Articles

Editorial

The Oncoforum Urology Programme

By: Claude C. Schulmanlowast

European Urology, Volume 6 Issue 1, March 2007, Pages 385-387

Published online: 01 March 2007

Abstract Full Text Full Text PDF (69 KB)

Take Home Message

This supplement summarises the results of the Oncoforum Urology Programme, which provides urologists with highlights from the 2006 major urologic and oncologic congresses on oncologic urology, that is, prostate cancer, bladder cancer, kidney cancer, penile cancer, and testicular cancer.

1. Introduction

With the increasing workload in clinical practice and the high number of urologic congresses that are held throughout the year, it is difficult for urologists to keep up to date with all new scientific information relevant to their own clinical practice. Bearing this in mind, the Oncoforum Urology Programme has been developed. This project provides urologists with highlights from major urologic and oncologic congresses on oncologic urology (prostate cancer, bladder cancer, kidney cancer, penile cancer, and testicular cancer). For the Oncoforum Urology Programme, senior urologists (“Oncoforum reporters”) have attended the European Association of Urology (EAU), American Urological Association (AUA), American Society of Clinical Oncology (ASCO), and the American Society for Therapeutic Radiology and Oncology (ASTRO) 2006 annual meetings. They have reviewed interesting abstracts on oncologic urology presented as posters and presentations at these congresses. Their selection of abstracts has been reported in a slide kit of about 400 slides. A summary slide kit of about 40 slides per organ has been presented and discussed at the Oncoforum Urology Meeting 2006 in Cannes, France, on 2–3 September 2006. This meeting was attended by 120 urologists from various European countries. The major key points on prostate cancer, bladder cancer, kidney cancer, penile cancer, and testicular cancer discussed during the closed meeting are summarised in this supplement.

2. Conclusions

2.1. Highlights on prostate cancer

The major urologic and oncologic congresses in 2006 provided many interesting data on screening and treatment of patients with prostate cancer (PCa), which are discussed by Michel Soulié et al [1]. There was a great deal of discussion on the relevance of prostate-specific antigen (PSA) screening. There seems to be no PSA threshold for early detection of clinically significant PCa. PSA doubling time (PSADT) and PSA velocity (PSA-V) provide the physician with a more appropriate and clinical picture of the patient and are better predictors to determine the risk of PCa diagnosis and progression. Patients with an initial PSA of 8–50ng/ml and a PSADT <12 mo are at high risk for progression and death due to PCa and therefore define a subgroup of patients with PCa in need of immediate hormone treatment.

With respect to the histopathologic analysis and staging, it was shown that there was low agreement between local pathologists and review pathologists on extracapsular extension and margin status of radical prostatectomy specimens.

The first randomised controlled trial comparing a small series of radical prostatectomy with external beam radiation therapy showed no significant differences between the treatments in terms of survival or disease progression with a limited follow-up period.

Intermittent hormone treatment gains increasing interest. In patients with advanced PCa, intermittent hormone therapy seems to be comparable to continuous hormone therapy with regard to disease progression. Intermittent hormone therapy had less effect on sexual function and a lower incidence of hot flushes. Although more long-term data are needed, it seems that intermittent hormone therapy might be an option in regular practice. In addition to PSA monitoring, testosterone monitoring is recommended in patients receiving androgen-deprivation treatment.

Finally, in hormone-refractory patients with PCa, docetaxel is becoming a standard treatment. Combination of docetaxel and small doses of estramustine may improve results.

2.2. Highlights on bladder cancer

Jacques Irani discusses the highlights on bladder cancer (BCa) [2]. In the field of BCa management, the urologic meetings mainly focused on surveillance and treatment of patients with superficial BCa. Special attention was paid to the development of European Organization for Research and Treatment of Cancer (EORTC) prognostic tables to calculate short- and long-term recurrence and progression in patients with superficial BCa. These tables are considered useful for decision-making and patient follow-up in daily urologic practice. In addition, diagnostic and prognostic biomarkers for superficial BCa were discussed as potential tools to improve cystoscopy and cytology. With respect to the treatment of superficial BCa, intravesical therapy with Bacillus Calmette-Guérin (BCG) and interferon-α (IFN-α) was discussed as a promising combined therapy for patients refractory or intolerant to BCG. Data concerning invasive BCa were rather limited. There were some controversial reports on the impact of delayed cystectomy or hospital volume on (cancer-free) survival rates. The bladder cancer index (BCI), a new questionnaire to assess quality of life in patients with localised BCa, was presented as an interesting tool.

