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EAU 2021: Radiotherapy After Radical Prostatectomy in the PSMA-PET Era

EAU 2021: Radiotherapy After Radical Prostatectomy in the PSMA-PET Era (UroToday.com) At the controversies in Onco-Urology session of the European Association of Urology 2021 annual meeting, Dr. Alberto Bossi discussed radiotherapy after radical prostatectomy in the PSMA-PET era. Adjuvant radiotherapy is defined as immediate postoperative radiation in the case of extraprostatic extension, positive margins, seminal vesicle infiltration, high Gleason score, or pN+ disease. Salvage radiotherapy is defined as a wait-and-see policy in that radiation is only given in the case of a rising postoperative PSA. The ARTISTIC meta-analysis was published in 2020, combining data from RADICALS, GETUG-AFU 17, and RAVES showing no difference in PSA-driven event-free survival with a hazard ratio of 1.12 (95% CI 0.88-1.42), and a potential absolute difference of 1% at 5-years in favor of early salvage radiotherapy

EAU 2021: Is There A Role For Neoadjuvant Immunotherapy In Muscle Invasive Bladder Cancer?

3 IMvigor 210 First-line maintenance treatment: JAVELIN Bladder 100 5 Given the above success of immunotherapy in bladder cancer, there is great interest in the possibility of moving immunotherapy into the neoadjuvant disease space. Currently, there are many ongoing clinical trials for neoadjuvant immunotherapy: 6 7 and ABACUS 8 phase II trials. PURE-01 enrolled 143 patients that were treated with 3 cycles of pembrolizumab, resulting in a pT0 rate of 37%. ABACUS enrolled 95 patients that were treated with two cycles of atezolizumab, resulting in a pT0 rate of 31%. Three clinical trials have assessed the utility of immunotherapy combination therapy, including the NABUCCO (ipilimumab + nivolumab x 3), DUTRENEO (durvalumab + tremelimumab x 3), and durvalumab + tremelimumab x 2 (NCT02812420). As follows is a summary of these trials:

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