Prostate cancer remains one of the most prevalent malignancies threatening men’s health worldwide. A major research focus today lies in developing accurate screening and diagnostic strategies that minimize the invasiveness and psychological burden of biopsy procedures. Landmark studies like SMART and PRECISION aim to address these challenges. At the 2025 European Association of Urology (EAU) Annual meeting, Professor Chiu Ka Fung Peter from the Department of Urology at The Chinese University of Hong Kong presented the latest findings from the SMART study. Following his presentation, Professor Chiu spoke with UroStream to share key updates in prostate cancer diagnostics and care.01 UroStream: You had multiple studies accepted for oral and poster presentation at this year’s EAU conference. Could you share the key findings?
Professor Chiu Ka Fung Peter: Thank you for the interview. I’m Dr. Chiu Ka Fung from the Chinese University of Hong Kong. I’m glad to share our key abstract, the SMART study, a randomized controlled clinical trial comparing two prostate cancer screening strategies, similar to the PRECISION study published in the NEJM.
We conducted two screening strategies In our study,one strategy uses mpMRI first, with targeted biopsies only if suspicious lesions (PI-RADS score ≥3) are found (MRI group). The other uses transperineal systematic biopsy (TP group). While the PRECISION study found transrectal systematic biopsy inferior to MRI – guided strategy for cancer detection(the MRI group had a lower rate of clinically insignificant cancer, with a difference of -13 percentage points; 95% CI, -19 to -7; P<0.001), our study shows the MRI – first approach were comparable with transperineal biopsy in detecting clinically significant prostate cancer (csPCa)(25.1% vs 29.0%,absolute difference 3.9%,95%CI:-11.9%，4.1%;P=0.34). Notably, the MRI – first approach reduces unnecessary biopsies by about 45.2%( In MRI-arm, 45.2% had PI-RADS score ≤2 and avoided biopsy), a major patient benefit. Transperineal biopsy is a good alternative if MRI resources are limited or there are long waiting times. This is our study’s core message.
02 UroStream: Your research includes prostate cancer, like reporting mHSPC treatment from the PIONEER big data alliance. This large real-world study mainly utilized data from European and American countries, with Hong Kong being a crucial Asian hub. Could you introduce the key insights this study has brought to the treatment of mHSPC?
Professor CHIU Ka Fung Peter: It’s very important to recognize that the treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) has changed significantly in the past five years. Previously, we treated patients with androgen deprivation therapy (ADT) alone. But now, over the last five to ten years, the standard has evolved to combination treatments—either doublet or even triplet therapies.
In our study, we are proud that the Chinese University of Hong Kong is the first site outside Europe to join the PIONEER Big Data platform for prostate cancer, which is the world’s largest database for advanced prostate cancer.One of our initial findings is that over 40%, and in some cases up to 50%, of patients—whether in Europe, the U.S., or Asia—are still receiving ADT alone, even though guidelines now recommend doublet or triplet therapy. So, there’s still a lot of work to be done. This data gives us a clear insight into the gaps and highlights what we could do better to optimize care for our patients.
03 UroStream: How can we look forward to the future of precision diagnosis of prostate cancer?
Professor CHIU Ka Fung Peter: At our center, we have developed a novel system using AI assistance to automatically diagnose prostate cancer on MRI prostate scans. By simply uploading the films into the software, it can identify where the prostate and tumor are.The accuracy of the AI is comparable to that of a radiologist’s interpretation. It not only helps us diagnose prostate cancer via MRI, but also allows us to precisely target biopsies — improving diagnostic accuracy and reducing unnecessary interventions.
I believe AI-guided tools for radiology and MRI interpretation will become more common and eventually be adopted in hospitals worldwide. This will be the future of precision prostate cancer diagnosis.
Dr. CHIU Ka Fung Peter
MBChB (CUHK), FRCSEd (Urol), FCSHK, FHKAM (Surg)
- Clinical Associate Professor, The Chinese University of Hong Kong
- President, Hong Kong Urological Association (since 2022)
- Member, EAU Young Urologists Office – Prostate Cancer Working Group
- Board Member, uCARE Research Council, Société Internationale d’Urologie (SIU)
- Editorial Board Member, International Journal of Urology
- Associate Editor, Frontiers in Surgery – Urology Section
- Associate Editor, Grand Rounds in Urology
Reference
[1]Chiu P.K-F.,et al.A multi-center randomized controlled trial comparing the detection of clinically significant prostate cancer by MRI-targeted approach versus 24-core transperineal systematic biopsy: Final results of the SMART trial. EAU25,abstract A0746
[2]Kasivisvanathan V, Rannikko AS, Borghi M, et al. MRI-Targeted or Standard Biopsy for Prostate-Cancer Diagnosis. N Engl J Med. 2018;378(19):1767-1777. doi:10.1056/NEJMoa1801993
[3]Liu A.Q., et a.Differences in baseline characteristics and medication profiles in mHSPC patients based on real world evidence: PIONEER 2.0 Big Data Consortium for prostate cancer. EAU25,abstract P183
