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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| Personalizing Salvage Radiation and Hormone Therapy for Biochemical Recurrence |
| Daniel Spratt, MD |
| Alicia Morgans speaks with Dan Spratt about his presentation on the management of biochemical recurrence in prostate cancer post-surgery. Dr. Spratt explains the considerations for using hormone therapy alongside salvage radiation, emphasizing the variability in treatment needs based on PSA levels. |
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| EMBARK Trial: Enzalutamide Monotherapy and Combination Therapy for High-Risk Biochemical Recurrence |
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Neal Shore, MD, FACS
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| Alicia Morgans speaks with Neal Shore about managing biochemical recurrence in high-risk patients, particularly following radiotherapy and radical prostatectomy. Discussing findings from the EMBARK trial, Dr. Shore emphasizes that combining enzalutamide with LHRH, or using enzalutamide alone, significantly improves metastasis-free survival compared to leuprolide monotherapy.
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| Advancing Treatment for High-Risk Biochemical Recurrence Prostate Cancer: The ARASTEP Trial |
Alexander Chehrazi-Raffle, MD
Zach Klaassen discusses the ARASTEP trial with Alex Chehrazi-Raffle. The trial focuses on patients with high-risk biochemical recurrence of prostate cancer, specifically those who show positive results on PSMA PET scans but are negative on conventional imaging. |
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| In Patients Who Receive Salvage Radiation Therapy for BCR, Who Needs Additional Systemic Therapy, What and for How Long? |
| Daniel Spratt, MD |
| Daniel Spratt highlighted that additional systemic therapy, specifically hormone therapy (ADT), may not be necessary for all patients receiving salvage radiotherapy for biochemical recurrence (BCR) of prostate cancer. The decision should be personalized, with early salvage radiotherapy (PSA 0.1-0.5 ng/mL) showing no clear survival benefit from ADT, whereas late salvage radiotherapy (PSA ≥ 0.5 ng/mL) may benefit from long-term ADT to improve overall survival. |
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| Are Some Patients with Biochemical Recurrence (After Radiotherapy and/or Radical Prostatectomy) Candidates for Androgen Receptor Antagonist Monotherapy and How to Manage the Systemic Therapy? |
| Neal Shore, MD, FACS |
| Neal Shore discusses the suitability of androgen receptor antagonist monotherapy for patients with biochemical recurrence after radiotherapy or radical prostatectomy. He highlights that while some patients could be candidates for such monotherapy, the management of associated side effects like gynecomastia is crucial. |
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| ARASTEP: Darolutamide plus ADT in Patients with High-Risk Biochemical Recurrence of Prostate Cancer: A Phase 3, Randomized, Double-Blind, Placebo-Controlled Study |
| Alex Chehrazi-Raffle, MD |
| Alex Chehrazi-Raffle presented the ARASTEP trial, a phase 3, randomized, double-blind, placebo-controlled study evaluating darolutamide plus ADT in patients with high-risk biochemical recurrence of prostate cancer. The trial's primary endpoint is radiological progression-free survival, with secondary endpoints including metastasis-free survival, time to CRPC, and overall survival. |
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| COBRA: Assessment of Safety and Efficacy of 64Cu-SAR-bisPSMA in Patients with Biochemical Recurrence of Prostate Cancer Following Definitive Therapy |
| Luke Nordquist, MD |
| Luke Nordquist presented the COBRA study, which assessed the safety and efficacy of 64Cu-SAR-bisPSMA in detecting prostate cancer lesions in patients with biochemical recurrence following definitive therapy. The study demonstrated that 64Cu-SAR-bisPSMA was safe and effective, identifying lesions in up to 80% of patients who had negative or equivocal standard imaging results, and leading to changes in treatment plans for 48% of patients. |
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| Randomized PROSTATE-IQ Trial to Reduce ADT Treatment Burden for Patients with Biochemical Recurrence After Prostatectomy |
| Karen Hoffman, MD, MHSc, MPH |
| Karen Hoffman presented the PROSTATE-IQ trial, which aims to reduce the treatment burden of ADT for men with biochemical recurrence after radical prostatectomy. This randomized, multi-center trial utilizes the ArteraAI Post-RP Test to tailor the intensity of androgen axis treatment, investigating apalutamide-based therapies as an alternative to traditional ADT. The trial's primary outcome is patient-reported fatigue, with secondary outcomes including quality of life, cognitive assessment, and cancer control metrics. |
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| Development and Validation of a MMAI-Derived Digital Pathology-Based Biomarker Predicting Metastasis for Radical Prostatectomy Patients with Biochemical Recurrence in NRG/RTOG Trials |
| Todd Morgan, MD |
| Todd Morgan presents the development and validation of a multimodal artificial intelligence (MMAI)-derived digital pathology-based biomarker for predicting metastasis in radical prostatectomy patients with biochemical recurrence. Using digitized tumor samples from two phase III trials, the MMAI model was trained and validated to predict distant metastasis, demonstrating significant associations with long-term outcomes such as distant metastasis, prostate cancer-specific mortality, and overall survival. |
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| Predicting Positive 68Ga-PSMA PET/CT Scans in Biochemical Recurrence Following Prostatectomy |
| Maya Ataya, MD |
| Maya Ataya presented a retrospective study examining the factors associated with positive 68Ga-PSMA PET/CT scans in patients experiencing biochemical recurrence following radical prostatectomy. The study analyzed data from 815 patients, of which 542 had BCR post-RP. Among these, 339 had positive PSMA-PET scans. Significant predictors of a positive scan included a PSA value ≥0.2 and ISUP grade ≥3, while the time since treatment was not a significant predictor. |
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