PROWESS: (PROstate Cancer Wearables, Exercise, and Structured Supports)
Jamie Jacobs, PhD, presents a talk on the PROWESS study for Black and Latino men with metastatic prostate cancer undergoing ADT.
Read More
Topic: Advanced Disease
Treatment of Oligometastatic Disease
Mary-Ellen Taplin, MD, discusses the evolving treatment landscape for oligometastatic prostate cancer.
Read More
Using Genetic Testing in Prostate Cancer: When and How
Alan H. Bryce, MD, delves into the critical role of genetic testing in prostate cancer management.
Read More
PCa Commentary | Volume 198 – February 2025
Pluvicto was approved in March 2022 for therapy in men with heavily pretreated castration resistant metastatic prostate cancer, and since then, it has become a frequently prescribed life-prolonging treatment. Sartor et al., NEJM 2021, reported that the median imaging-based progression-free survival for 177Lu PSMA was 8.7 months vs. 3.4 for ADT alone, and the median overall survival was 15.3 months vs.11.3 for ADT. Quality of life was similar. Pluvicto is administered via a short IV infusion every 6 weeks for 4-6 cycles.
Read More
mCRPC: Lu-177 PSMA and Beyond
William K. Oh, MD, discusses prostate cancer diagnosis and treatment, focusing on PSMA diagnostics and LU-177 PSMA therapy.
Read More
Multi-Disciplinary Approach to Advanced Prostate Cancer Care
Kelvin A. Moses, MD, PhD, FACS, explores a multidisciplinary approach to advanced prostate cancer care and treatment.
Read More
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.
Read More
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.
Read More
Metastatic Castrate Sensitive Prostate Cancer
Rana McKay, MD, discusses the evolving treatment strategies for metastatic hormone-sensitive prostate cancer (mHSPC), emphasizing advancements over the past decade. In this 20-minute presentation, McKay shares that prostate cancer remains a leading cause of mortality among men. While traditional androgen deprivation therapy (ADT) has long been the cornerstone treatment, newer approaches integrating chemotherapy, androgen receptor signaling inhibitors (ARSIs), and combination regimens have transformed patient outcomes. She refers to landmark studies like CHARTED, LATITUDE, and STAMPEDE, highlighting the benefits of early intensifying treatment and showing significant survival advantages with doublet and triplet therapies. She also shares recent trials, including PIECE-1 and ARASENS, that underscore the effectiveness of adding agents like abiraterone or darolutamide to ADT and docetaxel for high-risk, high-volume disease.
Dr. McKay asserts clinical decision-making now incorporates disease factors such as volume and risk, patient comorbidities, and drug-specific considerations like toxicity profiles and cost. Emerging genomic and molecular tools are poised to refine treatment personalization further, with ongoing trials exploring the optimal integration of novel agents.
Read More
How to Best Select Doublet vs. Triplet Therapy in MCSPC
Scott B. Sellinger, MD, FACS, addresses key considerations in deciding between doublet and triplet therapies for metastatic castration-sensitive prostate cancer.
In this 12-minute presentation, Dr. Sellinger highlights the superiority of androgen deprivation therapy (ADT) combined with androgen pathway inhibitors. He discusses evidence from pivotal trials, including TITAN, ARCHES, PEACE-1, and ARASENS, demonstrating that doublet and triplet therapies offer superior survival benefits compared to ADT alone.
Sellinger emphasizes that selecting between doublet and triplet therapy is both an art and a science, balancing clinical guidelines with patient-specific factors such as age, comorbidities, and access to treatment. While higher volume and symptomatic patients might benefit from more intensive triplet therapy, the importance of patient preference, PSA response, and cost considerations is underscored. He suggests that establishing clearer guidelines on doublet versus triplet therapy could help practitioners make more confident decisions for their patients in this nuanced field.
Read More
Novel Ways of Targeting the Androgen Receptor
Daniel P. Petrylak, MD, explores novel approaches for targeting the androgen receptor (AR) in prostate cancer, highlighting that around 90% of prostate cancer specimens express the androgen receptor, which persists through castrate resistance.
In this 7-minute talk, Dr. Petrylak focuses on targeting the AR ligand-binding domain with molecules known as proteolysis-targeting chimeras (PROTACs). Laboratory findings reveal that PROTACs can degrade AR variants resistant to traditional therapies like enzalutamide, showing efficacy against androgen gene amplification mutations.
He shares that ARV-110, a PROTAC developed for clinical use, showed promise in phase 1 trials with castration-resistant prostate cancer patients. However, due to significant side effects, the ARV-110 trials were abandoned in favor of a newer compound, ARV-766. While ARV-110 has demonstrated efficacy in castration-resistant prostate cancer, ARV-766 offers a broader range of AR degradation with improved patient tolerance, making it the preferred candidate for continued clinical evaluation.
Read More
Cardiometabolic Health for Men with Advanced Prostate Cancer: Lessons Learned and Future Directions
Andrew W. Hahn, MD, addresses cardiometabolic health in men with advanced prostate cancer, focusing on the impacts of hormone therapy and strategies for managing cardiovascular risks.
In this 10-minute talk, Dr. Hahn highlights the common overlap of prostate cancer and cardiometabolic risk factors and underscores the necessity of evaluating cardiovascular risk in prostate cancer patients. He reviews data indicating that androgen deprivation therapy (ADT) can indirectly increase cardiovascular risks by altering body composition and intensifying metabolic syndrome. Adding androgen receptors nearly doubles cardiovascular event risk. Despite FDA advisories, guidelines, and the availability of cardiovascular risk assessments, many patients undergoing ADT lack appropriate cardiovascular monitoring.
Dr. Hahn highlights future directions in identifying men at heightened risk for cardiovascular events using imaging and genomic biomarkers. Promising approaches include myocardial perfusion PET scans and exploring genomic markers that correlate with cardiovascular toxicity in hormone therapy. Managing cardiometabolic health in advanced prostate cancer requires careful risk assessment and personalized approaches. Biomarkers are needed to effectively predict cardiovascular complications from hormone therapy.
Read More