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PEER-TO-PEER CLINICAL CONVERSATIONS |
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The STEEL Trial: Evaluating Enzalutamide Plus ADT with Salvage RT for High-Risk Recurrent Prostate Cancer
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Edwin Posadas, MD
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| Edwin Posadas delves into the complexities and aspirations of the STEEL RTOG 3506 trial, a study initiated as a follow-up to the RTOG 9601 trial's insights into androgen ablation's role in improving outcomes for men undergoing salvage radiation therapy post-biochemical relapse.
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Advancing Prostate Cancer Care: The EMBARK Study and Implications for Clinical Practice
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Stephen J. Freedland, MD
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| Daniel George and Stephen Freedland delve into the EMBARK study, a trial on Enzalutamide for high-risk non-metastatic biochemical recurrence of prostate cancer. They explore the approach of using Enzalutamide, both in combination with Leuprolide and as monotherapy, highlighting its significant impact on metastasis-free survival.
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| Guideline Revisions Seek to Optimize Detection and Management of Recurrent Prostate Cancer Without Evident Metastasis, Journal Club |
Rashid Sayyid, MD, MSc, and Zachary Klaassen, MD, MSc
Rashid Sayyid and Zach Klaassen discuss the amended AUA guidelines on advanced prostate cancer, focusing on biochemically recurrent prostate cancer without metastasis after local treatment. |
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| PSA Persistence After Radical Prostatectomy: Optimal Treatment in the Case of PSA Persistence
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| Nick James, MBBS, PhD
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| Nick James discusses the optimal treatment for PSA persistence following radical prostatectomy. He emphasized that treatment decisions depend on prior surgical history, surgical pathology, and imaging availability. Evidence from the RADICALS trials suggests delaying radiotherapy until clear disease progression to minimize toxicity, and the addition of long-term ADT may improve metastasis-free survival. The complexity of relapse patterns and the importance of imaging, particularly PSMA PET, were highlighted for guiding treatment in this setting.
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| Which Patients with High-Risk First BCR after Radical Prostatectomy Are Candidates for Systemic Therapy Alone Without Local Salvage Radiotherapy? |
| Bertrand Tombal, MD, Ph.D. |
| Bertrand Tombal discusses the management of high-risk first BCR after radical prostatectomy, questioning the necessity of local salvage radiotherapy when systemic therapy may suffice. He highlights that while EAU guidelines recommend early salvage radiotherapy, particularly for patients with a PSA > 0.2 ng/mL, recent evidence suggests that systemic therapy alone, especially with androgen receptor-targeted agents like enzalutamide, may be effective in improving metastasis-free survival in high-risk patients. |
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| Baseline Characteristics of Patients with PSMA-PET-Positive and –Negative Disease with High-Risk of BCR After RP in the Ongoing Phase 3 PRIMORDIUM Study |
| Boris Hadaschik, MD |
| Boris Hadaschik presented baseline characteristics from the ongoing phase 3 PRIMORDIUM study, which investigates high-risk biochemical recurrence after radical prostatectomy using PSMA-PET imaging. The study includes both PSMA-PET–positive and –negative patients, with the positive group randomized to either standard treatment (whole pelvic salvage radiotherapy plus LHRH agonist) or an intensified regimen with added apalutamide. |
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| Real-World Treatment Patterns for Patients with High-Risk Biochemically Recurrent Nonmetastatic Castration-Sensitive Prostate Cancer
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| Stephen Freedland, MD
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| Stephen Freedland presents findings from a real-world analysis of treatment patterns in patients with high-risk, biochemically recurrent, nmCSPC. The study analyzed data from 535 patients, collected through the Adelphi Real World nmCSPC retrospective survey, focusing on the first-line treatment strategies following a high-risk biochemical recurrence diagnosis.
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| High-Risk Biochemical Recurrence After Radical Prostatectomy and Negative PSMA PET: What to Do? Systemic Therapy Alone |
| Antti S. Rannikko, MD, PhD, FEBU |
| Antti Rannikko discusses systemic therapy for high-risk biochemical recurrence after radical prostatectomy in patients with a negative PSMA PET scan. He emphasizes that these patients may be beyond the curability window for salvage radiotherapy, making systemic therapy, such as intermittent enzalutamide monotherapy, a key approach to limit harm. The timing of therapy initiation and the role of PET imaging in guiding treatment were also highlighted as critical considerations. |
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