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05:54 CET
E³ 219 - Early detection of prostate cancer
Oncologic Imaging Genitourinary Evidence-Based Imaging
Wednesday, February 27, 10:30 - 12:00
Room: M 4
Type of session: E³ - ECR Academies: Hot Topics in GU Cancer
Topic: Oncologic Imaging, Genitourinary, Evidence-Based Imaging
Moderator: G. M. Villeirs (Ghent/BE)

A-0091
10:30
Chairperson's introduction
G. M. Villeirs; Ghent/BE
Abstract

Prostate cancer is traditionally diagnosed on the basis of the combination of elevated PSA, abnormal digital rectal examination and transrectal biopsy. New biomarkers, including imaging, are currently challenging this gold standard diagnostic test. They are equally useful in the choice between immediate versus deferred treatment. Both aspects will be covered in detail during this session.

A-0092
10:36
A. Screening for prostate cancer: where are we now? (part 1)
A. George; London/GB
Learning Objectives

1. To be aware of important prostate cancer genetics and familial cancer.
2. To learn about the difference in low risk vs high risk genetic groups.
3. To be aware of the use of imaging and other biomarkers.

Abstract

Screening for prostate cancer with prostate-specific antigen (PSA) has been widely investigated. Several large screening studies, e.g. prostate, lung, colorectal and ovarian (PLCO), European randomised study of screening for prostate cancer (ERSPC) and cluster randomised trial of PSA testing (CAP), have shown PSA screening may lead to increased prostate cancer diagnoses, and at best may result in a small benefit in disease-specific mortality over 10 years but does not improve overall mortality. These benefits need to be considered against possible harms of PSA screening, including complications from a biopsy and subsequent treatments and the risk of overdiagnosis and treatment. Recent studies suggest incorporating MRI in the investigation of those with positive PSA test reduces the false positive rate and unnecessary biopsies and also increases the accuracy of biopsies in those with clinically significant cancer. Trials screening for prostate cancer with MRI is being proposed. Incorporating the patient’s genetic mutation status into risk algorithms may allow development of targeted screening programs for early cancer detection and treatment, and may improve survival. Those with germline mutations such as BRCA2 have an increased risk from the age of 40yrs, and often more aggressive disease. There is also ongoing work stratifying prostate cancer risk at a population level with the use of single nucleotide polymorphism (SNP) panels. This use of targeted PSA and MRI screening in men with DNA repair mutations, adverse SNP profile and Afro-Caribbean ethnicity may result in improved outcomes and management algorithms based on biological disease behaviour.

A-0093
10:50
A. Screening for prostate cancer: where are we now? (part 2)
A. Sohaib; London/GB
Learning Objectives

1. To be aware of important prostate cancer genetics and familial cancer.
2. To learn about the difference in low risk vs high risk genetic groups.
3. To be aware of the use of imaging and other biomarkers.

Abstract

Screening for prostate cancer with prostate-specific antigen (PSA) has been widely investigated. Several large screening studies, eg prostate, lung, colorectal and ovarian (PLCO), European randomised study of screening for prostate cancer (ERSPC) and cluster randomised trial of PSA testing (CAP), have shown PSA screening may lead to increased diagnoses of prostate cancer and at best may result in a small benefit in disease-specific mortality over 10 years but does not improve overall mortality. These benefits need to be considered against the possible harms of PSA screening, including complications from a biopsy and subsequent treatments and the risk of overdiagnosis and treatment. Recent studies suggest incorporating MRI in the investigation of those with positive PSA test reduces false positive rate and patients undergoing unnecessary biopsies and also increases the accuracy of biopsies in those with clinically significant cancer.
Trials screening for prostate cancer with MRI is being proposed. Incorporating the patient’s genetic mutation status into risk algorithms may allow development of targeted screening programs for early cancer detection and treatment, and may improve survival. Those with germline mutations such as BRCA2 have an increased risk from the age of 40yrs, and often more aggressive disease. There is also ongoing work stratifying prostate cancer risk at a population level with the
use of single nucleotide polymorphism (SNP) panels. This use of targeted PSA and MRI screening in men with DNA repair mutations, adverse SNP profile and those of Afro-Caribbean ethnicity may result in improved outcomes and management algorithms based on biological disease behaviour.

A-0094
11:04
B. Pre-biopsy detection and new techniques for detection in prostate cancer
S. Punwani; London/GB
Learning Objectives

1. To understand the role of mpMRI in tumour detection.
2. To be aware of texture features of prostate cancer.
3. To learn how texture analysis differentiate benign from malignancy prostate lesions.

A-0095
11:32
C. Active surveillance: best practice
J. J. Fütterer; Nijmegen/NL
Learning Objectives

1. To be familiar with case selection for active surveillance.
2. To know the frequency of imaging.
3. To understand when treatment will be commenced.

Abstract

In order to avoid unnecessary radical treatment, active surveillance (AS) is becoming a viable treatment alternative in low-risk prostate cancer. Because most low-risk prostate tumours have an indolent course and the slow growth rate allows ample time during follow-up to detect tumours that begin more aggressive while remaining in a window of definitive curability. Patients are carefully observed every three or four months for changes in PSA, digital rectal examination or changes upon performed transrectal ultrasound (TRUS) guided biopsy. MR imaging is an appealing imaging technique to select and to surveil patients who choose for active surveillance. The addition of prostate MR imaging to the biopsy strategy or, in select patients, using MR imaging as a substitute for a repeat biopsy improves prostate cancer detection.

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