oyen also provided the key messages based on the deliberations during Plenary Session 4: Kidney cancer: Multidisciplinary case discussions. He stated, "When finding an incidental renal mass, a tailored approach for elderly and frail patients or patients with comorbidities is most suitable. It is very important that the patients and their relatives are well-informed on what the place of additional imaging is in diagnosis and staging; when and how biopsies are performed; therapeutic options and potential risks; when the follow-up is, and if there are shortcomings of the follow-up."
Oncology The last presentation of EMUC21 came from Prof. Oldenburg, who took to the stage and provided conclusions from oncology-centric presentations. He stated PSMA PET findings are predictive for decreased biochemical recurrence (BCR) and treatment-free survival. This was one of the key messages from the debate "Should PSMA PET impact on treatment in newly diagnosed PCa (debate yes vs no)?", wherein Prof. Tobias Maurer (DE) represented “Yes.” In addition, Prof. Oldenburg cited the lecture “Circulating tumour DNA for decision making in high risk and metastatic bladder cancer” by Prof. Lars Dyrskjøt (DK) and said, “Circulating tumour DNA (ctDNA) comes from cancer cells. If you can measure ctDNA, then you’ll know there could be a tumour somewhere. DNA fragments can be analysed from blood and urine. The likelihood of detecting ctDNA increases by the stage and the size of the tumours.”
ESUI21 highlights One of the aims of ESUI21 was to examine current and emerging imaging technologies. In the aforementioned “The MRI Corner: Faster and cheaper” session, Dr. Brembilla described the current concerns surrounding MRI. An increased demand for prostate MRI and a limited availability of MRI scanners and dedicated radiologists and radiographers cause long waiting times while MRI contrast media can bring about side effects, Dr. Brembilla explained. On top of this, MRIs are costly, too. Non-contrast MRI, better known as bpMRI, not only avoids contrast media but is also cheaper and faster with only a minor implication for PI-RADS scoring. Thus, Dr. Brembilla asked himself and the audience, “Is bpMRI THE solution?”
The answer, of course, is not that black and white. bpMRI lacks dynamic contrast-enhanced MRI (DCE-MRI). “The absence of DCE could have an effect on the identification of the lesion, especially when the reader of the MRI is less experienced,” Dr. Brembilla said.
In the same session, Prof. Jelle Barentsz (NL) outlined the strategies for approaching lower PIRADS-III lesions, lesions in which the presence of clinically significant prostate cancer is unclear. He set out six strategies.
The MRI should be of a good quality and should be read by an expert, Prof. Barentsz emphasised. Furthermore, he laid out that the use of a contrast MRI is advised while the use of prostate-specific antigen density (PSAD) may help, too. A double read and the use of artificial intelligence completes the approach, with one possible addition. “PSMA PET/CT, but this is a work in progress,” Prof. Barentsz said.
Dr. Pim Van Leeuwen (NL) expanded on PSMA PET in Plenary Session 6: The PSMA PET corner. He tried to answer the question whether PSMA PET/CT is going to replace multi-parametric magnetic resonance imaging (mpMRI) for primary prostate cancer diagnosis and staging in the future. “PSMA PET/CT will not replace mpMRI for primary diagnosis and staging. There’s no reason to,” Dr. Van Leeuwen said; however, he underlined that there are occasions a PSMA PET should be performed for primary staging: “In those patients who cannot have an mpMRI, who have a high-risk disease for metastatic screening, and in PIRADS 1-3 patients who are considered for observation rather than biopsy.”
“Also, PSMA PET/CT is better than mpMRI for the primary staging of the pelvic lymph nodes.”
Award winners At EMUC21, six Best Poster Awards were bestowed on professionals from diverse fields. Dr. Ekaterina Laukhtina (AT) achieved the remarkable feat of winning an award for Best Poster in two different categories: “Renal Cell Cancer, Testicular Cancer, and Penile Cancer” and “Urothelial Cancer.” Dr. Anke Richters (NL) also won a Best Poster Award in the category of urothelial cancer while Dr. Simon Spohn (DE), Dr. Constantinos Zamboglou (DE), and Prof. Stenzl each received a Best Poster Award for their and their team’s work in prostate cancer research.
A special shout-out to Prof. Philippe Grange (DE), who won the second prize in the Best ESUI Abstract Awards for his abstract “Virtual arterial clamp: A 3D step towards personalised medicine?” He donated the prize money to the Young Academic Urologists (YAU), who will use it for a new platform to collect data for future research.
Explore the Resource Centres Relive the congress experience, watch/review all the sessions, (award-winning) abstracts, and (e-)posters in full in the Resource Centres of EMUC21 (www.urosource.org/resource-centre/EMUC21) and ESUI21 (www.urosource.org/resource-centre/ESUI21).
Look back on conversations on Twitter by using the hashtags #EMUC21 and #ESUI21. Check out the photo impressions on Facebook (www.facebook.com/ EAUpage). Feel free to retweet and/or share!
See you in Budapest! We look forward to welcoming you at the 14th European Multidisciplinary Congress on Urological Cancers (EMUC22), which will take place from 10 to 13 November 2022 in Budapest, Hungary, with ESUI22 happening on 10 November. Save the dates and see you there!
During the ESU/ESUI HOT course in prostate MRI reading
Deliberations during the multidisciplinary case discussions
