How to cite: Crawford ED and Sellinger SB. CAPItello-281 Trial: PTEN Testing and Treatment in Metastatic Hormone-Sensitive Prostate Cancer. Grand Rounds in Urology. June 2026. Accessed Oct 2026. https://grandroundsinurology.com/capitello-281-trial-pten-testing-and-treatment-in-metastatic-hormone-sensitive-prostate-cancer/
Summary
E. David Crawford, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology at the University of California, San Diego, San Diego, California, and Scott B. Sellinger, MD, FACS, Advanced Urology Institute, Tallahassee, Florida, review the CAPItello-281 trial and its implications for patients with PTEN-deficient metastatic hormone-sensitive prostate cancer.
The discussion focuses on PTEN, a tumor suppressor gene that can be lost to varying degrees in metastatic prostate cancer. Dr. Sellinger notes that patients with greater PTEN loss often have more aggressive disease characteristics and shorter times to castration resistance. He suggests that patients with the highest degree of PTEN loss may be particularly relevant candidates for therapies targeting the AKT pathway.
The speakers discuss the practical implementation of PTEN testing. Dr. Sellinger notes that PTEN status can be evaluated through somatic testing and immunohistochemical analysis and explains that clinicians may need to become more deliberate about requesting PTEN-specific information as treatment options expand. The conversation also reviews management of adverse events, including hyperglycemia, rash, gastrointestinal toxicity, and diarrhea.
Dr. Crawford and Dr. Sellinger consider future biomarker-driven treatment strategies and the expanding role of precision medicine in metastatic hormone-sensitive prostate cancer.
ABOUT THE AUTHOR
Researcher-physician E. David Crawford, MD, has devoted his medical career to educating the public about men's health issues and finding effective techniques and procedures to address prostate cancer, the most common malignancy affecting men in the United States. He is currently a Professor of Urology and Jack A. Vickers Director of Prostate Research at the University of California, San Diego. Dr. Crawford earned his MD from the University of Cincinnati and his postgraduate training, which included an internship and residency in Urology, at the Good Samaritan Hospital in Cincinnati, Ohio. He subsequently completed a fellowship in Genitourinary Cancer at the University of California, Los Angeles. Dr. Crawford is an internationally-recognized expert in benign prostate hypertrophy, urologic cancers, and, in particular, prostate cancer. He has conducted research in the treatment of advanced bladder cancer, metastatic adenocarcinoma of the prostate, hormone-refractory prostate cancer, and other areas of urological infections and malignancies.
Scott B. Sellinger, MD, FACS, has been a urologist at Southeastern Urological Center, now a division of Advanced Urology Institute, since 1991. He received his B.S. degree in Chemistry from Syracuse University in Syracuse, New York, and attended medical school at the University of Florida in Gainesville. He completed his Urology residency at the University of Florida and has lived in Tallahassee for over 35 years. He was President of the Capital Medical Society in 2003 and served as President of the Florida Urological Society in 2005.
In 2018, he served as President of the Southeastern Section of the American Urological Association (SESAUA). In 2019, he served as President of the American Association of Clinical Urologists (AACU). In addition to his urology-specific work, Dr. Sellinger has developed a special interest in risk management and the prevention of medical errors, and has lectured extensively on this subject. He is also interested in large group practice development and management. For several years, Dr. Sellinger served on the board of Advanced Urology Institute (AUI), representing his Tallahassee care center. In January 2021, he became the second President of AUI, now one of the largest independent urology practices in the United States. He served in that role until October 2025. Dr. Sellinger also chaired the Advanced Prostate Cancer (APC) Committee and oversaw seven APC clinics within AUI for over a decade. He continues to lecture worldwide, helping to educate urologists and oncologists on the ever-changing APC space. Since 2015, he has also served on the Large Urology Group Practice Association (LUGPA) Board of Directors, where he currently serves as President. At LUGPA, he is proud to represent over 2300 Urologists by working to preserve and advance the independent, physician directed, practice of urology.
