With a record-breaking attendance of 1,500 delegates from 75 countries and the auditoriums packed to capacity, the 16th European Multidisciplinary Congress on Urological Cancers (EMUC24) took place from 7 to 10 November 2024 in bustling Lisbon, Portugal.
The scientific programme comprised 20 Plenary Sessions (some of which focused on artificial intelligence [AI], including dedicated sessions courtesy of the Kidney Cancer Association); four hands-on training (HOTs); two European School of Urology (ESU) courses; the Fellowship in Anatomic deLineation and CONtouring (FALCON) Workshop; the European Society of Uropathology (ESUP) Symposium; and the “Soft skills” session organised by the Young Academic Urologists (YAU), to name a few. The congress commenced with EAU Section of Urological Imaging sessions, which was spearheaded by Section Chair Prof. Francesco Sanguedolce (ES). EMUC24 was organised through the collaborative efforts of the European Society for Medical Oncology (ESMO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Association of Urology (EAU), represented by Congress Chairs Prof. Karim Fizazi (FR), Dr. Alison Tree (GB), and EAU Secretary General Prof. Arnulf Stenzl (DE), respectively.
Read on for some of the EMUC24 highlights presented during the “Take-Home Messages” session.
Pathology matters
Chair of the EAU Section of Uropathology, pathologist Prof. Maurizio Colecchia (IT) initially cited the presentation “AI in genitourinary cancer pathology” by Dr. Yuri Tolkach (DE) which concluded that the prerequisite for using AI tools in pathology includes establishing digital pathology infrastructure and that at present, there is no reimbursement mechanisms for using AI tools.
On AI’s role in grading urologic cancers, Prof. Colecchia also discussed Dr. Gladell Paner’s (US) presentation, which stated that AI has comparable accuracy and reproducibility in grading of prostate cancer (PCa) with uropathologists. In addition, it can enhance PCa grading by assisting pathologists, identify other grade-derived elements (e.g. cribriform pattern and Gleason pattern 4 percentage), and help pinpoint the most objective morphometric features for grading bladder cancer.
However, the limitations of AI in the histopathologic diagnosis of PCa include costly digital pathology workflow; required human supervision; susceptibility to changes in input data leading to variable performance; lack of accountability for missed diagnoses, large-scale studies, and regulatory guidelines in the deployment of AI tools, to mention a few.
Some of the future prospects of AI-based diagnostics for PCa mentioned in Dr. Paner’s presentation included to help improve the understanding of PCa biology and beyond, and combine pathology with radiomics and genomics to provide the highest level of integrated diagnosis for urologic cancers.
Prof. Colecchia also cited Dr. N. Papanikolaou’s (PT) presentation on AI’s role in the EUropean Federation for CAncer IMages (EUCAIM) project. EUCAIM aimed to prevent the reproducibility crisis when dealing with imaging biomarkers, radiomics, and low level-of-evidence results; build an atlas of cancer images and stimulate AI research on images; and establish a network of distributed data repositories to foster federated machine learning/deep learning models and facilitate observational studies.
Prof. Colecchia also provided insights from the poster by Dr. Manju Mathew (GB), et al. which covered the concordance among mpMRI, biopsy, and surgical findings in patients undergoing prostatectomy. The conclusion was “Studies prior to the use of mpMRI showed a discordance in the Gleason scores between biopsy and surgical samples. Our analysis has displayed that since having adopted pre-operative MRI to guide biopsy, there is lower discordance between the two samples. The findings also highlight that occult MRI lesions exist in the prostatectomy cohort. Therefore, post-treatment MRI monitoring after focal therapy and in active surveillance cohorts should not only be considered to monitor the known disease, but also to survey for progression of disease which may not have been initially visible or sampled at biopsy.” Watch the full presentation of the pathology take-home messages here.
Radiation oncology essentials
Radiation oncologist Prof. Thomas Zilli (CH) provided updates on radiation oncology such as excerpts from Prof. Christophe Hennequin’s (FR) presentation on the GETUG 18 trial wherein high-risk patients with at least one risk factor who received 80 Gy dose-escalated radiotherapy (RT) with three years of androgen deprivation therapy (ADT) showed improved progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) without an increase in toxicity rates.
Prof. Zilli cited the presentation on various views on AI by Dr. Jan Peeken (DE) such as for risk classification (using AI for histology) and in the radiotherapy workflow to improve volume definition, treatment panning, and adaptive treatment delivery. The abstract by Ms. Evelien Van Altena (NL) was also discussed by Prof. Zilli which stated that PSMA PET/CT can detect recurrences before the Phoenix criteria (nadir + 2ng/mL) at less advanced stage in 77% of the patients who were treated with definitive RT. This translates to a better outcome and potential for salvage local treatments or metastasis-directed therapy (MDT). Additionally, early PSMA-PET is associated with a delayed onset of ADT, castration-resistant prostate cancer (CRPC), and longer OS.
