You are here
Role of focal treatments in management of small renal masses
What is really high-risk prostate cancer? Role of biomarker and genetic assessment.
Should primary cancer be treated in metastatic patients?
PET scanning in bladder cancer
Prediction of prostate cancer prognosis using a 17-gene panel
Genomic health developed panel was validated in their cohort not to replace PSA but predict biochemical recurrence, metastases and death of prostate cancer. The gene panel will not replace PSA for the early diagnosis but will help predict the risk of progression in the individual patient. The 17-gene panel (oncotype-DX) is used in conjunction with available clinical predictors such as stage and Gleason grade. The 17-gene panel predicted equally well in Caucasian and African-Americans.
Improving outcome of patients with muscle invasive bladder cancer
The optimal combination of local and systemic therapy is essential to obtain longer term survival. Level of evidence for adjuvant chemotherapy is limited and trials available on adjuvant chemotherapy are flawed are had problems with accrual. Neoadjuvant chemotherapy is now recommended by the EAU guidelines. Adjuvant chemotherapy is optional according to the EAU-guidelines. No head-to-head comparisons of cystectomy versus radiotherapy are available. Three randomized compared the use of radiotherapy and chemotherapy. 5FU and mitomycine C showed improved survival in combination with radiotherapy in a recent trial published in the New England Journal of Medicine. Trimodality using TURT, chemotherapy and radiotherapy may be comparable to cystectomy in selected patients but randomized studies in this field are lacking. Chemotherapy alone is not recommended. Radiation, such as hypofractionated schemes is a valuable option for palliation in non-operable muscle invasive bladder cancer.
Increased risk of urological cancer
Lynch syndrome, DNA mismatched repair syndrome is associated with upper tract urothelial cancers but the majority of inherited genetic abnormalities are associated with the development of renal cancers. The Von Hippel-Lindau syndrome and tuberous sclerosis, causing renal cancer of angiomyolipomas are just 2 frequently found syndromes. Many germ line mutations may be associated with multiple renal tumors and nephron sparing therefore is essential. The role of VHL mutations in sunitinib resistance is topic of study. In prostate cancer a hereditary component of up to 30-40% cases has been suggested, but only BRCA-2 mutations are currently known to be associated with an increased risk. Most likely single nucleotide polymorphisms or SNPs are associated with the hereditary occurrence of prostate cancer. Men with BRCA-2 mutations are at an elevated risk of developing high risk prostate cancer.
Being a prominent robotic surgeon that adopted the method of robotic prostatectomy in an earl y phase of introduction of the technique, Dr. Patel stresses the role of robot simulators, expert teachers and video in robotic training. Multiple learning curves do exist but between 20-50 cases most surgeon acquire the basic proficiency with the system. Exceptional outcome may only be obtained after several hundreds of cases. A passport for robotic surgery has been considered in recent times. The driver or surgeon determines robotic surgery outcome and the Society of robotic surgery is currently validating a structured training program.
A big shift is recently apparent on the value of surgery in more advanced prostate cancer where surgery can be “an extremely effective intervention”, Dr. Murphy addresses. Multimodal treatment does consist of upfront prostatectomy and extended nodal dissection. Followed by radiotherapy and androgen ablation where needed. Robotic prostatectomy does become economically effective at 140-150 cases on a yearly basis. Men should be informed on the option of surgery for more advanced prostate cancer and robotic prostatectomy may form a nice alternative to more the more classical open procedure.
The goals of ERUS are science and education in robotic urological surgery. A robotic curriculum has recently been validated. “We absolutely need robotic training”. “We have to train the team” since robotic surgery is clearly a team effort. He gets more careful when certification of robotic surgery is addressed. Validated training will be available from ERUS research soon and may finally help to develop a certification program. Live-surgery course as ERUS2014 in Amsterdam are an essential step in robotic surgical practical training.
EAU 2017 Scientific Programme and Sessions
View the Scientific Programme and Sessions of the 2017 EAU Annual Congress, Munich, Germany.