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PEER-TO-PEER CLINCIAL CONVERSATIONS |
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| Novel Hormone Therapy and Coordination of Care in High-Risk Biochemically Recurrent Prostate Cancer |
Jason A. Efstathiou, MD, DPhil, and Alicia Morgans, MD, MPH
In this review, Jason Efstathiou and Alicia Morgans discuss challenges associated with Biochemical recurrence (BCR) management and explore the potential benefits and opportunities of multidisciplinary care (MDC) and treatments based on optimizing risk stratification. |
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| Biochemical Recurrence in Patients with Prostate Cancer after Primary Definitive Therapy: Next-Generation Imaging and Treatment Based on Risk Stratification - Beyond the Abstract |
Judd W. Moul, MD, and Neal Shore, MD, FACS
Biochemical recurrence (BCR) occurs in about one-third of prostate cancer patients after primary definitive therapy, with next-generation imaging (NGI) technologies offering improved sensitivity for detection at low PSA levels compared to conventional methods. |
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| Olaparib plus Abiraterone Versus Placebo plus Abiraterone in Metastatic Castration-Resistant Prostate Cancer (PROpel): Final Prespecified Overall Survival Results of a Randomised, Double-Blind, Phase 3 Trial |
| Fred Saad, MD, FRCS |
| PROpel met its primary endpoint showing statistically significant improvement in radiographic progression-free survival with olaparib plus abiraterone versus placebo plus abiraterone in patients with first-line metastatic castration-resistant prostate cancer (mCRPC) unselected by homologous recombination repair mutation (HRRm) status, with benefit observed in all prespecified subgroups. |
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| Sequential [177Lu]Lu-PSMA-617 and Docetaxel Versus Docetaxel in Patients with Metastatic Hormone-Sensitive Prostate Cancer (UpFrontPSMA): A Multicentre, Open-Label, Randomised, Phase 2 Study - Beyond the Abstract |
| Arun Azad, PhD & Michael Hofman, MBBS, FRACP, FAANMS, FICIS, GAICD |
| The UpFrontPSMA trial demonstrated that [177Lu]Lu-PSMA-617 followed by docetaxel significantly improved undetectable PSA rates, PSA progression-free survival, and freedom from castration resistance compared to docetaxel alone in patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC). |
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| Comparison of 18F-Based PSMA Radiotracers with [68Ga]Ga-PSMA-11 in PET/CT Imaging of Prostate Cancer - A Systematic Review and Meta-Analysis - Beyond the Abstract
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| Siyu Huang, MSD
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| This systematic review and meta-analysis compared 18F-based PSMA radiotracers with [68Ga]Ga-PSMA-11 for PET/CT imaging in prostate cancer. [18F]DCFPyL was found to have high concordance and similar lesion SUVmax to [68Ga]Ga-PSMA-11, making it a suitable alternative. While [18F]PSMA-1007 demonstrated higher locoregional lesion detection, its high benign bone uptake could lead to diagnostic challenges. The study highlights the need for further evidence to evaluate clinical impact and logistical factors, such as production and distribution challenges with Gallium-68.
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| Impact of Concomitant Cardiovascular Therapies on Efficacy and Safety of Relugolix vs Leuprolide: Subgroup Analysis from the HERO Study in Advanced Prostate Cancer - Beyond the Abstract
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| Neal D. Shore, MD, FACS
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| This HERO trial subgroup analysis found that relugolix maintained consistent efficacy in suppressing testosterone levels in advanced prostate cancer patients receiving concomitant CV medications, similar to the overall population. While both relugolix and leuprolide had manageable side effect profiles, relugolix showed fewer CV-related fatal adverse events, supporting its use as a safer ADT option for patients with high CV risk. However, certain subgroups, particularly those on antithrombotics or lipid-modifying agents, experienced higher rates of serious adverse events.