Prof. Zilli provided insights shared during the “Debate: Towards evidence for local tumour control in metastatic RCC”. With regard to Dr. Anna Bruynzeel’s (NL) presentation on stereotactic ablative body radiotherapy (SABR), he quoted the results of the FASTRACK II trial: 100% control rate and CSS, and 99% freedom from distant failure, with a minimal impact on renal function. He stated, “SABR is a highly effective and well-tolerated treatment option in patients with primary renal cancer. SABR as an alternative treatment option ticks all the boxes; it avoids general anaesthesia, can treat peri-hilar and large tumours, and it is non-invasive.”
Another notable abstract was cited by Prof. Zilli which focused on the RE-ARM trial results. Prof. Robert Huddart’s (GB) abstract stated that data were limited due to early closure, and RT failed to improve response in metastatic urothelial carcinoma treated with atezolizumab when used with an immunomodulatory intent. See full presentation on the take-home messages about radiation oncology.
Insights in urology
Chair of the European Urological Scholarship Programme Prof. Axel Merseburger (DE) presented the key takeaways in urology. He cited the abstract by Prof. Zilli which concluded that in patients with a very high-risk localised or locally advanced PCa treated with external beam radiotherapy (EBRT) and long-term ADT (i.e., 18 to 36 months), the gonadotropin releasing hormone (GnRH) antagonist
degarelix compared to luteinizing hormone-releasing hormone (LHRH) agonists failed to achieve a better PSA nadir within 6 months after EBRT, to improve PFS and urinary function. However, results of the trial suggest a reduction with degarelix in the risk of developing cardiovascular events (CVEs) and treatment-related deaths in patients with a previous history of a CVE.
Regarding penile cancer, Prof. Merseburger mentioned the poster by Ms. Ranya Kumar (GB), et al. which centred on the European report of long-term follow-up demonstrating the oncological safety of video-endoscopic lymph node dissection (VEILND). It has comparable outcomes of recurrence, OS and CSS with significantly reduced complication rates and length of stay in penile cancer at a minimum of eight years and a mean of 11.3 years follow up.
On the topic of testicular germ cell tumours (TGCTs), Prof. Merseburger provided insights from the abstract of Dr. Panagiotis Vlachostergios (GR). It illustrated that the potential value of two novel microRNA (miRNA) signatures which could be useful in differentiating between various subtypes of TGCTs upon prospective validation. This might be particularly useful for both diagnostic and prognostic purposes and allowing for patient stratification to different treatment options.
Prof. Merseburger cited the abstract of Dr. Antoni Vilaseca (ES) which focused on TAR-210, a novel intravesical drug delivery system. The abstract stated that TAR-210 was designed to release sustained local erdafinitib for three months in the bladder. The first-in-human results showed that TAR-210 demonstrated promising clinical activity in patients with fibroblast growth factor receptor (FGFR)-altered high-risk non-muscle invasive bladder cancer (HR-NMIBC) and intermediate-risk NMIBC (IR-NMIBC). Based on these first-in-human results, the phase 3 MoonRISe-1 study in FGFR-altered IR-NMIBC has been initiated.
Prof. Merseburger also shared insights from the presentation of Dr. Tamás Fazekas (HU) which touched on the OLIGOMET study. The presentation centred on the outcomes of local treatment for oligometastatic PCa diagnosed using PSMA PET imaging. The outcomes included CRPC-free survival, radiographic PFS, and clinical PFS. The study is currently collecting local treatment-related outcomes (e.g., pathological outcomes, complications, and functional outcomes) and survival outcomes (e.g., OS, CSS, and radiographic response).
(Re)view the key takeaways in urology here.
On medical oncology
Medical oncologist Dr. Elena Castro (ES) underscored the two overarching themes of EMUC24: multidisciplinarity and the rapidly evolving focus on genitourinary cancers (e.g., “new imaging techniques shaping the way we stage patients”).
In addition to commenting on the aforementioned abstracts of Prof. Huddart and Dr. Vlachostergios already discussed by her colleagues, Dr. Castro cited the poster by Dr. Ugo De Giorgi (IT), et al. which assessed the impact of talazoparib-dose reductions regarding the efficacy of combined talazoparib and enzalutamide treatment in patients involved in the TALAPRO-2 (TP-2) study. The conclusions included that talazoparib-dose reductions do not appear to lead to detrimental effects in clinical outcome, mostly maintaining quality-of-life endpoints. This information could contribute to the optimal clinical management of patients with metastatic castrate-resistant prostate cancer (mCRPC).
Another noteworthy poster that Dr. Castro mentioned was provided by Dr. Alejo A. Rodriguez-Vida (ES), et al. which concluded that in patients in the TITAN study who have high disease burden defined as >10 bone metastasis, the combination apalutamide (APA) and ADT resulted in robust long-term benefit in OS, rPFS and PSA response, compared to placebo and ADT. The findings provided strong evidence in favour of early intensification with APA in metastatic castrate-sensitive prostate cancer (mCSPC) patients with features of a more aggressive disease. Learn more about the take-home messages on medical oncology in detail here.
Explore all congress presentations, abstracts and presentations via the EMUC24 Resource Centre. In addition, check out the news coverage straight from the congress floor.
