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PEER-TO-PEER CLINICAL CONVERSATIONS
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Epidemiology Applied to Focal Therapy in Prostate Cancer: Where Do We Stand?
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Kae Jack Tay, MBBS, MRCS, MMed, MCI, FAMS
Zach Klaassen interviews Jack Tay about the evolution and current practices in focal therapy for prostate cancer. Dr. Tay discusses the precision and reduced toxicity offered by focal therapy, which targets only cancerous tissues within the prostate, sparing non-cancerous areas.
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| Integrating Genetic Variants and Clinical Factors for Improved Prostate Cancer Prognostication |
Susan Halabi, MD
Susan Halabi discusses her presentation on prognostic factors in metastatic castration-resistant prostate cancer based on the Alliance trial. The phase three trial, which enrolled 1,311 patients, compared the effects of enzalutamide alone to enzalutamide combined with abiraterone and prednisone. |
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| The Biological Basis of Metastatic Prostate Cancer – The Unmet Medical Need for New Targets and Novel Treatment Pathways |
| Daniel George, MD |
| Dan George joins Alicia Morgans as part of an online medical education program, Beyond Androgen Blockade to new pathways and novel treatments in metastatic hormone-sensitive prostate cancer and metastatic castration-resistant prostate cancer. He discusses the biological basis of metastatic CRPC, the unmet medical need for new targets and treatments |
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| How to Select Patients with Biochemical Relapse in Whom Salvage Radiation Therapy Can Be Postponed?
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| Barbara Jereczek-Fossa, MD, Ph.D.
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| Barbara Jereczek-Fossa highlightes criteria for postponing salvage radiation therapy (SRT) in patients with biochemical relapse of prostate cancer. Key considerations include EAU risk categories, genomic classifiers, and AI-based assessments. She stressed that low-risk patients, particularly those with favorable imaging and genomic profiles, might safely defer SRT, though regular follow-up is essential to avoid missing the optimal treatment window.
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| When to Do Tumor Genomic Profiling in Advanced Prostate Cancer and What?
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| Niven Mehra, MD, Ph.D.
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| Niven Mehra discusses the optimal timing and methods for tumor genomic profiling in advanced prostate cancer. He emphasized the importance of profiling at different disease stages using archived or fresh tissue and liquid biopsies. Key genes to test include BRCA1, BRCA2, HRR, and others, with the potential need for re-testing at progression to identify new actionable mutations.
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| How to Identify Aggressive Variant Prostate Cancer?
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| Himisha Beltran, MD
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| Himisha Beltran discusses the identification of aggressive variant prostate cancer (AVPC), characterized by specific genomic alterations (such as TP53, and distinct clinical features (like exclusive visceral metastases and low PSA with high-volume bone metastases). Identifying AVPC is essential for treatment intensification, and detection methods include genomic sequencing, immunohistochemistry, and advanced imaging techniques.
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| How to Treat Men with Aggressive Variant or Neuroendocrine Prostate Cancer |
| Andrew Armstrong, MD, ScM, FACP |
| Andrew Armstrong discusses treating aggressive variants and neuroendocrine prostate cancer, highlighting the lack of level 1 evidence for systemic therapy choices. Current NCCN guidelines recommend platinum-based chemotherapy combinations, which offer modest short-term responses. The treatment challenge lies in distinguishing neuroendocrine variants from other aggressive types and understanding their genomic profiles, with ongoing clinical trials exploring novel therapies and combination approaches to improve outcomes. |
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