Tag Archive for: #EAU15


March 2017 #urojc summary: Pelvic Lymph Node Dissection with Radical Prostatectomy – Is there enough evidence for and against?

The twitter-based international urology journal club @iurojc #urojc is back with a splash after a brief hiatus. For the March 2017 #urojc, a lively discussion takes the theme of pelvic node dissection (PLND) on radical prostatectomy (RP) reviewing a timely article by Nicola Fossati et al. The paper was made available open access courtesy of European Urology @EUplatinum.

A systematic review of the literature was performed including all comparative studies of both randomized and non randomized studies, with at least one experimental and one control arm. This summarised 66 studies including more than 250.000 patients with particular focus on different extents of pelvic lymphadenectomy as proposed by the European Association of Urology. Outcome measures studied included oncological features of biochemical recurrence, development of metastases, cancer-specific survival, and overall survival. Adverse events were covered under secondary outcomes, both intra- and postoperatively observed. Finally, quality of PLND was addressed in terms of total number of nodes and total number of positive nodes. Risk of bias was assessed for all studies judging on basis of specific confounders.

The journal club ran for 48 hours from Sunday 5th march. The central question addressed is balance of benefits and drawbacks of lymph node dissection. The corresponding author of the manuscript, Steven Joniau from the University Hospitals of Leuven, Belgium highlighted the role of lymph nodes in prostate cancer recurrence.

However despite this idea, the benefit of PLND is heavily scrutinized from the start. Long term data from a single centre  suggested limited benefit.


However PLND has since earlier times been employed as a diagnostic tool, where an optimal template (presacral in addition to extended LND) may be optimal for staging and removal of lymph nodes.

Despite the current state of evidence, PLND is frequently mentioned in the various guidelines available for prostate cancer. However the exact situations when to employ them is questioned by some participants.

The various therapeutic options for lymph node metastases also coloured the discussion.

The discussion further continued to the important issue of morbidity, and the associated question of performing an extended PLND (ePLND).

Despite the current state of evidence, PLND is frequently mentioned in the various guidelines available for prostate cancer. However the exact situations when to employ them is questioned by some participants.


The discussion further continued to the important issue of morbidity, and the associated question of performing an extended PLND (ePLND).

The increasing use of PSMA PET/CT provided other spread pattern data to be considered. And finally temporal changes in PSA testing is observed to affect the need for LND.


From the poll which ran during the discussion, about half responders would perform extended PLND for staging, while the rest were divided almost equally between therapeutic benefit and adherence to guideline recommendations.

Probably all participants of the discussion agrees for the need of a proper randomised study addressing role of PLND.

At the end of a busy 48 hours, the discussion had been joined by top experts in the field of prostate cancer, generated more than 200 tweets and reached more than 700 thousand impressions the world over.

Yodi Soebadi (@yodisoebadi) is an Indonesian urologist, trained at Universitas Airlangga, currently pursuing doctoral research at KU Leuven in Belgium.


EAU 2015 Review Days 3 and 4

Persistent rain throughout this year’s 30th EAU Annual Congress failed to dampen the spirits of over 12,000 delegates who have enjoyed another fantastic congress here in Madrid. The EAU Scientific Committee, led by Arnulf Stenzl, deserve tremendous credit for the work they have done to construct an extremely comprehensive and stimulating programme once again this year. I do recall my last EAU Congress in Madrid 12 years ago and there is no doubt but that the standard of this meeting has risen exponentially during this time. It is not just be Annual Congress of course which has developed in this time; the EAU has seen enormous growth in its global influence through the meteoric rise of European Urology, the activities of the European School of Urology (even beyond Europe), the pre-eminence of the EAU Guidelines, and the introduction of new initiatives such as UroSource. The Annual Congress is the nidus for much of this activity and it has become an unmissable event for many of us (even when based in Australia as I am!).

Rebecca Tregunna and Matthew Bultitude have already covered some of the highlights of the opening days of this year’s Congress in their BJUI blog . I will give you some further highlights and point you towards the excellent congress website which has archived a huge amount of material to allow you to catch up on sessions you may have missed.

Big highlights for me on day 3 and 4 include the following (please forgive my oncology focus):

PSMA PET scanning – there was considerable interest in the early data on PSMA PET scanning for recurrent prostate cancer at last year’s EAU Congress, and this year has seen some very positive data being presented from Munich and Heidelberg and further enthusiasm for this imaging modality. Tobias Maurer (Munich) presented a number of papers showing the high sensitivity in particular for PSMA PET in detecting recurrent prostate cancer at low levels of biochemical recurrence using either PET CT or PET MRI (poster 928).


