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Educational Needs & Objectives

18th Annual Meeting of the Society of Urologic Oncology

November 29 – December 1, 2017
Renaissance Washington DC Downtown Hotel
Washington, DC

Educational Needs

Advanced Imaging in Prostate Cancer

The ability to detect, stage, and monitor both local and metastatic prostate has been hampered by a paucity of sensitive and specific imaging modalities and imaging tracers for generations. However, this situation has begun to change dramatically with the emergence of novel bone, metabolic, and prostate cancer specific tracers, as well as advances in anatomic and functional imaging such as MRI. Published results as well as ongoing clinical trials are accumulating for each of these modalities, but their availability is still somewhat limited and sporadic depending on the community in which one practices. Therefore, there is an urgent need for the SUO community to be educated on the different existing and developing modalities and tracers, their use, their sensitivity and specificity, and how they might alter management decisions throughout the course of the disease.

Immuno-Oncology

The field of immunotherapy of genitourinary cancer has developed recently such that this is an important area of interest and clinical utility to the practicing urologist. Thoughtful critique, discussion, and debate are critical for dissemination and implementation in the clinical care of patients with various forms of these challenging diseases. Notably, an expanding armamentarium of immunologic and molecular therapeutics for treatment of advanced and metastatic genitourinary cancer has led to interest in the development of novel immunologic agents alone and in combination with recently approved targeted agents. Practicing urologists and medical oncologists need to be familiar with the immunologic and genomic drivers for various forms of genitourinary cancers, the approach toward personalized medicine in this field, the novel pathways, mechanisms, and safety profile and efficacy of available agents. Further, this understanding will support rational trial design and execution for the advancement of our patient care mission. Urologists and medical oncologists should understand the role of checkpoint inhibition in promoting tumor killing by the innate immune system and be familiar with results of promising combination trials in renal and other cancers. Clinicians need to understand the growing choices in immunologic therapy for patients affected with advanced genitourinary malignancies and to know the role of genomics in helping to select candidates for therapy.

Bladder Cancer

This year’s bladder cancer sessions will address identified knowledge gaps including understanding the molecular characterization of non-muscle invasive bladder cancer and trying to optimize evaluation and treatment of patients with variant histology identified in NMIBC. For patients with muscle-invasive disease, we focus on perioperative assessment and management to optimize outcomes, updating our current status of knowledge regarding molecular subtypes of muscle invasive cancer, and, finally, identifying which patients might benefit from surgical treatment of metastatic disease.

Kidney Cancer

Recent changes in oncologic medical care have had a profound impact in urologic malignancies and particularly in field of kidney cancer management that are of critical clinical utility to the practicing urologist. Thoughtful critique, discussion, and debate on these topics go hand-in-hand with the process of dissemination and implementation in the clinical care of patients with various forms of this challenging disease. Notably, an expanding armamentarium of molecular therapeutics for treatment of advanced and metastatic disease has sparked interest in the development of an array of neoadjuvant and adjuvant applications being tested in clinical trials with recently reported results becoming available. The mixed results of such studies are open to careful interpretation and thoughtful discussion as additional studies develop. Practicing urologists and medical oncologists need to be familiar with the genomic drivers for various forms of kidney cancers, the approach toward personalized medicine in this field, the novel pathways, mechanisms, safety profile, and efficacy of available agents. Further, this understanding will support rational trial design and execution for the advancement of our patient care mission. Urologists and medical oncologists should understand the role of checkpoint inhibition in promoting tumor killing by the innate immune system and be familiar with results of promising combination trials.

The standards of interventional treatment are shifting in the management of localized disease, not only through advances in surgical techniques and technologies, but also through risk-stratified approaches to patient management. These approaches take into account features such as tumor aggressiveness, patient comorbidities, and life-expectancy as well as the risks of contemporary interventions. Developed guidelines based on these variables require dissemination and discussion. Important as well is to understand the limitations of surgical techniques and areas in which data-driven decisions regarding the appropriate application of surgical intervention warrant development and oversight.

Prostate Cancer

For prostate cancer patients, especially those with low risk tumors, therapeutic decision making remains a challenging process with a risk of over or under treatment. As such, there is a need for robust biomarkers to better stratify indolent from aggressive prostate cancer both at time of diagnosis as well as after definitive therapy to better guide timing and type of adjuvant or salvage therapy.

Many studies have examined the clinical need for a predictor of recurrence or metastatic potential of primary prostate cancer including gene expression signatures, genomic alterations, and protein profiling. The purpose of the first session is to discuss the role of MRI imaging in determining which men with elevated PSA levels may or may not need a biopsy. The value of genomic signatures that promise to better stratify risk in men with early stage prostate cancer need to be better understood both in newly diagnosed men at the time of diagnosis from biopsy as well as in the post prostatectomy state. Additionally, more recent data is allowing clinicians to more precisely recommend and time the role of combined androgen deprivation therapy and radiation therapy in men with adverse risk factors after prostatectomy. Indeed, there are recent genomic predictions biomarkers that promise to more accurately select the ideal patient at greater risk of benefiting from combined hormone therapy, plus radiation in a precision oncology manner.

The management of metastatic prostatic cancer continues to evolve quickly with some disruptive new biomarkers and therapies emerging into the clinic that will change patterns of practice. Recent advances in genomics are now allowing less expensive ways to survey the adaptive mutation landscape in CRPC under the selective pressures of treatment. While this could only until recently be done with tissue biopsies, recent advances using liquid biopsies and plasma circulating tumor DNA are allowing a more feasible way to serially survey the emergence of treatment resistance while on ADT and AR pathway inhibitors. The role of plasma DNA assays as prognostic and predictive markers will be discussed to provide an up-to-date review on these advances.