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Combination of PARP Inhibitors and Androgen Receptor Pathway Inhibitors in Metastatic Castration-Resistant Prostate Cancer - Beyond the Abstract
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| Louise Kostos, and Arun A. Azad, MBBS, PhD, FRACP |
| Combination therapy with PARPis and ARPIs in mCRPC has demonstrated therapeutic synergy, particularly in patients with BRCA or homologous recombination repair (HRR) mutations. Phase III trials (PROpel, MAGNITUDE, TALAPRO-2) showed significant rPFS benefits in HRR-mutant populations, with BRCA-mutant patients deriving the greatest advantage. While toxicity, especially anemia, was a concern, early HRR mutation testing is critical to guide treatment, and ongoing trials aim to refine patient selection and optimize therapeutic strategies. |
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Development of a Visually Calculated SUVmean (HIT Score) on Screening PSMA PET/CT to Predict Treatment Response to 177Lu-PSMA Therapy: Comparison with Quantitative SUVmean and Patient Outcomes - Beyond the Abstract
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| Mina Swiha, MD, PhD |
| 177Lu-PSMA therapy is an effective treatment in patients with metastatic castration-resistant prostate cancer. SUVmean is a valuable screening biomarker to assess the suitability for 177Lu-PSMA therapy but requires quantitative software. |
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OncoTherad® (MRB-CFI-1) Nanoimmunotherapy: A Promising Strategy to Treat Bacillus Calmette-Guérin-Unresponsive Non-Muscle-Invasive Bladder Cancer - Beyond the Abstract
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| João Carlos Cardoso Alonso, PhD and Wagner José Fávaro, PhD |
| OncoTherad® (MRB-CFI-1) nanoimmunotherapy represents a promising, non-surgical treatment for Bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC), addressing a critical gap in managing patients who are not candidates for radical cystectomy. In a phase I/II study involving 44 patients, OncoTherad® demonstrated high pathological complete response rates (100% at 6 months, 72.7% at 24 months) and a mean relapse-free survival of 21.4 months, with manageable safety profiles dominated by mild adverse events. |
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| Patterns of Treatment of High-Risk BCG-Unresponsive Non-Muscle Invasive Bladder Cancer (NMIBC) Patients Among Arab Urologists - Beyond the Abstract |
| Mohamad Abou Chakra, MD, Neal D. Shore, MD, FACS, & Michael A O'Donnell, MD |
| A survey of Arab urologists highlighted significant challenges in managing high-risk BCG-unresponsive NMIBC, with 68% reporting persistent BCG shortages. Radical cystectomy was the most favored treatment (50%), contrasting with lower rates in other regions like the US. While intravesical sequential doublet chemotherapy (SDC) options like gemcitabine/docetaxel and gemcitabine/mitomycin C are gaining traction globally as affordable and effective alternatives, their adoption in Arab countries varies, influenced by economic disparities. |
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The Spectrum of Cutaneous Toxicities Related to Novel Genitourinary Cancer Therapies - Beyond the Abstract
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| Rachel Daher, Andrew Ruplin, Shilpa Gupta et al. |
| Advances in genitourinary cancer therapies, including immune checkpoint inhibitors, antiangiogenic agents, and novel drugs like enfortumab vedotin and erdafitinib, have improved outcomes but introduced diverse dermatologic adverse events (AEs). Common AEs include rashes, pruritus, and alopecia, while severe reactions like Stevens-Johnson syndrome and unique manifestations like hand-foot skin reactions and onycholysis are therapy-specific. A multidisciplinary approach involving dermatologists and oncologists is vital for managing these AEs, preserving treatment adherence, and improving patient care. |
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Stereotactic Body Radiotherapy (SBRT) for the Treatment of Primary Localized Renal Cell Carcinoma: A Systematic Review and Meta-Analysis - Beyond the Abstract
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| Agata Suleja, MD, Marcin Miszczyk, MD and Shahrokh F. Shariat, MD |
| Stereotactic body radiotherapy (SBRT) offers a promising non-invasive alternative for patients with localized renal cell carcinoma (RCC) who are ineligible for or decline surgery. A meta-analysis of 13 trials involving 308 patients demonstrated high local tumor control up to three years post-treatment and low rates of severe adverse events (3%). While surgical management remains the standard of care, SBRT's safety, efficacy, and accessibility at tertiary centers highlight its potential as a personalized treatment option, particularly for patients unfit for surgery. |
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Thermal Ablation versus Partial Nephrectomy for cT1 Renal Mass in a Solitary Kidney: A Matched Cohort Comparative Analysis - Beyond the Abstract
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| Carlos Munoz-Lopez & Steven C. Campbell, MD, PhD |
| A matched cohort analysis comparing thermal ablation (TA) and partial nephrectomy (PN) for treating cT1 renal mass in a solitary kidney (RMSK) showed that while TA offered better functional outcomes (preserving more renal function), it had weaker local disease control compared to PN. Local recurrence-free survival at five years was significantly lower for TA (62%) than PN (86%). Despite similar cancer-specific survival, the study emphasized the importance of careful patient selection for TA, particularly considering factors like tumor multifocality and the approach used, as local recurrence was more common with older laparoscopic TA methods. |
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Immunomodulatory Response to Neoadjuvant Nivolumab in Non-Metastatic Clear Cell Renal Cell Carcinoma - Beyond the Abstract
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| Nirmish Singla, MD, MSCS, FACS, |
| A phase I trial investigating neoadjuvant nivolumab in high-risk, non-metastatic ccRCC found that PD-1 inhibition induced an inflammatory state in the primary tumor, with nivolumab binding to tumor-infiltrating lymphocytes (TILs). The study revealed that baseline immune infiltration predicts better response to nivolumab, with more inflamed tumors showing improved outcomes. Although 3 cycles of nivolumab alone did not achieve pathologic complete responses, the findings suggest potential for combining neoadjuvant PD-1 inhibition with adjuvant therapies, as nivolumab exposure increased markers like CTLA-4 on TILs and circulating sPD-L1, which are targetable for future combination strategies. |
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