Saturday, 29 March - Milan - The first Meet-the-expert sessions, a new feature at the annual meeting of the European Association of Urology, proved to be quite successful. These sessions are press meetings with eminent urologists, held in the press centre of the MIC. In one of these exclusive sessions, journalists have the opportunity to ask the experts their questions practically on a one-on-one basis.

27 March - Prof. Sandra Mazzoli (Florence, IT) - Prevention and early assessment of infectious diseases

The session started yesterday at 10:00 hours and several journalists attended. Professor Mazzoli's focus was on the Human Papailloma Virus, especially in males. HPV infection is a very common sexually transmitted disease with more than 6 million people infected every year. It is clear that this infection has been established as a cause of cervical cancer. The recent development of prophylactic vaccines against HPV is an unprecedented opportunity for woldwide cervical cancer protection. The fact that male circumcision is associated with a reduced risk of genital HPV infection in men an a reduced risk of cervical cancer in women is a clear demonstration of the role of male HPV infection in cervical cancer control. Professor Mazzoli has recently submitted an article to The Lancet favouring a correct HPV vaccination programme for young males.

Prof. Truls Erik Bjerklund Johansen (Århus, DK) - Worldwide infections

At 13:30 hours, the turnup was tremendous; many people were interested to hear the latest information in this field.

The prevalence of nosocomial urinary tract infections (NAUTI) was 10 percent in the PEP-study (Pan European Prevalence Study), 14 percent in the PEAP-study (Pan-Euro-Asian Prevalence Study) and 11 percent in the combined analysis. The PEP study was fostered by the EAU. "The prevalence of NAUTI is 10 to 14 percent of all patients in urological departments," Bjerklund Johansen stated. Asymptomatic bacteria are most common. It's important to have urinary culture tests to precisely identify the infection and decide about the antibiotic therapy most suitable. The study also showed that the prevalence of NAUTI is lower if protocols on catheterisation and use of antibiotics are used in hospitals. "The more you pay attention to NAUTI the lower prevalence will be," Bjerklund-Johansen underlined.

"The largest group was asymptomatic bacteriuria with 29 percent followed by cystitis 26 percent, pyelonephritis 21 percent and urosepsis 12 percent. There were significant differences between regions and types of hospitals. Indwelling urinary catheter was the most important risk factor," Bjerklund-Johansen pointed out.

However the GPIU-studies showed that the prevalence might be reduced by simple measures. More culture tests were taken in urology departments in 2005 than in previous study years and the prevalence fell from 11 percent in the first study years to 5 percent in 2005. In 2006 more urology departments reported to have authorised infection control programmes than in the first studies. "These data are, however, awaiting final statistical analysis before publication but we believe these are signs that our quality improvement initiative is effective", says Bjerklund Johansen.

"For E. coli," Bjerklund-Johansen underlined, "there seemed to be increasing resistance as one moves from west to east, as illustrated by the lowest resistance to cefuroxime in Germany of 6 percent and the highest resistance to co-trimoxazol of 88 percent in Asia. Turkey and Asia had the highest resistance to all of the most commonly used antimicrobials."

"Combinations of antibiotics were most frequently used in Russia, where fluoroquinolones were given to 42 percent of patients," Bjerklund-Johansen summarised. Aminoglycosides were also most frequently used in Russia (26 percent) while cephalosporins were mostly used in Asia (48 percent). Only 3.9 percent of German patients received aminoglycosides for treatment. Differences between countries and regions were highly significant.

28 March - Prof. Cora Sternberg (Rome, IT) - New insights in bladder cancer

Professor Sternberg stated that perioperative chemotherapy in muscle-invasive bladder cancer possibly enhances survival or could be a new strategy for bladder preservation.

