S. Joniau MD, PhD

Novel strategies in the management of high-risk and oligometastatic prostate cancer

SUMMARY

The aim of this thesis was to assess the impact of intensive hormonal therapy prior to radical prostatectomy in high-risk prostate cancer (PCa) in order to optimise the outcome of this patient population. Next, the recurrence patterns of PCa patients with prostate-specific antigen (PSA) relapse following localised therapy were assessed using novel imaging techniques such as prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT). Moreover, the safety and oncological outcomes of PCa men with oligometastatic recurrence (1–5 lesions) following localised therapy treated with metastasis-directed therapy were investigated. Lastly, the safety and efficacy of radium-223 in men with PSA relapse following localised therapy without visible lesions on PSMA PET/CT were assessed.

(Belg J Med Oncol 2023;17(7):267–70)

Traveling the prostate cancer timeline in chase of treatment paradigms: Can we cure the incurable?

SUMMARY

When prostate cancer (PCa) patients are diagnosed as ‘incurable’, most patients still have many years to live and often undergo a continuum of burdensome and expensive systemic treatments that can impair quality of life. Due to the active promotion of new systemic therapies in the treatment of metastatic and/or castrationrefractory PCa patients, other treatment modalities such as modern radiotherapy (RT) have been considered as therapies that relieve symptoms, without offering any possibility of cure or additional quality of life-adjusted life years. This PhD thesis investigated whether the implementation of modern RT in previously non-RT indications could prove otherwise. To achieve this, the PCa timeline was followed in search of treatment paradigms, and re-introduced RT in different disease settings. Firstly, the addition of elective para-aortic lymph node radiotherapy was investigated in patients diagnosed with locally advanced pN1 prostate cancer, with local treatment of the prostate (bed) and pelvic lymph nodes, along with 24 months of ADT, in the prospective multicentric PART study. Secondly, a large retrospective study was performed, focused on patients with oligorecurrent prostate cancer who were treated with metastasis-directed therapy (MDT). Finally, the use of MDT was investigated in patients diagnosed with oligoprogressive metastatic castration-resistant prostate cancer (mCRPC), while continuing otherwise successful ongoing systemic treatment. Will this approach lead to a substantial postponement of next-line systemic treatment (NEST)?

(BELG J MED ONCOL 2022;16(7):363–6)

Stromal tumour of unknown malignant potential of the prostate: A case report and review of the literature

SUMMARY

Stromal tumour of unknown malignant potential (STUMP) is a rare type of mesenchymal tumour of the prostate. These tumours often cause obstructive urinary symptoms, haematuria or haematospermia and can be misdiagnosed as benign prostatic hyperplasia (BPH). STUMP has a variable and unpredictable clinical course. Generally, these tumours have a good prognosis since they are mostly confined to the prostate. However, a minority recurs after surgery and uncommonly can adhere to adjacent organs or (even more rarely) metastasizes. Progression to prostatic stromal sarcoma has rarely been reported. The diagnosis is made on histological examination of prostate tissue (from biopsy or transurethral resection of the prostate (TURP)). The appropriate treatment approach is currently unknown. Treatment recommendations should be based on patient age, treatment preference, size or extent of the lesion. This case report describes a case of a 68-years old man who presented with a STUMP and provides an overview of the literature on this topic.

(BELG J MED ONCOL 2022;16(6):303–6)

Repeated stereotactic body radiotherapy (SBRT) in a patient presenting with oligometastatic prostate cancer while treated with anti-androgens: a case report

SUMMARY

This case report of an 80-year-old patient, who presented with up to six manifestations of oligorecurrent prostate cancer (PCa) over a time period of nine years, shows that repeated treatment with metastasis directed therapy (MDT) in this setting is feasible and nearly atoxic.

(BELG J MED ONCOL 2021;15(6):325-30)

Appropriateness of treatment options in patients with metastatic castrationresistant prostate cancer with a focus on radium-223: outcomes of a Belgian multidisciplinary Consensus Meeting

SUMMARY

The treatment landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the approval of a variety of therapeutic agents including abiraterone acetate, cabazitaxel, docetaxel, enzalutamide and radium-223 dichloride and the introduction of docetaxel and abiraterone acetate in combination with androgen deprivation therapy in newly diagnosed metastatic prostate cancer. Evidence on the optimal sequence of these therapies is scarce. In practice, the most appropriate treatment (sequence) depends on patient and disease characteristics. This article summarises the recommendations of a multidisciplinary group of Belgian experts in sequencing treatments for patients with mCRPC, with a focus on radium-223 dichloride.

(BELG J MED ONCOL 2019;13(6): 240–250)

Multimodality treatment for high-risk prostate cancer: New perspectives

High-risk prostate cancer represents the most aggressive form of the disease worldwide. In the past it was largely treated without curative intent but during the last years there has been a paradigm shift with an increase of curative procedures (particularly radical prostatectomy) for high-risk patients and, vice versa, active surveillance for low-risk disease. For this reason the high-risk group represents the novel target for contemporary research. The pre-operative risk groups are considered homogeneous in terms of prognosis and therapeutic response but there are grey zones within each group that have not been adequately studied. The main hypothesis of this PhD thesis (ISBN-NUMBER: 9789082757606 for the printed version and 9789082757613 for the e-version) is that not all high-risk prostate cancer patients have the same outcomes after surgery and also not the same response to multimodality therapies. In this context, novel treatments or their combinations should be tested. We analysed the largest high-risk database in the world demonstrating that not all high-risk patients after surgery have the same outcome according to their postoperative pathologic features. The European Multicentre Prostate Cancer Clinical and Translational Research group classifier was then defined as three different prognostic groups to predict cancer specific death. Interestingly, patients in these groups did not respond homogenously to adjuvant radiotherapy and/or androgen deprivation therapy. We also analysed the survival impact of neoadjuvant hormonal therapy before surgery, showing that patients who need adjuvant radiotherapy and were exposed to neoadjuvant hormonal therapy have the best prognosis. This outcome opens new perspectives for neoadjuvant treatment with or without other treatment combinations. The ARNEO trial is a phase II randomised, double blind, placebo controlled trial to study the association of apalutamide and degarelix before surgery for intermediate and high-risk disease.

(BELG J MED ONCOL 2018:12(3):130–132)

Highlights of Scientific Summits Meeting

Summary

Since last year a board of respectively three urologists and one radiation oncologist created the ‘Scientific Summits’. This is a scientifically independent Belgian congress for urologists, radiation oncologists, medical oncologists and radiologists with special interest in urology and more specifically in urologic oncology. The aim of Scientific Summits is providing up-to-date scientific information based on the highlights of the most recent international congresses. The 4^th edition took place in the charming city of Durbuy, Belgium.

The first day of the meeting focussed on the treatment and prevention of side effects of various anticancer treatments in urologic oncology. Experts in the field shared practical tips and tricks, based on interactive case discussions. They illustrated difficult situations and how to deal with them. On the second day of the meeting, interactive state-of-the-art lectures provided us with up-to-date information on how to evaluate and manage advanced and recurrent prostate cancer.

(BELG J MED ONCOL 2018;12(2):82–85)