European Urology Today Official newsletter of the European Association of Urology
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View the souvenir photos of awardees at EAU18 Copenhagen awardees in pictures
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Vol. 30 No.2 - March/May 2018
Testis cancer and fertility
CAM in urology
Exploring options in preserving male fertility
N. Love-Retinger writes on complementary and alternative medicine in urology
Dr. C. Fuglesang Skjødt Jensen
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N. Love-Retinger
EAU18: Sustaining advances in medicine Challenges remain in integrating patient-centred approaches By Joel Vega
already using molecular markers, despite not being in the guidelines…This is a pressing issue and there’s a lot of uncertainty at the moment.”
With reports from E. De Groot, L. Keizer, and J. Tidman Sustaining advances in medicine whether in the fields of new technology, health administration to research development remains a tough challenge considering current financial constraints, political hurdles and the lack of integration among European healthcare systems.
Advances in onco-urology Consensus and game-changing segments also preceded Plenary Sessions 3 and 5 with the former focusing on advances in onco-urology and the latter highlighting key developments in precision medicine particularly in adolescent urology and prostate cancer (PCa) treatment. In kidney and bladder therapies, Prof. Marc-Oliver Grimm (DE) outlined frontline research trials such as KEYNOTE-045 in urothelial carcinoma and CheckMate 214 in renal cell carcinoma. “Future directions indicate combination therapy with PD-1/PD-L1 inhibitors in RCC with nivolumab plus ipilimumab and PD1/PD-L1 inhibitors plus VEGFR-TKI. For urothelial cancer we have tremilimumab plus durvalumab/nivolumab plus ipilimumab… while adjuvant treatment is PD-1/PD-L1 plus combination,” Grimm said.
This was one of the recurring messages in the recent 33rd Annual EAU Congress held in Copenhagen last March 16 to 20. The second annual congress to be held in Copenhagen since 1984, EAU18 was marked not only by new features in the scientific programme, but also widened the coverage and content by introducing topics and issues that are becoming relevant in recent years. Around 10,880 participants from 122 countries attended the five-day meeting. At the Opening Ceremony, European Commissioner for Health and Food Safety, Prof. Vytenis Andriukaitis (LT) gave the keynote speech where he highlighted the flagship European Reference Networks (ERNs) project. “We have achieved a lot and although it’s important that we recognise that, we also need to look ahead, maximise our potential at the European Reference Networks and ensure sustainability,” he said. “So what challenges lie ahead? Integrating European Reference Networks into the national or regional healthcare systems is the most pressing challenge.“
"Use of biomarkers is evolving into a feasible third pillar..." - A. Stenzl Andriukaitis also noted the efforts of the European urological community as represented by the EAU when he thanked EAU Secretary General Prof. Chris Chapple for the EAU’s commitment to ERNs and the eUROGEN network which currently numbers 29 active units in 11 EU member states. “To ensure the sustainability of this project we need to form partnerships and work on common goals,” Chapple said in his response and opening remarks at the full auditorium where he welcomed participants. In the same evening, recognition were given to new Honorary Members Gunnar Aus (SE), Patrick Coloby (FR), Mani Menon (US) and Ajit Vaze (IN). “For urologists our biggest concern is how to boost our medical and surgical strategies, and balance these without neglecting our core competencies,” said Prof. Vincenzo Mirone (IT), this year’s recipient of the prestigious EAU Willy Gregoir Medal (See Related Articles and Award Photo Gallery on Pages 4-7). Nightmare of litigation Seven Plenary Sessions and 19 Thematic Sessions covered a wide range of urology and urology-related issues, and on top of the comprehensive programme were the specialised and in-depth discussions held during the nine EAU Section Meetings which involved the various section offices. With two simultaneous plenary sessions held each day from Saturday to Monday, and the concluding Plenary Session on stones held on the last day, the programme brought to fore the most hotly debated topics from novel
European Commissioner V. Andriukaitis (left) congratulates EAU General Secretary C. Chapple for the EAU's commitment to eUROGEN
