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Highlights from the 2022 European Association of Urology Annual Meeting |
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| Clinical Trial Protocol for LuTectomy: A Single-arm Study of the Dosimetry, Safety, and Potential Benefit of 177Lu-PSMA-617 Prior to Prostatectomy |
| Declan Murphy, MB, BCH, BaO, FRACS, FRCS, Urol |
| The 2022 EAU annual meeting featured a game-changing session, including a presentation by Dr. Declan Murphy discussing initial results of LuTectomy, a single-arm study of the dosimetry, safety, and potential benefit of 177Lu-PSMA-617 prior to radical prostatectomy. Dr. Murphy notes that in patients with high-risk localized prostate cancer, we need to do better. |
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| Discussion: LuTectomy – A Single-Arm Study of the Dosimetry, Safety, and Potential Benefit of 177Lu-PSMA-617 Prior to Prostatectomy
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| Tobias Maurer, MD
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| Tobias Maurer discussed the clinical context of the initial results of LuTectomy, a single-arm study of the dosimetry, safety, and potential benefit of 177Lu-PSMA-617 prior to radical prostatectomy. Dr. Maurer started by highlighting that 177Lu-PSMA-617 has been on the rise since ~2015, the year the SNMMI’s Image of the Year was awarded to the group in Heidelberg, Germany.
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| ARNEO: A Randomized Phase II Trial of Neoadjuvant Degarelix With or Without Apalutamide Prior to Radical Prostatectomy for High-Risk Prostate Cancer |
| Steven Joniau, MD, Ph.D. |
Steven Joniau discussing the results of ARNEO, a randomized phase II trial of neoadjuvant degarelix with or without apalutamide prior to radical prostatectomy for high-risk prostate cancer. Dr. Joniau notes that according to recent SEER data, treatment for high- and very-high-risk prostate cancer remains a clinically unmet need. The incidence of high- and very-high-risk prostate cancer is ~20%, with 5- and 10-year prostate cancer-specific mortality rates of ~75% and 65%, respectively.
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| Discussion: ARNEO - A Randomized Phase II Trial Of Neoadjuvant Degarelix With Or Without Apalutamide Prior To Radical Prostatectomy For High-Risk Prostate Cancer |
| Alexandre De La Taille, MD, Ph.D. |
| Alexandre De La Taille discussed the results of ARNEO, a randomized phase II trial of neoadjuvant degarelix with or without apalutamide prior to radical prostatectomy for high-risk prostate cancer. Dr. De La Taille notes that the EAU guidelines provide a strong recommendation that we should not offer neoadjuvant androgen deprivation therapy before surgery. Although neoadjuvant hormonal therapy decreases the pT3, positive surgical margin, and lymph node positivity rates, there has yet to be definitive evidence for an effect on PSA or cancer-specific survival. |
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PCa High-Risk Local Treatment
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| Limited Bone Involvement Detected by PSMA PET Only: From Curative to Palliative Treatment? YES |
| Nicolas Mottet, MD, Ph.D. |
| Nicolas Mottet discussed that limited bone involvement detected by PSMA PET/CT is associated with palliative treatment. To start, Dr. Cladia Kesch from Germany presented a case for discussion. The patient is a 66 year old man with a PSA of 8.2 ng/mL, normal digital rectal exam, prostate volume of 60 mL, IPSS score of 11, and IIEF score of 25. |
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| Limited Bone Involvement Detected by PSMA PET Only: From Curative to Palliative Treatment? NO |
| Stephanie G. C. Kroeze, MD, Ph.D. |
Stephanie Kroeze discussed that limited bone involvement detected by PSMA PET/CT is not palliative treatment and may be curative. Dr. Kroeze concluded her presentation discussing that limited bone involvement detected by PSMA PET/CT is not palliative treatment and may be curative by emphasizing that retrospective studies show a benefit in prognosis to multidisciplinary total eradication therapy in select patients.
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Improvements in Metastatic Prostate Cancer: Focus on Imaging and Treatment
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| BRCA1/2 and ATM Mutated Metastatic Prostate Cancers May Present With Low Serum PSA |
| Hyunho Han, Ph.D. |
Hyunho Han discussed PSA levels at presentation for men with BRCA1/2 and ATM mutated metastatic prostate cancer. PARP inhibitors have previously shown survival benefits in mCRPC patients with homologous recombination repair (HRR) genes (BRCA1/2, and ATM) mutations. Dr. Han concluded that PSA levels at presentation for men with BRCA1/2 and ATM mutated metastatic prostate cancer by emphasizing that these genomically altered cases of prostate cancer may present with low serum PSA.
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| Sustained Castration to 20 ng/dl for Relugolix vs. Leuprolide in Men with Advanced Prostate Cancer: Results from the Phase 3 HERO Study |
| Bertrand Tombal, MD, Ph.D. |
| Bertrand Tombal discussed the results from the phase 3 HERO study, specifically sustained castration to < 20 ng/dl for relugolix versus leuprolide in men with advanced prostate cancer. Achieving testosterone level of <20 ng/dL (≤0.7 nmol/L) for castration is associated with improved overall and cancer specific survival outcomes. |
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| The Changing Landscape of Systemic Therapy in the Treatment of Newly-Diagnosed Metastatic Prostate Cancer
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| Nicolaas Lumen, MD, Ph.D.
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| Nicolaas Lumen discussed the changing landscape of systemic therapy in the treatment of newly-diagnosed metastatic prostate cancer. Phase 3 trials have proven the benefit of adding 2nd line systemic treatment to ADT in newly-diagnosed metastatic prostate cancer.
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| PSMA-Flare After ADT Evaluated With 18F-PSMA-1007 PET/CT in Hormone-Sensitive Metastatic Prostate Cancer: Possible Predictor of Tumour Aggressiveness? |
| Simona Malaspina, MD |
| Simona Malaspina discussed the implications of PSMA-flare after ADT evaluated with 18F-PSMA-1007 PET/CT in hormone-sensitive metastatic prostate cancer. This prospective, registered (NCT03876912) trial enrolls patients with newly diagnosed metastatic (M1) prostate cancer. All patients undergo 18F-PSMA-1007 PET/CT before and 3-4 weeks after the initiation of Degarelix (240 mg). |
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