Plenary Session 2 “Addressing unmet needs: Approaches to prostate cancer challenges in high-risk and metastatic disease” kickstarted today with topics on novel risk classifications and intensification approaches concerning high-risk and locally advanced prostate cancer. The session was chaired by Prof. Juan Gómez Rivas (ES).
Risk stratifications, can we do better?
In “The need for novel risk classifications in high-risk prostate cancer”, radiation oncologist Dr. Simon Spohn (DE) used the Spider-Man film franchise as an analogy to the transformation of risk classifications. Starting from the first Spider-Man starring Toby Maguire, Dr. Spohn described the fundamental risk classifications as “profound, solid, and very valuable” but raised the question, “Can we do better at this time?”. He then focused on tools such modern imaging and biomarkers.
According to Dr. Spohn, modern imaging defines state-of-the-art staging. The results have prognostic value, however, implementation in risk group classification is pending. In addition, radiomic signatures have not yet arrived in clinical practice. He compared modern imaging to Marvel’s Spider-Man movies starring Tom Holland. “[Modern imaging] looks and exciting, but then again, can we do better?”.
“Biomarkers as getting more interesting in this setting. They are genomic classifiers and there are AI-supported tools where genomic profiling is done with prostate cancer patients. These tools were designed to predict oncological outcomes. There are tests that are already commercially available,” stated Dr. Spohn.
He compared biomarkers to the latest Spider-verse Spider-Man movies: “innovative, taking on a new approach, and making things better than before.” However, he added that biomarkers still need to be validated.
According to Dr. Spohn, biomarkers may outperform classical risk stratification systems but mostly post hoc analysis of older clinical trials, and there is no strong evidence for the biomarkers’ predictive value.
“We have the right tools to develop novel risk classification but we need the right studies to generate high-level evidence demonstrating their benefits; to provide predictive value; and to consider cost-effectiveness,” Dr. Spohn concluded.
Intensification
Is intensification for every high-risk PCa patient? Urologist Dr. António Rui Azevedo Freitas (PT) addressed this question in his presentation “Intensification approaches in high-risk and locally advanced prostate cancer”. “Intensification is not for every patient due to the potential toxicity, and even long-term ADT (androgen deprivation therapy) has the potential increase in the risk of cardiovascular events, as seen in DART (Dexamethasone: A Randomized Trial).” He added that de-intensification is also important in some patients.
Dr. Azevedo Freitas stated, “Patients who have high-risk and locally advanced PCa are a heterogeneous population. High-risk and locally advanced PCa are responsible for two-thirds of prostate-cancer-specific mortality within the localised PCa setting. “We have tools to intensify treatments but some need more data and some come with an increased risk of toxicity. The risk factors, AI, and genomic panels can stratify patients that need intensification.”
Watch their full presentations on the EMUC24 Resource Centre.
