Instead of treating the whole prostate gland there has been a steady rise in partial-gland therapies, also known as focal therapies. This approach has been incorporated into the surgical treatment pathway of nearly every solid organ system, the prostate has been particularly challenging due mainly to two concerns: (i) PCa cancer can often have more than one location, even at an early stage. (ii) There is the difficulty of accurately imaging the boundaries of a distinct tumour(s) as may typically occur in other organs.

The acceptance of the concept of focal therapy for prostate cancer has been growing over the past 20 years and it is becoming part of the standard range of treatments to be considered by patients and clinicians. It must be stated clearly that only some men will be suitable for focal therapy.  Support for the development of image-targeted interventions is also extended to industry partners and collaborative scientists who continue to push the envelope on technical enhancements and new discoveries that aid in the detection, characterisation, and image-guided treatment of such tumours. The widespread adoption of multiparametric MRI, means we now have a reliable imaging platform for patient selection and to provide procedural guidance and post-therapy surveillance.

MRI still leaves room for improvement, as up to 15% of tumours are MRI-invisible. Also, over the past 2 decades, physicians and patients have become more comfortable with the management of multifocal PCa, provided that untreated, small, and indolent tumours can be confidently monitored and do not pose a threat to a patient’s life expectancy. From a functional point of view, most would agree that the results of focal therapy overall have been exceptional at preserving urinary function and continence. Potency outcomes have also been “very competitive” with, if not better than, traditional whole-gland therapies. However, cancer control has yet to demonstrate mature long-term data. Regarding oncologic outcomes, the reality is that even traditional therapies such as radiation and surgery have failure rates and certainly have adverse effects on the quality of life of many men.

To read the full article click here and see p.261-269.

Medical devices make it only rarely to the pages of Update. The recent approval by the US Food and Drug Administration [FDA] of a focal therapy sparked our interest. The Avenda Health Focal Therapy System, a product designed to deliver prostate cancer treatment in the doctor’s office, was granted breakthrough device designation by the FDA,

Shyam Natarajan, co-founder and CEO of Avenda Health, said in a press release. “We see our approach as similar to that of a lumpectomy for breast cancer – if the cancerous tumour and appropriate treatment margins can be identified, the standard approach of removing the entire prostate gland and surrounding tissue may not be necessary.”

The system claims it is able to deliver accurate, tailored laser treatment to the tumour and spare healthy tissue in the process.   This offers the possibility to minimise the adverse effects of therapy—such as urinary, sexual, a bowel dysfunction—and, crucially, to perform the procedures in a physician’s office.

Read more by clicking on the link: CancerNetwork (2021)

Annual Report:  The Board met through the Zoom conference facility to consider the draft Annual Report which will be issued to all delegates and member organisations by June 4. The Board also reviewed nominations received so far for the two new additional Board positions.  At the time of this issue of Update the number of nominations is now four. While our statutes allow nominations up to the day of the election, the Board requests that member organisations consider making their nominations in advance of the GA so that there can be a chance for members to consider the candidates and for members to instruct their Voting Delegate accordingly.

Motion for GA: The Board also reviewed the motion from the UK’s Tackle affiliate calling for the examination of the case for the professionalisation of Europa Uomo to for the GA submitted by Tackle the UK affiliate of Europa Uomo. The practical issues raised by the motion were discussed by the Board and Tackle last week and an alternative motion has been agreed for the consideration of the General Assembly on 19 June.

ECPC:  The Board reviewed the issues which have arisen with the European Cancer Patient Coalition (ECPC) and its forthcoming Annual General Meeting on 26 June. Europa Uomo is a full member of ECPC and it shares the concerns of a number of ECPC affiliates at the turmoil which appears to afflict that organisation. The Board decided to contact Europa Uomo members who are also full members of ECPC and to ask them to support the current ECPC Board at the ECPC AGM. The Board decided to review as a matter of urgency the outcome of the ECPC meeting and to consult with other members of that organisation in the light of the decisions made at the ECPC AGM.

Webinars on AS:  The Board reviewed the first Webinar which was adjudged a great success and various suggestions were discussed for the second Webinar in May and the third Webinar on June 10.

