Treating Oligometastatic Prostate Cancer in the PSMA PET Era
Andrew W. Hahn, MD, addresses the treatment of oligometastatic prostate cancer in the PSMA PET era from a medical oncology perspective.
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PSMA PET
Utilization and Disparity in Prostate Cancer Risk Assessment Tools
Michael Leapman, MD, MHS, delivers a presentation on disparities and utilization patterns of prostate cancer risk assessment tools.
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Prostate Cancer Risk Assessment in Black Men
Adam B. Murphy, MD, MBA, MSCI, delivers a compelling 12-minute talk on prostate cancer risk assessment in black men.
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Post-Treatment Assessment and Creating Imaging-Based Short- and Intermediate-Term Patient Outcomes
Faina Shtern, MD, introduces an international group to advance research and clinical strategies for focal treatment of prostate cancer.
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PCa Commentary | Volume 197 – January 2025
PCa Commentary | Volume 197 – January 2025 Posted by Edward Weber | January 2025 ...
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Oral Abstracts – SV Recurrences After Radiation
Aaron E. Katz, MD, FACS, examines the clinical management of seminal vesicle (SV) invasion following radiation therapy in prostate cancer patients. In this 18-minute presentation, Dr. Katz highlights its significance in recurrence and treatment, emphasizing the anatomy, detection, prognosis, and ablative techniques for managing SV invasion.
Dr. Katz shares emerging management options, including robotic excision of SVs and cryotherapy. Integrating PSMA PET scans and MRI enhances diagnostic accuracy, aiding surgical planning.
Dr. Katz calls for a multidisciplinary approach, emphasizing careful patient selection and robust imaging protocols. Ablative therapies, while feasible, require expertise and may benefit from combining modalities for optimal outcomes.
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Future Directions (FD) in Molecular Targeted Imaging (MTI) and Theranostics Discussion
Robert E. Reiter, MD, MBA, highlights advances in molecular targeting and imaging in prostate cancer, with a focus on PSMA PET imaging. PSMA PET is expanding its role, particularly in identifying primary or secondary tumors when MRI results are negative or ambiguous. This application, under investigation in the Primary Two study, could reduce unnecessary biopsies and improve tumor detection.
In this 7-minute presentation, Dr. Reiter reviews PSMA-guided surgical resection using fluorescence or radioguidance to enhance precision. He asserts that this approach could reduce positive margins, optimize node removal, and support nerve-sparing techniques when appropriate, improving functional outcomes.
Reiter also discusses PSMA PET in oligometastatic disease, specifically the optimal treatment approach when few metastases are present. In addition, PSMA imaging is being explored in focal and radiation therapies, where it could provide a more accurate assessment of recurrence and treatment response; in advanced prostate cancer, PET could help identify resistant lesions for targeted radiotherapy.
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Horizons of Diagnosis and Treatment with PSMA PET MRI
Paul D. Maroni, MD, discusses advancements in prostate cancer imaging, emphasizing PSMA PET/MRI. Recent trends show that most new patients arrive with MRIs or even PSMA PET/CT scans; however, access to PSMA PET/MRI remains limited due to approval issues.
In this 10-minute presentation, Dr. Maroni highlights findings from the Primary Trial, which combines MRI and PSMA PET to screen for clinically significant cancers. This fusion is highly specific in identifying high-risk patients, potentially bypassing biopsies in specific cases. Moreover, studies in Canada are investigating PSMA PET/MRI’s role in guiding treatments like SBRT and focal ablation, indicating its potential as a prognostic and predictive biomarker.
Maroni suggests PSMA PET/MRI could serve in initial workups, replacing PET/CT, and aiding in post-treatment follow-up to assess cure or recurrence. There’s also interest in advancing fusion technology to overlay PSMA PET with pre-existing MRIs, optimizing cost-effectiveness and patient care by minimizing additional radiation.
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Key Principles from the 2024 AUA Guidelines Updates on Salvage Prostate Cancer Therapy
Justin J. Badal, MD, reviews the updated 2024 guidelines for advanced prostate cancer, reflecting substantial advancements since the last revision in 2013. The revision synthesizes evidence from numerous trials to reshape recommendations, focusing particularly on treatment strategies for biochemical recurrence (BCR) following radical prostatectomy.
