LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 2

Video Transcription

Video Summary

The session opened with meeting organizers thanking attendees and emphasizing a shift away from mass prostate cancer screening toward targeting higher-risk patients, aiming to find and treat those who truly need intervention rather than simply increasing active surveillance numbers.<br /><br />A presentation reviewed PSMA-PET/CT as a highly specific imaging biomarker for prostate cancer, highlighting superior staging and recurrence detection versus conventional imaging, usefulness at low PSA levels in biochemical recurrence, and the emerging role of PET/MR and delayed imaging to clarify urinary-tract artifacts. The speaker also connected PSMA imaging to theranostics, particularly selection and assessment for PSMA radioligand therapy (e.g., Lu-177), noting ongoing debate about relying on PSA response versus imaging response.<br /><br />Another talk focused on pre-biopsy biomarkers and early detection. PSA was defended as a strong screening tool, but clinicians were urged to simplify messaging for primary care and use additional markers and MRI to reduce unnecessary biopsies and overdiagnosis. The speaker proposed a practical PSA threshold (e.g., ~1.5) to guide follow-up and referral, stressing that biomarkers provide probabilities rather than binary answers.<br /><br />Pathology speakers described how digitized pathology and AI can predict molecular features such as PTEN loss and BRCA2 alterations from histology, potentially guiding confirmatory testing and risk stratification. Discussion emphasized improving baseline clinical stratification and incorporating newer adverse histologic features (e.g., intraductal/cribriform patterns). Artera and other pathology-AI tools were presented as emerging tests, with Artera highlighted for predicting which radiation patients benefit from adding ADT.<br /><br />A debate compared transrectal vs transperineal biopsy. Recent randomized trials and meta-analyses suggest similar cancer detection and low infection rates when done well, though TP may reduce sepsis in real-world data but can cause more pain/urinary symptoms. Coding changes for 2026 biopsy procedures were reviewed. An abstract reported favorable early experience with in-office robotic transperineal MRI-fusion biopsy, with high detection in PIRADS 4–5 lesions and reconsideration of biopsying PIRADS 3 lesions.

Keywords

risk-adapted prostate cancer screening

PSMA-PET/CT

biochemical recurrence low PSA imaging

PET/MR delayed imaging urinary artifact

PSMA theranostics radioligand therapy Lu-177

PSA threshold 1.5 ng/mL referral strategy

pre-biopsy biomarkers and MRI triage

reducing unnecessary prostate biopsies overdiagnosis

digital pathology AI PTEN loss prediction

AI histology BRCA2 alteration risk stratification

intraductal cribriform adverse histology features

transperineal vs transrectal biopsy MRI-fusion robotic in-office