EUPROMS 1:  Our communications consultant, Simon Crompton and a small design team are preparing a draft online version of the EUPROMS 1 Study. The intention is to brief delegates on the approach to date and how member organisations can avail of different language versions of both the on-line and hard copy booklet which is preparation. Members are requested to submit their observations by June 28. Printed hard copies of the patient-friendly version of the EUPROMS study in A5-booklet form will be available in July, subject to the approval of the Board. Member organisations are asked to indicate to the Secretariat the number of copies of the English language version of the study they require and whether there is a demand for the preparation of other language versions of the study.

EUPROMS 2:  Work on the follow-up survey now named EUPROMS 2  has been progressing at some speed. A report on EUPROMS 2 will be made at the General Assembly on 19 June.

EAU Patient Day on 9 July:  Despite the change to a Virtual Congress the EAU Patient Office is pressing ahead with a busy programme for the Patient Day on 9 July. The programme is still being finalised but it will have the following topics:

• Presentations on Bladder, Kidney, Prostate cancers; Life After Cancer Treatment, a session on functional Urology.
• Patient Poster Session – Patient advocates have been encouraged to actively contribute to the Congress by submitting a poster abstract. This provides an opportunity for patient advocates to to share knowledge with insights into treatment and quality of life issues.
• The poster session is supported by Pfizer but the editorial content is written independent of the sponsor
• ADT Educational Programme: this is intended to help prostate cancer patients deal with Androgen Deprivation Therapy with a workshop and book for participant in the ADT Workshops.
• How will the next decade of early detection and active surveillance affect the patients, their organisations and the impact on the health services.
• Round Table: “the road to successful intervention” – discussion of shared responsibilities of both the healthcare provider and the prostate cancer patient’s care pathway.

European Patients Forum – Europa Uomo now a full member.   The application by Europa Uomo to join the European Patients Forum (EPF) as a full member was successful. John Dowling and Ioannis Vanezos attended as Europa Uomo Observers/Delegates to the EPF AGM.

Resignation of Louis Denis as ex-officio Board member representing OCA:  The Board learned with great regret of the decision of Prof. Louis Denis, ex-officio Board member, former Secretary of Europa Uomo and distinguished urologist, has submitted his resignation from the Board with effect from the 2021 General Assembly. The Board resolved to mark in a suitable manner, at the GA, Prof. Denis’ contribution to the development of Europa Uomo from its founding to the present day.

ESMO Patient Guide: The Chairman announced that he had been notified personally about a planned update of the ESMO Patient Guide on Bone Metastases/Bone Health and prostate cancer and to review the guidelines on prostate cancer. He confirmed the assistance of EUomo but awaits further details.

Europa Uomo GA : In addition to the Annual Report and Tackle UK Motion as mentioned above, the Board also reviewed arrangements for the election of new Board members, voting procedures, the GA Programme.

EUomo Office Move:  Due to increased rental costs, Europa Uomo has been informed that OCA will move its offices to another premises before November 1, 2021. The proposed new location is near where the OCA office was until 2018. This will require minor administrative changes for Europa Uomo.

EUOMO Patient Day during the EAU meeting:  It is customary to invite the EAU host country Europa Uomo affiliate to hold a local patient day, but this is not so straight-forward when the EAU Congress is Virtual. The Board is willing to organise a virtual patient day during the EAU21,  and will contact the Congress department and see if a change in date to the third day of the Congress is possible and that the Patient Meeting be limited it to a maximum of 3 hours.

7th European School of Oncology Prostate Cancer Observatory: Topic- “innovation and Care in the next 12 months”.  This will be held as part of the EAU Virtual Congress on July 12, 13:30-14:30 Central European Summer Time. As is customary, Europa Uomo is granted access to this meeting and our EUomo logo will be published in the Observatory-related announcements as done in the past editions.

GA Europa Uomo 2022 in The Netherlands: Will Jansen reported on the preparations being made for the Europa Uomo General Assembly in June next year. GA Europa Uomo 2022: This will take place in the AFAS theatre in Leusden (see pictures below), close to Apeldoorn/Utrecht, The Netherlands. After the summer holidays a more detailed program will be presented.