Many other plenary speakers also highlighted the positive data surrounding PSMA PET and also the possible theragnostic potential of this in the future (poster 675 and Dr Haberkorn plenary lecture). However in the scientific souvenir session which closed the meeting, Dr Peter Albers burst the bubble somewhat by warning that we need much better data (tissue validation in particular), before we all rush towards PSMA. He has a point of course, although I have been extremely impressed with our initial experience using PSMA PET in Melbourne over the past six months and I do expect it to live up to the hype.

CHAARTED data looking good – Nine months after he made world-wide headlines when he presented the overall survival data of the CHAARTED study at ASCO, Dr Chris Sweeney crossed the Atlantic to again present this data to a packed eUro auditorium. This randomised study of 790 men with metastatic prostate cancer, has demonstrated that men who receive six cycles of docetaxel chemotherapy upfront at the time of starting androgen deprivation therapy, have a considerable survival benefit compared to those who receive ADT on its own (the current standard of care). This was especially so for men with high volume metastases who had a 17 month survival benefit (HR 0.61).


Although the French GETUG study has not shown the same benefit, Sweeney and others have proposed rational explanations for why this might be so. While the final paper has not yet been published (will be submitted this week), very many of us have already embraced the CHAARTED as the new standard of care for men presenting with high-volume metastatic prostate cancer. A proper landmark study.

Metastatic castrate-resistant prostate cancer (mCRPC) – still more questions than answers. What an amazing few years for this disease area! Five years ago, urology trainees only had a handful of “essential reading” papers in the world’s top journal, the NEJM, that we could cite to support evidence-based practice. It is now difficult to keep up with all the landmark trials in NEJM and other top journals reporting overall survival advantage for a variety of agents targeting mCRPC. Enzalutamide has already joined the ranks of these blockbuster drugs and this year’s EAU saw more data illustrating the powerful activity of enzalutamide in the pre-chemo mCRPC space. In the Breaking News session on the final day, Dr Bertrand Tombal presented the final analysis of the PREVAIL study which confirmed the overall survival advantage of patients receiving enza pre-chemo when compared with placebo. The HR of 0.77 was strongly significant (p=0.0002) and the therapy was well tolerated.


However as pointed out by discussant Dr Maria de Santis, we have still a way to go to figure out which patient will benefit from which therapy and when. The sequence and combination of therapies is still being worked out, and while the potential of predictive biomarkers such as AR7 is certainly exciting, we are still bereft of data and tools (and funding), to figure out the best pathways.

Robot vs open surgery – cystectomy is the new battleground. As Alberto Brignati pointed out in his outstanding souvenir session on localised prostate cancer, it appears that the old debate of robotic vs open prostatectomy is no longer of interest. Despite the lack of prospective randomised data, there appears to be little doubt that robotic prostatectomy is the standard of care in many regions. A large number of posters and plenaries demonstrated convincing data of excellent outcomes in robotic prostatectomy series, including data from a multicenter randomised study (REACTT, poster 622) led by Dr Stolzenberg which demonstrated improved potency outcomes for robotic prostatectomy (not the primary endpoint).


The same cannot yet be said of robotic cystectomy. Despite my own enthusiasm for and publications on robotic cystectomy, it is hard to get away from some of the cautionary language being expressed about the role of robotic cystectomy at the moment. An excellent plenary featuring giants in the field of bladder cancer (Dr’s Bochner, Wiklund, Studer, Palou), debated the issue in the main eUro auditorium and the following day’s newsletter summed it up nicely:

This provoked much discussion on Twitter with some prominent names chiming in from the US. Dr Khurshid Guru got involved to reassure us that the International Robotic Radical Cystectomy Consortium which he leads will provide the answer.


Well said @khurshidguru!

On a non-cancer note, it is clear that some of the most popular session and courses at EAU15 were focused on uro-lithiaisis. Stone surgeons are also very active on Twitter and although I did not attend any stone sessions, I was pleased to see that standardization of terminology is also important to the “pebble-ologists”:


Finally, #EAU15 was truly a social experience, not just in the wonderful bars and restaurants of Madrid, but also through Twitter and other social media channels, strongly supported by the excellent communications team at EAU. We recently published a paper in the BJUI documenting the growth of social media at major urology conferences and at EAU in particular. Between 2012 and 2014, the number of Twitter participants increased almost ten-fold, leading to an increase in the number of tweets from 347 to almost 6,000 At #EAU14, digital impressions reached 7.35 million with 5,903 tweets sent by 797 participants.

(From Wilkinson et al BJUI 2015)

As might be expected, #EAU15 has continued this trajectory with almost 8000 tweets sent by 1220 participants.







One of the only criticisms I have of EAU15 is that the scientific program is now so large that it is impossible to get to all the sessions I am interested in. There did seem to be a lot of prostate cancer running simultaneously but I am not sure how much the Scientific Committee can do to avoid such clashes. Thankfully, the EAU meeting website www.eaumadrid2015.org contains a huge amount of material including webcasts, interviews, posters etc which allows delegates and EAU members to catch up on some of the outstanding content.

