LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 6

Video Transcription

Video Summary

The session opens with Dr. Parker moderating a localized prostate cancer panel. Radiation oncologist Sean Collins reviews advances in prostate radiotherapy, highlighting the randomized PACE-B trial in mostly favorable intermediate-risk patients: 5-fraction SBRT achieved similar 5-year biochemical control (~95%) compared with conventional/moderate hypofractionated IMRT, with no GI toxicity increase but more grade 2 late GU “urinary flare” treatable with tamsulosin and short steroids. He discusses focal boosting of MRI-visible dominant lesions (FLAME: improved 10-year biochemical control with focal boost) and feasibility data for SBRT boosting (hypoFLAME), noting rectum/urethra dose constraints and the importance of precise image guidance and, in his view, rectal spacers. He also cites early experience treating pelvic nodes in 5 fractions for higher-risk disease with high pelvic control, predicting broader adoption pending trials.<br /><br />Urologist Scott Eggener presents on low-risk disease: all major guidelines favor active surveillance. Long-term cohorts (e.g., Hopkins) show extremely low metastasis/death rates for Grade Group 1. The ProtecT trial found no survival difference at 15 years between surgery, radiation, and “active monitoring,” though metastases were slightly higher with less rigorous monitoring. Key progression predictors on surveillance include PSA density, cancer length, MRI PI-RADS 4/5 lesions, BMI, and some germline mutations; free PSA, race (with equal care), and serial genomics are less helpful. He argues Grade Group 1 behaves essentially benign and supports redefining “cancer” to reduce overtreatment.<br /><br />A surgeon reviews prostatectomy modifications aimed at quality-of-life: MRI-guided and partial nerve-sparing, Retzius-sparing and “hood-sparing” approaches to improve early continence with careful patient selection to avoid margin risk.<br /><br />Continence expert Diane Newman covers post-prostatectomy incontinence: stress incontinence is most common, but ~1/3 have de novo OAB responsive to medication. She emphasizes pre- and early post-op pelvic floor muscle training (with or without biofeedback) and realistic goals; men find even one pad highly distressing.<br /><br />The panel discusses cases with very large prostates and high PSA, emphasizing PSA density, use of PSMA PET in select scenarios, and treatment considerations (often favoring surgery when radiation is impractical due to gland size).

Keywords

localized prostate cancer

PACE-B trial

SBRT (5-fraction stereotactic body radiotherapy)

IMRT hypofractionation

late genitourinary toxicity urinary flare

tamsulosin management

FLAME focal boost MRI dominant intraprostatic lesion

hypoFLAME SBRT boost dose constraints rectum urethra

active surveillance low-risk Grade Group 1 ProtecT trial

post-prostatectomy incontinence pelvic floor muscle training OAB