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PEER-TO-PEER CLINICAL CONVERSATIONS |
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| EMBARK Trial: Age-Stratified Analysis of Enzalutamide in High-Risk Biochemically Recurrent Prostate Cancer |
| Neal Shore, MD, FACS |
| Zach Klaassen interviews Neal Shore about the EMBARK trial's post hoc analysis by age. The study examines the efficacy of enzalutamide alone or combined with leuprolide for high-risk biochemical recurrence in prostate cancer patients. |
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| Impact of a Rash Management Guide in Patients Receiving Apalutamide for High-Risk Localized Prostate Cancer in the Apa-RP Study - Beyond the Abstract |
| Jason Hafron, MD, CMO |
| Based on the SPARTAN and TITAN studies, apalutamide is approved for patients with nonmetastatic castration-resistant and metastatic castration-sensitive prostate cancer. Skin rash was a common adverse reaction across indications. We hypothesized that earlier identification and intervention could improve rash outcomes. |
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| The STEEL Trial: Evaluating Enzalutamide Plus ADT with Salvage RT for High-Risk Recurrent Prostate Cancer |
| Edwin Posadas, MD |
| 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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| Debate: How to Best Manage a Fit Patient with High-Risk Localised and Locally Advanced Prostate Cancer? Surgery as Radical Local Treatment (As Part of a Multimodality Approach) |
| Alberto Briganti, MD, PhD |
| Alberto Briganti argued for surgery as part of a multimodal approach for managing fit patients with high-risk or locally advanced prostate cancer. While surgery allows for a full pathological assessment and tailored post-operative treatments, current guidelines offer only weak support for this approach due to the lack of strong evidence from randomized trials. Surgery's role, especially compared to radiotherapy and ADT, remains uncertain, highlighting the need for future clinical trials. |
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| How to Identify Aggressive Variant Prostate Cancer? |
| Himisha Beltran, MD |
| Himisha Beltran discusses how to identify aggressive variant prostate cancer, a subset of castrate-resistant prostate cancer associated with poor outcomes. AVPC is characterized by specific clinical features such as visceral metastases, low PSA, and mutations in key tumor suppressor genes , leading to resistance to androgen receptor-targeted therapies. New diagnostic tools, including molecular imaging, liquid biopsies, and genetic testing, are being developed to better identify AVPC and guide treatment intensification strategies. |
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| How Do Non-DDR Genomic Alterations Influence Management of Patients with Advanced Prostate Cancer? |
| Ana Aparicio, MD |
| Ana Aparicio discusses the influence of non-DNA damage response (non-DDR) genomic alterations on managing advanced prostate cancer. Although rare, certain mutations, such as RET, NTRK, BRAF, and HER2 overexpression, can be targeted by FDA-approved drugs like selpercatinib, larotrectinib, dabrafenib, and trastuzumab deruxtecan. However, these mutations are uncommon in prostate cancer. |
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| A Comprehensive National Survey of Prostate-Specific Antigen Testing and Prostate Cancer Management in France: Uncovering Regional and Temporal Disparities - Beyond the Abstract
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| Olivier Cussenot, MD, PhD
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| A comprehensive national survey of prostate-specific antigen (PSA) testing and prostate cancer management in France revealed significant regional and temporal disparities. Despite guidelines recommending early PSA testing from age 50, most first tests occurred between ages 65-75, with late diagnoses associated with reduced chances of curative treatment and higher mortality. The study highlighted regional variations in mortality and treatment approaches, such as brachytherapy use and low uptake of initial surveillance, along with an increase in metastatic diagnoses over time.
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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 |
| The COBRA study, presented at SNMMI 2024, assessed the safety and efficacy of 64Cu-SAR-bisPSMA in patients with biochemical recurrence of prostate cancer following definitive therapy. The study found that 64Cu-SAR-bisPSMA is safe, with only one related adverse event, and effective in detecting prostate cancer lesions, identifying lesions in up to 80% of patients with negative or equivocal standard imaging. The detection rate increased on next-day imaging, leading to changes in treatment plans for 48% of patients, underscoring its clinical potential to inform treatment strategies. |
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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 |
| The PROSTATE-IQ trial, presented at ASCO 2024, is a randomized multi-center study aiming to reduce the treatment burden of ADT in patients with biochemical recurrence after radical prostatectomy. It uses the ArteraAI Post-RP Test to classify patients into “Artera Low” and “Higher Risk” groups, and investigates the use of apalutamide-based therapies as a potential alternative to traditional ADT. The primary outcome is patient-reported fatigue, with secondary outcomes including quality of life, cognitive function, body composition, and cancer control measures. |
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