There is an ongoing debate on perioperative chemotherapy in muscle-invasive bladder cancer. "A retrospective meta-analysis of randomized studies of neoadjuvant and adjuvant chemotherapy has revealed a 5 percent improvement in survival with neoadjuvant cisplatin-based combination chemotherapy," Sternberg stated. Urologists wonder whether all patients should be treated with chemotherapy. A multidisciplinary approach, Sternberg added, with either neoadjuvant chemotherapy alone or in combination with radiation therapy has been advocated, but randomised trials have not compared this approach with cystectomy.

Sternberg reported on serious problems with the interpretation of results from analyses of randomised adjuvant chemotherapy trials after cystectomy for pT3 to T4a and/or pN(+)MO disease. "A retrospective meta-analysis of randomised adjuvant chemotherapy trials is hampered due to small patient numbers and underpowered survival curves," Sternberg pointed out. She encouraged the urologic oncology community to "actively support recruitment to ongoing adjuvant chemotherapy trials".

Sternberg is convinced that a neoadjuvant therapy before cystectomy for muscle-invasive bladder cancer provides an important paradigm and an interesting approach in developing novel agents. Unfortunately long-term outcomes for advanced urothelial cancer did not prove to be optimal. "Salvage therapy is an unmet need," Sternberg summarized.

From Sternberg`s point of view a multidisciplinary approach and collaboration among laboratory scientists, oncologists, urologists and radiation oncologists is needed to make therapeutic advances.

"One of the most important ongoing studies at this moment," Cora N. Sternberg, MD underlined during today's Meet-the-expert session, "is the phase III randomized trial in muscle-invasive bladder cancer." The EORTC trial 30994 compares immediate adjuvant chemotherapy with deferred management in patients with pT3, T4 N+ disease after radical cystectomy.

This study is coordinated by Prof. C. Sternberg for the GU group. "There is no good evidence from the trials. Metanalyses are very underpowered," Sternberg pointed out. Today there is no evidence that chemotherapy after cystectomy makes sense. It should be clear after the study, Sternberg underlined. 300 patients from many European countries and Canada are involved. However 600 patients are needed to finalize this important study.

Inflammation in prostate cancer - Prof. Jan-Erik Damber (Göteborg, SE)

In 1863, Rudolf Ludwig Karl Virchow (1821 - 1902, the Father of pathology) noted leucocytes in neoplastic tissues and made a connection between inflammation and cancer. Chronic inflammation is associated with the development of malignancy in organs such as esophagus, stomach, colon, liver and bladder. Inflammation incites carcinogenesis by causing cell and genome damage, promoting cellular turnover, and creating a tissue microenvironment that can enhance cell replication, angiogenesis and tissue repair. Recently, more and more studies suggested a link between chronic inflammation and prostate cancer. Damber indicated that pathologically, inflammatory infiltrates are commonly found in prostate cancer tissues of transurethral radical prostatectomy specimens, biopsy specimens and prostatectomy specimens. Epidemiologically, prostate cancer seems related to prostatitis and sexually transmitted infections/diseases. The cause of prostate inflammation can be viral and bacterial infections, hormonal changes, physical, chemical trauma, among others, Damber explained.

Although it is still a hypothesis that inflammation associates with the prevalence of prostate cancer, Damber and coworkers evaluated the association of COX-2 (cyclooxygense-2) expression with the local chronic inflammation within prostate cancer and the increased angiogenesis. Their study shows that the pro-inflammatory cytokines, released by T-lymphocytes and macrophages, up-regulate COX-2 in adjacent tumor cells and stimulate the angiogenesis in stromal tissues. According to Damber, COX-2 may be an effective therapeutic target in prostate cancer treatment.

Among the groups worldwide to study this hypothesis, Damber and coworkers belong to the leading groups as reflected by their highly-cited publication in Clinical Cancer Research (2005). Damber indicates the impossibility of inflammation screening because of its subclinical nature. As for prevention, the intake of antioxidant will definitely help, as he indicated at the end that taking vitamins, fruits and vegetables will help prevention. For a thorough understanding of immune suppression and discovery of immune modulating drugs, much more studies are needed.

All in all, these sessions proved to be helpful for media representatives' understanding of the latest developments in the field of urology.