Alongside these emerging promising biomarkers, the newer and more potent AR pathway inhibitors are now being combined with androgen deprivation therapy in metastatic castrate sensitive prostate cancer. Two recent trials combining androgen deprivation therapy plus abiraterone promises to alter patterns to practice and significantly prolong survival in patients with M1 castrate sensitive prostate cancer. These promising combination therapies will likely move upstream and to earlier stages in the disease both in neoadjuvant settings and will be important to urologists to be familiar with these opportunities. The neoadjuvant model provides an opportunity to use pathology and complete responses to assess contextually lethal novel combination regimens that promise to delay progression and possibly improve survival if used in appropriate candidates in the neoadjuvant setting. The neoadjuvant model in assessing androgen responsiveness will be reviewed, and how this, along with preclinical models, allows the study of resistance and the role of alterations, steroid metabolism, and AR responsiveness will also be reviewed.

Penile Cancer

Penile cancer is a rare disease in the United States. Most urologic oncologists evaluate patients with this condition infrequently. Knowledge of the most recent AJCC staging guidelines enables decision making and prognositication by urological oncologists. Many patients with penile cancer present at a late stage, and may be incompletely treated by conventional therapies. Understanding the latest treatments, including immunotherapy, is vital for urologic oncologists. The recently-opened worldwide INPACT trial is of significant interest in helping the entire community of physicians caring for patients to design the appropriate sequenced treatment strategies.

Educational Objectives

At the conclusion of the 2017 SUO Annual Meeting, attendees should be able to:

Advanced Imaging in Prostate Cancer

  1. Identify all new imaging modalities and tracers for prostate cancer.
  2. Explain up-to-date data on each of the new imaging modalities and tracers for prostate cancer.
  3. Describe how to use t he emerging tools in managing men with prostate cancer.

Immunotherapy of Genitourinary Cancer

  1. Explain the importance of PD-1 in renal cancer and the clinical impact of combined checkpoint inhibition.
  2. Identify the obstacles to trial accrual for patients with advanced genitourinary cancers.
  3. Describe the impact of immunotherapy on disease progression and survival for patients with advanced genitourinary malignancies.
  4. Explain the rationale for immunotherapy using novel targeted and immune modulating agents.
  5. Explain risk-stratified strategies for entering patients into clinical trials involving immunotherapies.
  6. Identify the key genomic drivers of genitourinary cancers and developing strategies to adjunctively manage these tumors following surgery.
  7. Explain the significance of tumor staining for PD-1 and PDL-1.
  8. Describe the current and potential future value of agents such as nivolumab, pembrolizumab, and/or ipilimumab in patients with advanced genitourinary malignancies.

Bladder Cancer

  1. Describe the pros and cons of post-TUR intravesical chemotherapy and the possible use of gemcitabine in this role.
  2. Describe the current understanding of the genomic profile of nonmuscle invasive bladder cancer and compare it to invasive cancer.
  3. Interpret the prognostic impact of variant histology when identified on TUR specimens in the absence of muscle invasion.
  4. Describe the scientific background supporting current clinical trials of checkpoint inhibitors in NMIBC.
  5. Describe observed changes in genomics of metastatic bladder cancer and tumor heterogeneity.
  6. Describe the advantage of new molecular imaging techniques for staging evaluation of patients with bladder cancer.
  7. Learn methods to optimize outcomes of performing radical cystectomy and using new checkpoint inhibitors in elderly, frail patients with bladder cancer.

Kidney Cancer

  1. Describe the impact of adjuvant systemic therapy on disease progression and survival following resection of localized renal cell carcinoma.
  2. Explain the rationale for neoadjuvant vs. adjuvant therapy using novel target and immune modulating agents.
  3. Identify the obstacles to trial accrual for localized renal cell carcinoma.
  4. Explain the importance of PD-1 in renal cancer and the clinical impact of combined checkpoint inhibition.
  5. Explain risk-stratified strategies for surveillance of incidental renal masses as well as the risks and the role of selective biopsy for renal tumors.
  6. Identify the details of the new guidelines for management of small renal masses.
  7. Identify the advantages and outcomes of interventional techniques for percutaneous treatment of renal tumors as well as limitations of new technologies in the field.
  8. Discuss the controversies surrounding minimally invasive surgical technologies for advanced renal cancers, the limitations of these approaches including aspects of case selection, serious pitfalls, and how to avoid them.

Prostate Cancer

  1. Define the role of MRI imaging in PSA detected prostate biopsies.
  2. Review the role of genomic signatures in risk stratification in men with early stage prostate cancer and following radical prostatectomy.
  3. Discuss advances in optimal management in adverse risk factors following a radical prostatectomy through integration of clinical pathologic features, serum biomarkers, and genomic signatures.
  4. Review recent advances using plasma circulating tumor DNA as a prognostic and predictive biomarkers in metastatic CRPC.
  5. Explain recent Phase III data on combination androgen deprivation therapies and discuss life prolonging therapies combining androgen deprivation therapy in men with metastatic castrate sensitive prostate cancer.
  6. Utilize the neoadjuvant pre-surgery model to study emerging combination therapies in prostate cancer.
  7. Review mechanism of action alterations in steroid metabolism that may affect responsiveness of AR pathway inhibitors in advanced prostate cancer.

Penile Cancer

  1. Identify the 2017 staging system just introduced for penile cancer.
  2. Describe the international INPACT trial now open in the USA as of 2017, and how this trial will be of pivotal importance in advancing penile cancer management, and also to highlight the role US urologic oncologists may play.
  3. Describe the latest treatments and immunotherapy options when first line systemic therapy has failed.
  4. Describe ‘real-world’ clinical cases with input from penile cancer thought leaders representing medical oncology, radiation oncology, and urologic oncology.