2.3. Highlights on kidney cancer

Many interesting data were presented on renal cell carcinoma (RCC) at the urology and oncology congresses in 2006. They are discussed in this supplement by Jean-Jacques Patard and colleagues [3]. Much attention was given to surgery and minimally invasive techniques. Data from the United States show that partial nephrectomy is still relatively uncommon compared to radical nephrectomy even in small tumours. A large study with a 5-yr follow-up showed that laparoscopic cryoablation had a high overall and cancer-specific 5-yr survival, suggesting that it is a potential approach for patients with small renal tumours. In addition, a study with a 2-yr follow-up suggests that radiofrequency ablation is feasible and safe.

There were also major contributions on angiogenesis inhibitors for metastatic RCC (mRCC). In low- and intermediate-risk mRCC patients, sunitinib as first-line treatment has a statistically significantly longer progression-free survival than the current standard treatment with IFN-α. In addition, temsirolimus statistically significantly increases overall survival compared to IFN-α as first-line treatment in poor-risk patients with advanced/mRCC. Next to these important new data, a phase 3 study presented at the EAU confirmed the role of sorafenib as second-line therapy in mRCC. These new and interesting findings may change the impact on treatment of metastatic RCC.

2.4. Highlights on penile and testicular cancer

Penile and testicular cancers are relatively rare malignancies and therefore research on these topics is limited. Despite this, interesting data were presented at the 2006 urology and oncology congresses that may aid urologists in their daily management of patients. The most important findings are discussed further in this supplement by Eric Lechevallier et al [4]. Progress is being made with respect to penile-preserving surgery in patients not only with T1, but also those with T2–T4 disease and in the selection of patients suitable for inguinal lymph node dissection (LND). The role of neoadjuvant chemotherapy prior to LND in N2–N3 penile cancer is getting more established.

Progress has also occurred with respect to risk factors and treatment of testicular cancer. An important contribution with respect to stage I non-seminoma germ cell tumour (NSGCT) suggested that instead of retroperitoneal LND (RPLND), chemotherapy should become the standard treatment option. In addition, high-dose chemotherapy for poor-prognosis NSGCT does not seem to be beneficial compared to the standard dose. Many relevant new data were presented with respect to postchemotherapy residual masses. The major conclusion was that a modified nerve-sparing postchemotherapy RPLND is appropriate for patients with stage II NSGCT but that a full bilateral postchemotherapy RPNLD is mandatory in patients with metastatic NSGCT. Other data showed that patients with a postchemotherapy nodal size >5cm, clinical stage III, and absence of a full postchemotherapy RPLND are at higher risk of relapse and should be closely followed. Finally, long-term follow-up studies of survivors of testicular cancer show that these patients have a high morbidity (eg, neurologic, musculoskeletal, sexual problems) and mortality from noncancer causes.

References

  • [1] M. Soulié, N. Mottet, L. Salomon, J. Irani, F. Staerman, C.C. Schulman. What's new in prostate cancer: highlights from urologic and oncologic congresses in 2006. Eur Urol Suppl. 2007;6:404-412
  • [2] J. Irani, N. Mottet, M.J. Ribal Caparrós, P. Teillac. New trends in bladder cancer management. Eur Urol Suppl. 2007;6:388-395 Abstract, Full-text, PDF, Crossref.
  • [3] J.-J. Patard, E. Lechevallier, B. Congregado Ruiz, F. Montorsi. New research on kidney cancer: highlights from urologic and oncologic congresses in 2006. Eur Urol Suppl. 2007;6:396-403 Abstract, Full-text, PDF, Crossref.
  • [4] E. Lechevallier, N. Mottet, R. Berges. Penile and testicular cancer: what's new in 2006?. Eur Urol Suppl. 2007;6:413-422 Abstract, Full-text, PDF, Crossref.

Footnotes

University Clinics of Brussels, Brussels, Belgium

lowast Department of Urology, University Clinics of Brussels, Hôpital Erasme, Route de Lennik 808, 1070 Brussels, Belgium. Tel. +32 2 555 36 14; Fax: +32 2 555 36 99.

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