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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| Integrating Genomic Testing with MRI Enhances Stratification of Surveillance Patients |
Mark Sultan, MD, and Eric Kim, MD
Mark Sultan and Eric Kim discuss research on predicting prostate cancer progression during active surveillance using Decipher® genomic classifier scores and MRI characteristics. Their study reveals that while both high Decipher® scores and high-risk MRI findings independently predict progression, these markers are weakly correlated, suggesting they capture distinct risk information
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HIGHLIGHTS FROM THE 2024 SOCIETY OF UROLOGIC ONCOLOGY ANNUAL MEETING
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| Clinical Progression of Prostate Cancer from Active Surveillance is Predicted by Decipher® Genomic Classifier Score on Index Biopsy Independent from Risk Assessment by MRI Characteristics |
| Mark I. Sultan MD
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| Mark Sultan presented findings showing that the Decipher® Genomic Classifier (GC) score on the index biopsy is an independent predictor of clinical progression in prostate cancer patients on active surveillance, regardless of mpMRI findings. While mpMRI (PI-RADS 4-5 lesions) was associated with progression, the Decipher® GC score ≥0.45 was a stronger and independent predictor, suggesting its utility in refining risk stratification and supporting an individualized approach to active surveillance.
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| Prostate Cancer Screening with Biomarkers and MRI–A European Perspective |
| Tobias Nordström, MD |
| Tobias Nordström provided a comprehensive discussion on Prostate Cancer Screening with Biomarkers and MRI, presenting a European perspective on early detection strategies. He highlighted several key studies, including the Göteborg trial and ERSPC, which demonstrated that PSA screening significantly reduces prostate cancer mortality, though with contradictions in some studies like the PLCO trial, where no significant reduction in mortality was seen after 17 years. Dr. Nordström also discussed the ProScreen trial in Finland, where the addition of mpMRI and biomarker panels helped identify high-grade cancers with a relatively low number of screenings required. |
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| Characteristics, Treatment Patterns, and Outcomes of African American Versus Caucasian Patients with Metastatic Castration-Resistant Prostate Cancer: Post Hoc Analysis of TRUMPET Registry |
| Clara Hwang, MD |
| Clara Hwang presented a post hoc analysis of the TRUMPET Registry, comparing African American and Caucasian patients with metastatic castration-resistant prostate cancer (mCRPC). The study found that African American patients were younger, had more comorbidities, and received androgen receptor pathway inhibitors (ARPIs) and chemotherapy more often than Caucasians, who were treated more with radionuclides and immunotherapy. |
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| A Phase III Study of 177Lu-TLX591 plus Standard-of-Care Versus Standard-of-Care Alone in Patients with mCRPC (PROSTACT GLOBAL) |
| Scott T. Tagawa, MD, MS, FACP |
| Scott Tagawa presented the PROSTACT GLOBAL phase III trial, evaluating 177Lu-TLX591 (a PSMA-targeted radio-antibody drug conjugate) combined with standard-of-care (SOC) versus SOC alone in patients with metastatic castration-resistant prostate cancer (mCRPC). This ongoing trial includes 430 patients who have progressed on prior androgen receptor pathway inhibitors, with the primary endpoint of radiographic progression-free survival. |
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| Mevrometostat (PF-06821497) in Combination with Enzalutamide in Patients with Metastatic Castration-Resistant Prostate Cancer Previously Treated with Abiraterone Acetate: The Phase III Randomized Enz Study |
| Neeraj Agarwal, MD, FASCO |
| Neeraj Agarwal presented the MEVPRO-1 phase III trial, exploring the combination of mevrometostat (PF-06821497), an EZH2 inhibitor, with enzalutamide in patients with metastatic castration-resistant prostate cancer (mCRPC) who had been previously treated with abiraterone acetate. This global, randomized, open-label trial involves 600 patients and aims to assess whether adding mevrometostat can overcome resistance to androgen receptor pathway inhibitors, with the primary endpoint being radiographic progression-free survival. |
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| MK-5684-003: A Phase 3 Study of CYP11A1 Inhibitor Opevesostat Versus Next-Generation Hormonal Agent (NHA) Switch in Metastatic Castration-Resistant Prostate Cancer After NHA and Taxane-Based Chemotherapy |
| Evan Yu, MD |
| Evan Yu presented the design of the MK-5684-003 phase 3 trial, investigating the CYP11A1 inhibitor opevesostat (MK-5684) in patients with metastatic castration-resistant prostate cancer (mCRPC) who had progressed after receiving both novel hormonal agents (NHAs) and taxane-based chemotherapy. Opevesostat works by inhibiting CYP11A1, a key enzyme in steroid biosynthesis, which can reduce androgen receptor (AR) signaling and combat resistance to AR-targeted therapies. |
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| Phase III MK-5684-004 Study of CYP11A1 Inhibitor Opevesostat versus Next-generation Hormonal Agent Switch in Patients with Metastatic Castration-resistant Prostate Cancer after 1 Prior Next-generation Hormonal Agent |
| Christian Gratzke, MD |
| The MK-5684-004 phase 3 trial, presented at the 2024 SUO Annual Meeting, is evaluating the CYP11A1 inhibitor opevesostat in patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after one prior next-generation hormonal agent. The trial aims to compare the efficacy of opevesostat versus a switch to another NHA (abiraterone acetate or enzalutamide) in improving radiographic progression-free survival and overall survival. Secondary outcomes include time to progression on pain, PSA, and skeletal-related events, along with safety assessments. |
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| Evaluation of Response to 177Lu-PSMA-617 by Site Specific Disease in Metastatic Castrate-Resistant Prostate Cancer |
| Mohamed Ahmed, MD |
| Mohamed Ahmed presented a study assessing the response to 177Lu-PSMA-617 in patients with mCRPC, focusing on disease site. The retrospective analysis of 273 patients treated at the Mayo Clinic from April 2022 to September 2023 found that patients with lymph node-only disease had a better response to treatment, with higher PSA50 responses, lower post-treatment PSA levels, and a reduced likelihood of radiographic disease progression compared to those with bone-only disease. |
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| Comparative Analysis of PSMA-PET Imaging in Detecting Radio-Recurrent Prostate Cancer Above and Below Phoenix Criteria Thresholds |
| Umar Ghaffar, MD |
| Umar Ghaffar presented a study comparing the efficacy of PSMA-PET imaging in detecting biochemical recurrence (BCR) in prostate cancer patients, both above and below the Phoenix criteria threshold. The analysis found that PSMA-PET demonstrated high sensitivity in detecting lesions even in patients with PSA levels below 0.5 ng/ml, which is typically challenging for conventional imaging. Additionally, lesions identified in patients below the Phoenix threshold had a higher likelihood of being amenable to salvage therapies, highlighting the potential of PSMA-guided treatment in early-stage recurrent disease. |
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