2023-06-19 13:28:20
Prevention is the key word in Urology. But without forgetting the research that allows us to reach personalized medicine. Three experts in the field of Urology have spoken about this, among other things: José Luis Álvarez-Ossorio, president of the Spanish Association of Urology; José Manuel Cózar and Juan Moreno, presidents of the National Congress of Urology held in Granada.
-What have been the most important milestones presented at the congress of the Spanish Society of Urology?
-Juan Moreno: Urology is moving towards personalized medicine, precision medicine. We come from treating all patients the same, with the same pathology that is not the same, and increasingly, both in surgical and medical aspects, we are tending more to personalize this treatment. Not all prostate cancers are the same and not all kidney tumors are the same.
-José Luis Álvarez-Ossorio: We are seeing advances in the treatment of prostate, bladder and kidney tumors, as well as new robotic platforms and the application of artificial intelligence.
-What are the most promising technologies?
-Álvarez Ossorio: Without a doubt, robotic surgery and the use of new minimally invasive surgery techniques for the treatment of benign prostatic hyperplasia.
-Moreno: We have gone from a major surgery to being less and less invasive, with which the patient’s recovery and pain are infinitely less. We are heading towards a more personalized medicine, with more specific treatments for each group, but also taking genetic studies into account. There are specific drugs for this. Survival in prostate cancer has gone from an average of twenty months to more than eighty months. Survival has been increased in all phases.
-Let’s talk about risk factors for prostate cancer.
-José Manuel Cózar: There are patients, between 8 or 10%, in which it is related to the genetic load. What do the other nine cases out of ten produce? It has been closely related to food. For example, it has been seen that there are more prostate cancers in the US and Europe than in Asia. We know that androgens are the ones that favor it. In countries where we consume a lot of saturated fat from meats, not olive oil, it seems that the hamburger diet favors it. There is also a racial factor, it has more incidence in the black race than in the Caucasian.
-What are the current challenges in the prevention of prostate cancer?
-Álvarez Ossorio: The current challenges are to make all men over 45 years of age aware that they should go to the urologist for an annual review. Prostate cancer is the most common type in men, followed by bladder cancer and kidney cancer respectively, and we know that the risk factor’s They start at age 40. For this reason, early detection is key to the success of the treatment; but men often dodge the doctor, avoiding diagnostic tests until it’s too late. In this sense, an artificial intelligence (AI) program, which is currently being investigated, would allow incidental detection through routine computed tomography (CT) scans.
-How can it be detected early?
-Álvarez Ossorio: Prostate cancer is the most frequent malignant tumor in men in the European Union, although it is very rare before the age of 50. In 90% of cases it occurs in men over 65 years of age. Advances in imaging techniques and early detection programs for prostate cancer today allow the diagnosis of the disease in its early stages in more than 70% of patients. An early diagnosis program for people over 50 years of age is essential. These programs are of vital importance since, on many occasions, prostate cancer does not produce symptoms and is detected in routine check-ups. In addition, a multidisciplinary approach, with the joint or sequential action of the specialties involved (urology, radiology, pathology, radiotherapy and medical oncology), is the ideal scenario to guide and treat the patient.
-What obstacles are there in the development of more effective and personalized therapies for bladder cancer?
-Álvarez Ossorio: The biggest current obstacles are that there are several drugs approved in the US but have not yet been approved in Europe for high-risk non-muscle-invasive bladder cancer. In addition, we need molecular markers to know when we can perform a conservative treatment and when a radical cystectomy in this type of patient.
-How has immunotherapy impacted the treatment of urological cancers, such as bladder or kidney cancer?
-Álvarez Ossorio: Immunotherapy is the use of drugs to boost a person’s immune system so that it recognizes and destroys cancer cells more effectively. Various types of immunotherapy can be used to treat kidney and bladder cancer, in recent years it has been a revolution in the treatment of these tumors.
-What are the emerging areas of research in urology?
-Cozar: There has been an exponential increase in research in the last eight years. Urology has opened up to be one of the most comprehensive specialties because comprehensive care is provided at all stages of the disease. But we must also value the accompaniment that the patient provides throughout the process. That produces a lot of tranquility.
-Álvarez Ossorio: The emerging areas of research in urology continue to be those related to new treatments for prostate, bladder and kidney cancer, and, in the near future, the application of Artificial Intelligence in our usual clinical practice.
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