In this 18-minute presentation, Badal shares guidelines emphasizing utilizing prognostic factors, such as PSA doubling time and Gleason grade, to stratify patient risk and guide treatment timing. He notes that ultra-sensitive PSA testing for high-risk individuals and PET imaging, particularly PSMA PET scans, is recognized as valuable tools for detecting biochemical recurrence.
The integration of androgen deprivation therapy (ADT) with SRT is advised for patients showing high-risk features, while, for those without high-risk markers, radiation monotherapy remains an option. For recurrent or node-positive cases post-primary therapy, combined modality approaches, including the use of expanded radiation fields and intensified androgen receptor suppression, are encouraged within a clinical trial setting.
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Optimal Management of Biochemically Recurrent Nonmetastatic Prostate Cancer
Aaron Berger, MD, delves into the evolving landscape of non-metastatic castration-sensitive prostate cancer (nmCSPC) and high-risk biochemical recurrence, focusing on diagnostic and therapeutic updates. In this 7-minute presentation, Dr. Berger emphasizes advanced imaging, particularly PSMA PET scans, as the diagnostic standard due to its superior sensitivity over conventional CT and bone scans.
Dr. Berger discusses treatment strategies, including salvage radiation therapy and the use of androgen deprivation therapy (ADT). For radiation-treated patients, focal salvage therapies, including cryoablation, HIFU, and electroporation, are discussed as options. The presentation underscores the shrinking non-metastatic space due to advancements in imaging technology that now frequently identify micrometastases.
Dr. Berger reinforces the importance of genetic testing and surveillance protocols involving regular PSA monitoring and imaging triggered by symptoms or PSA progression. He highlights the dynamic shifts in prostate cancer management, driven by improved diagnostics and the integration of advanced systemic therapies within an increasingly precise treatment paradigm.
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Oligometastatic Prostate Cancer
Daniel Song, MD, explores the evolving role of metastasis-directed therapy (MDT) and androgen deprivation therapy (ADT) in oligometastatic prostate cancer. Initial studies, including SABR-COMET and STOMP, demonstrate that MDT, through approaches like stereotactic body radiotherapy (SBRT) or surgery, improves progression-free and ADT-free survival compared to observation alone. Recent trials also evaluate the combination of MDT and short-term ADT, such as the EXTEND trial, which shows significantly prolonged progression-free survival.
The 9-minute presentation highlights how advanced imaging, particularly PSMA PET scans, outperforms conventional imaging in detecting and targeting metastases, enhancing MDT’s efficacy. Comparisons of PSMA-guided versus choline-guided SBRT reveal superior outcomes in disease-free survival. Furthermore, ongoing research seeks to clarify whether systemic hormone therapy is necessary alongside MDT, with trials like DART exploring novel ADT strategies.
Dr. Song asserts that MDT improves survival metrics in oligometastatic prostate cancer, particularly when informed by advanced imaging. Combining MDT with prostate radiation or systemic ADT offers additional survival benefits.
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Course Introduction: Description of Terminology and Review of Guidelines
Natalie Reizine, MD, delves into the current understanding, treatment options, and future directions for managing prostate cancer. In this 23-minute presentation, Dr. Reizine discusses disease progression, from localized stages to advanced and metastatic forms, emphasizing the evolving role of imaging technologies like PSMA PET scans in early detection and monitoring.
Dr. Reizine reviews the biology of prostate cancer, particularly its reliance on androgen receptor signaling, which forms the foundation for many therapeutic strategies. She highlights the importance of understanding disease-specific nuances, such as low versus high-volume metastases, to tailor treatment strategies.
Bone health in prostate cancer is emphasized, particularly for patients on long-term ADT. Similarly, dental care and endocrinology referrals are underscored as part of comprehensive management.
Dr. Reizine focuses on emerging therapies and personalized medicine approaches, with attention given to biomarkers like DNA damage repair mutations and new treatment modalities, including PARP inhibitors, radioligand therapies, and T-cell activating constructs. She underscores the need for improved predictive and prognostic biomarkers to effectively refine therapy selection and sequence treatments.
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