Another big attraction of the EAU Annual Congress is of course that it takes place in Europe’s most wonderful cities. EAU16 heads to Munich – put the date in your diary 11-15 March 2016.


Declan Murphy, Urologist, Melbourne
Associate Editor – Social Media, BJUI

Click here for Declan Murphy’s disclosures

EAU 2015 Review Days 1 and 2

IMG_5462The 30th anniversary EAU congress is currently taking place in the beautiful but rainy city of Madrid with over 12,000 delegates attending. The opening Friday proved a monumental day with the start of the congress as well as personally as I gave into the pressure of social media, and joined Twitter. This is being heavily promoted by the EAU this year and with multiple engaging sessions going on at the same time this seemed to be the best way to have my cake and eat it and enjoy highlights from different parts of the meeting.

The second ESO prostate cancer observatory was well attended and led to interesting debates about PSA screening and informed consent due to risks of over-detection and subsequent overtreatment of indolent disease. Indeed Andrew Vickers also highlighted that the results of the much anticipated ProtecT trial should be interpreted with caution given the high number of Gleason 6 patients that have been randomised.

In the evening the opening ceremony took place with an emotional final introduction to the congress by Per Anders Abrahamsson as he steps down and hands over to Chris Chapple as EAU Secretary General (photo courtesy @uroweb).












The EAU also gave out a number of awards including the Crystal Matula award for promising young urologist which was given to Morgan Roupret.

The scientific programme on Saturday started with the main plenary session on controversies in bladder and kidney cancer. It is difficult to draw conclusions regarding lymphadenectomy in upper tract tumours due to a lack of randomised data but certainly based on retrospective data a benefit is seen both in terms of staging and cancer specific survival. A hot topic lecture on molecular profiling in bladder cancer gave a thrilling insight into how agents will be able to target pathways based on specific mutations and Professor Studer, in his last ever plenary session, led to an interesting debate on robotic vs. open radical cystectomy. This has caused much controversy recently with the Bochner randomised controlled trial and this debate will surely run and run. Maybe most importantly, as Studer concluded “The surgeon makes the difference not the instrument”. This was highlighted on the front cover of the congress news with a more downbeat headline on robotic cystectomy.


Next came an intriguingly titled talk “What would Charles Darwin make of renal cell carcinoma?” with discussion about the heterogeneity of renal tumours making it difficult to identify specific targeted treatments based on renal biopsy alone.
Multiple section meetings then ensued. From the EAU section of urolithiasis (EULIS) meeting it seems that PCNLs are increasingly being miniaturised with development to mini, ultra-mini and micro procedures. The issues behind “diabesity” and stones were discussed with Professor Reis Santos predicting an epidemic of stones either due to uric acid stone formation from obesity or calcium oxalate formation from malabsorbative bariatric procedures. There was also a recurring theme with poster and podium sessions on “ESWL – is there still a role?” While the argument is made for ESWL there is no doubt that worldwide treatment rates for ESWL are falling.
As the EAU Section of Female and Functional Urology there was an excellent series of talks on mesh and mesh complications. There was a fantastic review of dealing with these complications through a variety of approaches and techniques and whether all these should all be dealt with in high volume centres. Unfortunately, no one knows what high volume means for this. Interestingly the terminology is changing, moving away from ‘erosion’ to ‘exposure’ and ‘perforation’. Removing the mesh only relieves associated pain in 50% of cases and these dedicated centres need to offer multimodality treatments to deal with pain and ongoing continence issues.
In the parallel EAU section meeting of Genito-urinary Reconstructive Surgeons, Professor Mundy gave a personal 30 year series of 169 patients treated with both clam cystoplasty and artificial sphincter. The majority of complications were related to the sphincter. The largest subgroup was patients with Spina Bifida but were the patients with the best outcomes.
David Ralph in the EAU Section of Andrology stated that shunts were ineffective after 48 hours after priapism and that a prosthesis instead should be inserted to prevent corporal fibrosis.
The EAU section of Oncological Urology also heard that 68Ga-S+PSMA-PET improves detection of metastatic lymph nodes in prostate cancer and can be used intra-operatively in radioguided surgery for targeted lymph node dissection.
Overall the organisers have done a fantastic job with a well organised meeting and a great venue despite the disappointing weather. There were sessions that people could not get in to as the rooms were full.


However, with live TV screens outside those rooms and transmission to an adjacent overflow room this didn’t seem to matter too much. Much to look forward to for the rest of the conference #EAU15.

Rebecca Tregunna, Speciality Trainee, Burton Hospitals NHS Foundation Trust, West Midlands Deanery. @RebeccaTregunna

Matthew Bultitude, Consultant Urologist, Guy’s and St. Thomas’ Foundation Trust; Web Editor BJU International. @MattBultitude


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