Any Other Business:

• It was reported that Norway has decided to implement the programme on early detection. HVP and JD asked for some more information so that we can publish an article in the Update.
• It was also announced that at the next EAU General Assembly Prof. Hein Van Poppel (HPV) will leave the chair of the EAU Patient Office. His place will be taken by Eamonn Rogers, from Galway in Ireland. At the same meeting, HVP will also leave the position of Adjunct Secretary-General responsible for Education and Prof. James N’Dow from Aberdeen University, Scotland, will be appointed as his successor. HVP announced that he has applied to become the chairman of the European Policy Office. He suggested that as he will leave the executive of the EAU, that the ex-officio Board member representing the EAU in the future should be the Chair of the Patient Office.
• The meeting concluded with the Board’s special thanks to Prof. Van Poppel for his visionary initiative in persuading the EAU to establish the Patient Office which has, in a few short years, inured greatly to the benefit of both the patient world and the EAU’s appreciation of the patient role.

Androgen Deprivation Treatment often results in patients moving to low-carbohydrate diets to combat the gain of “belly fat” leading to problems with blood sugars and possible type 2 diabetes with cardiac issues.

For advanced PCa, including metastatic PCa standard first-line treatment is androgen deprivation therapy (ADT). This is a very effective treatment in containing the cancer but ADT has many metabolic side effects and not everybody on ADT is aware that there is some reduction in some the normal products in the blood and increased sugars (glucose). ADT reduces the biochemical process through which the body produces ketones that break down fatty acids and ketogenic amino acid – a process known as ketogenesis. The process supplies energy to certain organs, particularly the brain, heart and skeletal muscle, and under specific scenarios including fasting, reduction in calorie intake, sleep, or others.

In this interesting study researchers speculate that low-carbohydrate diets (LCD) may reverse many ADT-induced metabolic abnormalities in men with advanced prostate cancer.

Read more

With thanks to Prof. Louis Denis for bringing this article to our attention.

Prostate Cancer is a public health problem that affects the male genitourinary system causing a significant threat to mens’ quality of life (QoL). Experiencing a lack of money to spend on healthcare and a poor understanding of their illness (their perception) may add to a lack in the QoL of men with PCa. The study recruited 173 men with PCa from four university level health facilities in Nigeria. Data collection and the scoring of the financial issues and illness perceptions were collected. The participants had an average age of 71.57 and just over half had at least one co-morbid disease. A significant difference was found in overall QoL based on treatment site and number of comorbid diseases.

This study assessed the ability of individuals to fund their PCa healthcare and their lack of understanding or perception of their illness on the QoL of PCa patients in the Nigerian. The authors state that larger studies covering the six geopolitical zones in Nigeria would clarify the role of cultural variations in Quality of Life and help the useability of the findings. Gleason scores and clinical stage of PCa were not available in the patients’ files and this is seen by the researchers themselves as a major weakness in the study as were the limitations of the data on quality of life factors.

The conclusions reported that financial toxicity and illness perception have a significant influence on QoL of patients with PCa. The authors are of the view that the financial toxicity might be improved by the development of a comprehensive national health insurance scheme in which patients can be enrolled and by subsidising cost of treatment for men with PCa. The authors say that it is important for clinicians to intentionally create opportunities to provide appropriate counselling and information about the illness and what to expect following a cancer of the prostate diagnosis and treatment in order to improve “appropriate and adaptive illness perceptions”.

Read more: Akin Odanye et al. African Journal of Urology (2021)

From the Harvard Medical School

Over the past decade, the American Heart Association, the federal dietary guidelines, and other nutrition authorities have shifted away from advising people to limit the total amount of fat in their diets. “Instead, the focus is on an overall healthy dietary pattern. That means an eating style that emphasizes vegetables, fruits, whole grains, and beans, along with only modest or small amounts of meat, dairy, eggs, and sweets,” says Dr. Eric Rimm, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health.

The reality is that eating more whole or minimally processed, plant-based foods will naturally lower your intake of fat, especially saturated fat. Found mainly in meat and dairy products, saturated fat can boost levels of harmful LDL cholesterol, a key contributor to heart disease. But simply cutting back on all types of fat does not necessarily translate into a diet that lowers cardiovascular risk.

Read more