Best of EAU: Updates on imaging and treatment of prostate cancer

During the Best of EAU21 session, Prof. Alberto Briganti (IRCCS Ospedale San Raffaele, Milan, Italy) highlighted studies about prostate cancer [1]. The topics ranged from bi-parametric and multiparametric MRI and ^18FPSMA-1007 PET-CT scanning to salvage radiotherapy and results on apalutamide from TITAN.

The first study Prof. Briganti discussed was STHLM3MRI (NCT03377881), a randomised, population-based, screen-by-intervention diagnostic trial from Sweden. A total of 2,293 men with PSA ≥3 ng/mL or Stockholm3 ≥0.11 were randomly assigned to systematic prostate biopsies or bi-parametric MRI and subsequent targeted plus systematic biopsies. The Stockholm3 test algorithm included clinical variables (i.e. age and previous biopsy status), a single-nucleotide-based genetic score, and measurements of 5 protein levels (i.e. total PSA, free PSA, hK2, MSMB, and MIC-1).

Stockholm3 ≥0.15 provided equal sensitivity to detect significant cancers, 36% fewer MRIs, and 8% fewer biopsy procedures compared with PSA ≥3 ng/ml in the MRI-targeted biopsy study arm. “The combination of the Stockholm3 test and an MRI-targeted biopsy for prostate cancer screening is associated with decreased overdetection,” Prof. Briganti concluded, “while maintaining detection of clinically relevant cancer” [2].

Multiparametric MRI

A prospective, single-centre, non-inferiority, randomised trial from Italy compared fast MRI with multiparametric MRI in the detection of clinically relevant prostate cancer in >300 men. There was no significant difference in the detection of prostate cancer in the fast MRI versus multiparametric MRI arms (26% vs 30%, respectively). Fast MRI appeared to have a comparable sensitivity and negative predictive value compared with standard multiparametric MRI but was associated with substantially lower acquisition time and costs [3].

^18FPSMA-1007 PET-CT

In a separate study from the Netherlands, lymph node stage was assessed with ^18FPSMA-1007 PET-CT in newly diagnosed prostate cancer, using histopathological evaluation as a reference. The interest in this study resides in the use of ^18FPSMA-1007 rather than ⁶⁸Gallium-PSMA PET-CT. “Sensitivity at patient-, template- and side-based level were quite poor, being 50.0%, 13.5%, and 40.0%, respectively,” according to Prof. Briganti. Given its low sensitivity, ^18FPSMA-1007 PET-CT is unlikely to replace extended pelvic lymph node dissection as a staging procedure in intermediate- and high-risk prostate cancer patients” [4].

Salvage radiotherapy

In a retrospective study from Germany, the role of early salvage radiotherapy was assessed according to EAU biochemical recurrence risk features in ~2,500 patients. Although retrospective, the results appear to recommend this strategy in high-risk patients. Conversely, surveillance might be suitable for low-risk patients [5].

Apalutamide in TITAN

Lastly, the phase 3, randomised, placebo-controlled, double-blind TITAN study (NCT02489318) evaluated the role of apalutamide plus androgen deprivation therapy in 1,052 patients with metastatic castration-sensitive prostate cancer (mCSPC). In the current analysis, patients were stratified according to disease volume. At baseline, 63% of patients had high-volume disease and 37% had low-volume disease. Apalutamide extended both radiographic progression-free survival and overall survival in mCSPC, regardless of disease volume at baseline. The safety remained consistent in both groups, similar to the overall population [6].

1. Briganti A. Best of EAU21: Prostate Cancer. EAU21 Virtual, 8–12 July 2021.
2. Nordström T, et al. P1014, EAU21 Virtual, 8–12 July 2021.
3. Manfredi M, et al. P0901, EAU21 Virtual, 8–12 July 2021.
4. Hermsen R, et al. P0838, EAU21 Virtual, 8–12 July 2021.
5. Preisser F, et al. P1177, EAU21 Virtual, 8–12 July 2021.
6. Chowdhury S, et al. P0845, EAU21 Virtual, 8–12 July 2021.

 

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Posted on 31 August, 202116 February, 2024