Oncology 2

Kai-Jie YuTaiwan Moderator

Lui Shiong LeeSingapore Moderator Technical Pearls: Robotic Intra-Corporeal OBSThis session will demonstrate the key steps required in the intra-corporeal creation of a Studer type orthotropic bladder substitute.

Peter Ka-Fung ChiuHong Kong, China Speaker Minimal Invasive Therapy: Where do We Stand in 2025Endourological, Laparoscopic and robotic surgeries have replaced most open surgeries in Urology. Emergence of new robotic platforms have provided urologists with new opportunities. Both boom-type and module-type robots have been used, and they each have their strengths in practice. Tele-surgeries have provided a new paradigm of long-distance robotic surgeries to facilitate new surgical possibilities and proctorship. State of the art robotic surgeries in retrograde intrarenal surgeries and enbloc resection MDT Discussion: Personalizing Treatment in High Volume CSPCN/ADebate: Should We Only Offer Consolidative Cytoreductive Nephrectomy in Metastatic RCC?N/AFocal Therapy in Asia – Is It Prime Time?The increase in incidence of Prostate cancer has been rapid in Asia in the past 10 years. While Robotic radical prostatectomy and Radiotherapy has been the commonest treatments for localized prostate cancer, significant long-term morbidities are observed after surgery or radiotherapy including incontinence, erectile dysfunction and irradiation injury to the bladder and rectum. In the current era of MRI-guided prostate biopsy, focal diseases can be targeted and diagnosed, and image-guided focal therapy emerged as an alternative treatment. Although Focal therapy has a relatively higher rate of local recurrence, it has the advantages of minimal or no long-term complication after treatment, and it is possible to perform retreatment with focal therapy, prostatectomy or radiotherapy. In properly selected patients, the need for salvage prostatectomy or radiotherapy after focal therapy is less than 20% at 8 years, and patients’ quality of life could be preserved. In well-selected patients, focal therapy is an attractive option. Current focal therapy for prostate cancer available in Asia includes HIFU, Cryotherapy, Targeted Microwave Ablation (TMA), irreversible electroporation (IRE) and TULSA.

Zainal Adwin Zainal AbiddinMalaysia Speaker Primary Radical Prostatectomy in Low Volume Metastatic Prostate Cancer

