Thousands of urologists, urology nurses, scientists and other professionals in the field converged in Milan, Italy, in March for the 38th Congress of the European Association of Urology (EAU). Under spring sunshine in the shadow of the Tre Torri, the Allianz MiCo Centre became the focus of the field from 10 March until 13 March 2023.

A vibrant and exciting meeting was the result of a return to its traditional springtime schedule for EAU, which had been disrupted by COVID-19 since 2019. The Allianz MiCo centre, Europe’s largest convention centre, provided a fitting location for the congress, which was attended by nearly 10,000 participants (9,219 on-site registrations and 581 virtual registrations) at the 270 sessions. This meeting also expanded patient involvement in the congress (with a dedicated ‘Patient Day’), as well as hosting the EAU Nurses (EAUN) meeting and the International Congress on the History of Urology, which was timed to coincide with the end of the Association’s 50th anniversary celebrations. Highlights of this meeting included a talk from Prof. Pat Walsh, who described his discovery, alongside Prof. Pieter Donker, of periprostatic nerves, which led to the development of nerve-sparing prostatectomy in 1982.

Credit: A. Fenner

As usual, the meeting was also host to announcements from a number of large studies, including the 15-year follow-up data from the ProtecT Trial, which investigated outcomes after surgery, monitoring or radiotherapy for prostate cancer. The 15-year follow-up data were available for over 1,600 patients, 98% of the cohort. Death from prostate cancer rates were similar across all treatment groups, occurred in 45 men overall (2.7%); 17 of these (3.1%) were in the active-monitoring group, 12 (2.2%) were in the prostatectomy group, and 16 (2.9%) were in the radiotherapy group (P = 0.53). Thus, the ProtecT Study Group recommend a greater emphasis on balancing the risk and benefits of each treatment option for a particular patient.

In the realm of renal cancer, data were presented from the phase III ZIRCON study, which investigated 89Zr-DFO-girentuximab for PET–CT imaging of clear cell renal cell carcinoma (ccRCC). Girentuximab, a chimeric monoclonal antibody, has a high affinity for carbonic anhydrase IX (CAIX), which is highly expressed in ccRCC, meaning that this technique, using the labelled antibody (TLX250-CDx), could be helpful for differentiation of ccRCC from other types of renal lesions in the setting of indeterminate renal masses (IDRMs). Overall, the data confirm that TLX250-CDx PET–CT is well tolerated and accurate for noninvasive identification of ccRCC in the setting of IDRMs. This noninvasive approach could be a valuable addition to the diagnostic workup of patients with IDRMs, with the benefit of reducing the need for biopsies or unnecessary treatment of benign tumours.

An interesting plenary session on day 3 focused on the role of the microbiome and the development of genitourinary cancers. Chaired by experts Prof. Florian Wagenlehner and Prof. Mesrur Selçuk Silay, this session also considered the effective management of urosepsis. Highlights of the session included a state-of-the-art lecture from Prof. Andrea Alimonti discussing how the intratumoural microbiome could influence prostate cancer development, as well as conflicting evidence for a role of the microbiome in bladder cancer. The second state-of-the-art lecture of the session, from Dr Zafer Tandoğdu, considered the recognition of urosepsis and the use of early warning scores in this setting. The Société Internationale d’Urologie (SIU) Recognition Award lecture, presented by Dr A. Lenore Ackerman, complemented this talk and was entitled ‘A nightmare for urologists: How to manage urosepsis?’

Outside of the scientific session, this congress also signalled the end of an era, with transfers of power taking place within the society and in its affiliated journals. At the Sunday evening International Friendship Dinner, held at the beautiful Villa Necchi Campiglio, Prof. Chris Chapple, who had held the post of Secretary General of the EAU since 2015 and had completed his second term, formally handed over to his successor, Prof. Arnulf Stenzl. Batons were also passed on the EAU journals, where Prof. Jim Catto, outgoing Editor of European Urology, received a standing ovation for his success on the journal as he handed over to the new Editor-in-Chief Prof. Alberto Briganti.

Overall, the meeting seemed to recapture the excitement and vibrancy of the field that had been sorely missing since the COVID-19-enforced break and bodes well for the future of urology. EAU24 will be held in Paris, 5–8 April 2024.