EMUC discusses current and future prospects in imaging for prostate cancer

At the 4th European Multidisciplinary Meeting on Urological Cancers (EMUC) held this weekend in Barcelona, Spain, specialists from radiology, urology, medical oncology and pathology said that new developments and research are already underway but benefits to patients would take some time due to the need for clinical trials, the high cost of funding research and the ability of cancer experts to efficiently take advantage of new insights and approaches, among other challenges.

"The future of imaging for prostate cancer has already begun," said radiologist G. Villeirs (BE) in his overview lecture on current and future prospects in imaging for prostate cancer. Villeirs enumerated several technologies that can provide or improve current imaging techniques such as T2 Weighted MRI (Magnetic Resonance Imaging), Diffusion-Weighted Imaging, Dynamic Contrast-Enhanced MRI, Magnetic Resonance (MR) spectroscopy and Multiparametric MRI.

Many of these techniques have been undergoing research tests and refinements, according to Villeirs as he added that it would be a matter of time when the optimal use of these techniques will provide uro-oncological experts the benefits of more accurate, insightful diagnoses.

"In dynamic contrast-enhanced MRI, its most important use is in detection and localisation (of prostate tumours), with an accuracy of up to 90%," he said.

M. Rubin (USA) spoke on the research developments in biomarkers and noted that diseases like castration resistant prostate cancer (CRPC), for instance, remains a challenge to researchers due to its heterogenous nature.  He mentioned that the next generation of PCa biomarkers are urine-based assays (which detects early aggressive PCa), and tissue/CTC-based assays which are employed for prediction and precision medicine.

Urine-based assays include PCA3 (already FDA-approved), TMPRSS2-ERG  (in development), other fusions (in development) and  SPOP/CHD1 (early discovery), while tissue-based assays include androgen receptor gene (AR), BRCA2 and AURKA. Rubin said that TMPRSS2-ERG which has a specificity of 97% and sensitivity of 96% is commercially available for clinical use in the US and Europe.

The unmet biomarker needs for PCa, according to Rubin, should address the following aims: to distinguish BPH from prostate cancer, to detect the aggressive forms from the indolent cases and to identify the metastatic cancer predictors.

Meanwhile, urologist A. Briganti (IT) gave a comprehensive update on the future of surgery for prostate cancer and his expectations in the coming years. "We need to perform the correct surgery - in the right patient - to decrease the need for secondary therapies," said Briganti, adding that identifying the right patient for the correct surgery is "…key in optimizing the future of surgery."

He explained that correctly prescribed surgery will have the higher chance of cure only "…if combined with adjuvant therapy and delivered only to those patients who really deserve it." He also expects that minimally invasive approaches will change the toxicity profile of more extensive surgical approaches.

"But data are still lacking," Briganti noted.

M. Van Vulpen (NL) presented the radiation oncologist viewpoint regarding external beam radiotherapy and brachytherapy, while J. De Bono (UK) took up the topic of future medical therapies in prostate cancer.

Van Vulpen also expressed confidence that radiotherapy will remain in the forefront of new developments as he noted several breakthrough developments such as CT-linac (linear accelerator) which is used when prostate movements are problematic for intensity-modulated radiotherapy. He also mentioned computerised tumour detection which can localise tumour and show its aggressiveness.

De Bono gave a thorough overview on medical therapies, stressing that cancer experts should aim to decrease over diagnosis of benign PCa and the over treatment of 'benign' disease. De Bono noted that to improve therapeutic options doctors need to cure more high-risk/intermediate disease and improve the outcome from metastatic PCa.

He explained that three elements are important in improving treatment outcomes, namely an improved biological understanding of PCa, developing deliverable biomarkers that can be used for precision medicine, and by developing new drugs through hypotheses testing and are biomarker-driven.