Stephen A. BoorjianUnited States Speaker AUA Lecture: 2025 Update of AUA and EAU NMIBC GuidelinesBoth the American Urological Association (AUA) and European Association of Urology (EAU) have developed guidelines for the management of non-muscle invasive bladder cancer (NMIBC). While subtle differences in several aspects of these guidelines exist which merit mentioning, both guidelines emphasis the concept of risk stratification. In particular, understanding the criteria which classifies patients with NMIBC as high risk avoids undertreatment of the patients most likely to experience disease progress. Likewise, recognizing the indications for cystectomy among high risk NMIBC patients is critical to optimize survival. Meanwhile, continued options emerge for patients classified as having BCG unresponsive NMIBC, such that knowledge of that definition as well as current management strategies for these patients facilitates contemporary practice.From Bench to Bedside - A Comprehensive Overview of Kidney CancerEvaluation of patients with a newly identified renal mass includes dedicated cross-sectional imaging for appropriate characterization. Genetic syndromes which include renal cell carcinoma (RCC) are increasingly understood, and indeed knowledge of the intracellular pathways of these conditions has facilitate rationale drug development for kidney cancer. Managing patients with a small renal mass involves a critical assessment of competing risks inherent to the tumor, the patient (underlying comorbidity status), and the proposed treatment. Renal mass biopsy may play a role in select cases for additional information/risk stratification. The safety of active surveillance is being increasingly demonstrated as longer-term follow-up matures. Meanwhile, select patients with high risk disease now have the option of adjuvant immunotherapy following surgical resection. In the setting of metastatic RCC, again risk stratification plays a critical role in the decision for – and timing of – cytoreductive nephrectomy, particularly in the contemporary era of checkpoint inhibitor therapies.Real World Experience in the Management of Upper Tract Urothelial CarcinomaThe biggest challenging in managing upper tract urothelial carcionma (UTUC) remains accurate staging of tumors at diagnosis. Given the limited ability of contemporary staging methods, clinical risk stratification models have been developed to assist in providing risk-based treatment recommendations. For example, endoscopic management (e.g., ablation) represents the recommended first line approach for patients with low risk disease. Importantly, follow-up for these patients should include endoscopic re-evaluation. The value of testing patients with UTUC for Lynch syndrome is also critical to recognize. A role for neoadjuvant chemotherapy is being increasing explored for patients classified with high-risk UTUC, while several options exist for adjuvant chemotherapy and immunotherapy for patients with adverse pathology at surgical resection. Continued investigation into prevention of postoperative intravesical recurrences in patients with UTUC is warranted given the frequency of metachronous tumor development in the bladder among these patients.Updates on MIBC and Advanced Bladder Cancer: Where do We Stand in 2025While neoadjuvant chemotherapy prior to radical cystectomy has been demonstrated with randomized trial data to improve survival for patients undergoing radical cystectomy, nevertheless utilization is often restricted by misunderstandings regarding patient eligibility factors. As such, defining eligibility criteria will facilitate increased adoption. Likewise, new data indicates a role for adjust immunotherapy in select patients following surgery as well. Moreover, important recent evidence on the role of extended lymph node dissection and the opportunities for preserving sexual function after cystectomy by modifying surgical technique are critical to review in order to optimize future patient outcomes. Further, recent advancements in systemic therapy options for patients with metastatic urothelial carcinoma have led to unprecedented survival rates.Revisit on Testicular Tumors-What we Learned from past and Prepared for the FutureGerm cell tumor (GCT) progression typically occurs in a predictable sequence of disease spread to the retroperitoneum first and then distant metastases. Understanding the role of serum tumor markers at various disease stages is critical for guideline-concordant management and to optimize patient outcomes, avoiding both undertreatment and overtreatment. For patients with seminoma, retroperitoneal lymph node dissection now represents an option for patients with low volume retroperitoneal lymph node disease, with the goal of avoiding the long-term toxicities associated with chemotherapy and radiotherapy. For patients with residual postchemotherapy masses in seminoma, increasing evidence suggests that PET scans should be utilized/interpreted with caution, and that in the absence of mass growth continued follow-up may be the strategy for most patients. Similarly, for patients with nonseminomatous GCTs (NSGCT) and equivocal retroperitoneal lymph nodes at presentation, re-scanning after an interval of approximately 6-8 weeks may be preferable to initial treatment, as many of these nodes represent benign processes and as such will resolve. Nevertheless, postchemotherapy retroperitoneal lymph node dissection remains a critical component of the management of patients with NSCGT and a residual mass. Risk Stratification and Contemporary Management of Biochemical RecurrenceBiochemical recurrence (BCR) has been reported in up to 35% of patients following radical prostatectomy. Understanding the natural history and clinicopathologic risk factors associated with disease progression is critical to facilitate an individualized treatment approach. Likewise, recognizing the details of treatment delivery with salvage radiotherapy is necessary to optimize outcomes. Further, as data emerge on the utilization of systemic therapy for non-metastatic BCR, being able to contextualize reported outcomes with patient age, comorbidity status, and disease risk will enhance appropriate care delivery.

Ching-Chu LuTaiwan Speaker The Strategy to Initiate PSMA-Based Therapies for Advanced Prostate CancerPSMA-targeted radioligand therapy (PSMA RLT) has emerged as a promising treatment for metastatic castration-resistant prostate cancer (mCRPC), particularly after failure of androgen deprivation therapy, next-generation hormonal agents, and chemotherapy. While PSMA RLT is currently a third-line treatment, evidence from the PSMAfore trial suggests its potential efficacy when used earlier in the treatment sequence, prior to chemotherapy, offering a new strategy for improving progression-free survival (PFS) in mCRPC patients. In addition, PSMA RLT is being explored in metastatic hormone-sensitive prostate cancer (mHSPC), with ongoing trials such as PSMAddition, investigating its role in delaying disease progression and improving patient outcomes when combined with standard therapies. Moreover, PSMA RLT is being evaluated in combination with other treatments, including PARP inhibitors, immunotherapy, chemotherapy, and radiation therapy. Numerous ongoing trials are exploring these combination therapies to further enhance the therapeutic efficacy of PSMA RLT and improve patient outcomes in advanced prostate cancer. Novel radionuclides such as Actinium-225 (Ac-225) and Terbium-161 (Tb-161) are being investigated for their potential to improve the therapeutic profile of PSMA RLT. These isotopes offer unique advantages, including different radiation characteristics that could increase the efficacy and safety of PSMA-targeted therapies. In conclusion, PSMA RLT is becoming a cornerstone of precision oncology for prostate cancer. As research continues to explore its use earlier in the treatment continuum, in combination with other therapies, and with the incorporation of novel radionuclides, PSMA RLT holds great promise for improving outcomes in advanced prostate cancer patients.