surgical procedures, new medical outcomes, genetic research to patient-tailored therapies, amongst many other issues. The most-talked about was the Nightmare Session (Plenary Session 2) which tackled problematic bladder cancer cases moderated by Tim O’Brien (GB) with expert medical litigation lawyer Bertie Leigh (GB) firing the most inquisitive questions at Maximilian Burger (DE), Morgan Rouprêt (FR), Alexandra Masson-Lecomte (FR) and Hugh Mostafid (GB), who had to justify their treatment decisions. The session brought home the message that doctors often neglect to properly inform their patients, falsely assuming that their decisions are fool-proof and will not be subjected to potential legal scrutiny. “Doctors often hide behind the perceived protection provided by a consented patient but often miss the point of informing the patient,” said Leigh. “It would help if doctors were not always so nice to their patients. At some point you have to share your uncertainty with them and make patients understand the risks or severity of the treatment.” Plenary Session 1 on hot topics in andrology surveyed the most pertinent issues such as delayed fatherhood in Europe, environment and male fertility, surgical therapies for infertile men and case discussions that examined standard and novel fertility procedures. Meanwhile, at the day-long “Technology Strikes Back” session organised by the EAU Section of UroTechnology (ESUT) in collaboration with the EAU Robotic Urology Section (ERUS) and the EAU Section of Urolithiasis (EULIS), live and pre-recorded operations were transmitted in 3D to the eURO Auditorium where spontaneous commentary and expert moderation were given on sophisticated techniques in robot-assisted
High attendance at the day-long Live Surgery Session
March/May 2018
prostatectomy, percutaneous nephrolithotripsy, robotic bladder resection to radical nephrectomy, to name a few. Herlev Hospital played a central role in the complex programme that involved surgeons from various countries. Conventional vs. novel approaches At the Urology Beyond Europe and the Specialty Session on Bladder Cancer which both took place on the first day, some take-home messages hit a raw nerve among the congress participants and on social media. From the joint EAU-Société Internationale d’Urologie session, Prof. Prokar Dasgupta (GB) unleashed a torrent of online reactions with his statement that robotic technology is not viable in the developing world considering the high costs and the lack of convincing data on perceived superior surgical outcomes.
In prostate cancer, the PRECISION study released its results, published in the New England Journal of Medicine (NEJM) at the time of the Annual EAU Congress, which implied that traditional approaches which include 10-12 core TRUS biopsies can be avoided to minimise health risk complications for many men with suspected prostate cancer. “In biopsy naïve men with clinical suspicion of prostate cancer, a diagnostic pathway involving pre-biopsy MRI risk stratification and MRI-targeted biopsy is superior to 10-12 core TRUS biopsy,” said lead coordinator and author Dr. Veeru Kasivisvanathan (GB) who presented the results. His conclusions were warmly welcomed
“Strive to become a better surgeon, particularly if you are in the developing world. Stop obsessing about technology…There are no The Expert Guided Poster Tours prove to be popular among many participants differences in outcomes,” said Dasgupta. “Only 5% of operations are robotic. The cost of robot-assisted procedures rose and applauded by session chair Prof. Peter Albers by 13% in three years, resulting in around $2.5 billion (DE) who described the results as a “a brilliant in additional healthcare costs.” breakthrough” in PCa management. At the bladder cancer session, the Guidelines were subjected to scrutiny as new developments in bladder cancer biomarkers exert their place in treatment decision-making. “The use of biomarkers is evolving into a feasible third pillar,” said Prof. Arnulf Stenzl (DE).”Several speakers and audience members are
The randomised study which recruited 500 men allocated them into two groups, a multiparametric MRI (MPMRI) and a standard 10-12 core TRUS biopsy arm. Key eligibility criteria included a PSA < 20 ng/ml, DRE < T2, no prior biopsy and no contraindication to biopsy/MRI. In the MPMRI arm, areas of the prostate were scored on a five-point scale of suspicion for clinically significant cancer. Kasivisvanathan said the results showed that in detecting clinically insignificant cancer (Gleason 3+3), MRI+TB is superior to TRUS, and also in determining the proportion of cores positive for cancer. MRI + TB is also slightly better in determining maximum cancer core length over TRUS (7.8mm vs. 6.5mm, respectively). The study, led by chief investigators Caroline Moore and Mark Emberton, involved centres in Belgium, Canada, Finland, France, Italy, Germany, the Netherlands, Sweden, United Kingdom, USA, with funding from the EAU Research Foundation, NIHR Clinical Research Network, and a UK NIHR Doctoral Research Fellowship grant for Kasivisvanathan. European Urology Today
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