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Highlights from the 2023 American Urological Association Annual Meeting |
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EMBARK Trial Shows Promising Results for High-Risk Prostate Cancer Treatment, Enzalutamide's Impact on Metastasis-Free Survival
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Neal Shore, MD, FACS
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| Neal Shore discusses the EMBARK trial with Alicia Morgans. The study investigated whether enzalutamide plus leuprolide treatment or enzalutamide monotherapy could prolong metastasis-free survival compared with placebo plus leuprolide for men with high-risk biochemical relapse. |
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| EMBARK: A Phase 3 Randomized Study of Enzalutamide or Placebo Plus Leuprolide Acetate and Enzalutamide Monotherapy in High-Risk Biochemically Recurrent Prostate Cancer |
| Neal Shore, MD, FACS |
| Neal Shore presents the long-awaited results of EMBARK, a phase 3 randomized study of enzalutamide or placebo plus leuprolide acetate and enzalutamide monotherapy in high-risk biochemically recurrent prostate cancer. Enzalutamide in combination with ADT, if approved in this setting, has the potential to become a new standard of care for patients with high-risk BCR with a PSADT <9 months and no evidence of metastasis on conventional imaging. |
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| Associations Between Prostate MRI and Genomic Testing and Treatment Intensification Among Patients with Localized Prostate Cancer |
| Michael Leapman, MD |
| Michael Leapman examines the association between the use of prostate MRI and tissue-based genomic tests on the impact of clinical management in the real-world, using SEER-Medicare data. Prostate magnetic resonance imaging (MRI) and tissue-based gene expression (genomic) tests improve local staging and estimates of disease prognosis and have been incorporated into national and international guidelines. However, the impact of their use in clinical management is not well understood. |
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| Using the Negative Predictive Value and SUVmax of PSMA PET/CT for Avoiding Pelvic Lymph Node Dissection With Radical Prostatectomy |
| Gagan Prakash, MD |
| Based on the data, high NPV of PSMA-PET scan coupled with evaluation of the SUVmax of the primary prostatic lesion can help avoid a PLND in intermediate and high-risk patients with a ‘negative’ PSMA-PET scan. The results can be considered as hypothesis generating and indicate the use of PSMA as a biomarker for predicting nodal disease. Further larger studies can help determine the ideal cut-off values for the SUVmax of the primary lesion. |
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| SUVmax Of the Primary Prostate Lesion on the PSMA PET CT: an Indicator of Aggressive Pathology |
| Gagan Prakash, MD |
| PSMA PET/CT scans are being increasingly utilized in the staging evaluation of prostate cancer, quickly replacing traditional imaging, especially for high risk disease. However, there is limited data regarding the utility of the standardized uptake value (SUVmax) of the primary prostate lesion in the PSMA PET scan. Gagan Prakash evaluates whether the SUVmax of the primary prostate lesion can indicate aggressive pathological features in patients undergoing radical prostatectomy with an extended pelvic nodal dissection. |
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| The Prognostic Impact of Preoperative PSMA-PET on Early Oncological Outcomes in Prostate Cancer Patients Treated With Radical Prostatectomy: Results of a Multi-center Analysis |
| Simone Scuderi, MD |
| Simone Scuderi evaluates the impact of pre-operative PSMA PET/CT on early oncologic outcomes in prostate cancer patients treated with radical prostatectomy (RP), using a multi-center Italian experience. Clinically N0M0 PCa patients staged with PSMA PET scan are at lower risk of early recurrence when compared to those staged with conventional imaging alone. |
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Prostate Cancer: Advanced (Including Drug Therapy)
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| Multi-Institutional Analysis of Metastasis Directed Therapy With or Without ADT in Oligometastatic Castration Sensitive Prostate Cancer |
| Matthew Deek, MD |
| In this large multi-institutional cohort of patients with oligometastatic prostate cancer treated with metastasis-directed therapy, the addition of concurrent ADT appears to be associated with a greater rate of freedom from biochemical progression, though a small group of patients will have sustained biochemical response with metastasis-directed therapy alone. |
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| Treatment Pattern and HRQoL of Patients With mCRPC in the United States |
| Neal D. Shore, MD, FACS |
| Neal Shore discussing treatment patterns and health-related quality of life of patients with mCRPC in the US. Therapeutic advances in the management of mCRPC have given clinicians multiple treatment options and the potential for sequencing therapeutic agents, increasing the complexity of treatment decisions. |
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| Efficacy and Feasibility of Additional Cycles of Docetaxel in Combination with Androgen Deprivation Therapy in Metastatic Hormone-Sensitive Prostate Cancer |
| Can Aydogdu, MD |
| Can Aydogdu presents the results of an analysis of the efficacy and feasibility of additional cycles of docetaxel in combination with androgen deprivation therapy (ADT) in metastatic hormone-sensitive prostate cancer (mHSPC). Based on these results, the authors concluded that extended docetaxel treatment beyond 6 cycles is not associated with superior oncologic outcomes, although treatment-related toxicity appears to be comparable as well. |
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| Examining Testosterone Recovery in Androgen Deprivation Therapy for Prostate Cancer |
| Mark Preston, MD, MPH |
| Mark Preston presents the analysis of a real-world study examining testosterone recovery following androgen deprivation therapy (ADT) for prostate cancer. This was a retrospective, longitudinal cohort study that was conducted using the Optum Enriched Oncology EMR with integrated claims data. The objective of this study was to examine, in a real-world setting, clinical events among prostate cancer patients with and without testosterone recovery within 1 year after discontinuing injectable ADT.
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| Cost-Effectiveness of Systemic Treatment Intensification in Men With Metastatic Hormone-Sensitive Prostate Cancer
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| Niranjan Sathianathen, Ph.D.
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| Niranjan Sathianathen presents the results of a cost-effectiveness analysis of systemic treatment intensification in men with metastatic hormone-sensitive prostate cancer (mHSPC). Based on the price of systemic agents in the United States, systemic treatment intensification with doublet therapy only using docetaxel may be cost-effective.
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| Far From the Truth: Real-World Treatment Patterns Among Newly Diagnosed Metastatic Prostate Cancer in the Era of Treatment Intensification
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| Yu Guang Tan, MBBS (Sing) MRCS (Edin) DWD (CAW)
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| Yu Guang Tan present the results of a real-world analysis of treatment intensification patterns among Asian men with newly diagnosed metastatic prostate cancer. The utilization of treatment intensification between 2016 and 2020 at Singapore General Hospital has increased from 18% in 2016 to 56% in 2020.
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| Real-World Characterization of Patients Receiving Relugolix or Androgen Deprivation Therapy Injections in Combination with Oral Anti-Androgens in 2021 (The REAL ADT ORAL Study): Analysis from a US EMR Database
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| Jason Hafron, MD
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| In this real-world analysis, oral relugolix in combination with an ARSI is prescribed by urologists in relatively large numbers and similar percentages, compared with injectable ADTs. As additional data become available, future studies will focus on the duration of ADT in combination with other prostate cancer medications and associated outcomes.
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| Real-World Outcomes Among Men with Nonmetastatic Castration-sensitive Biochemical Recurrence After Definitive Therapy with Short PSA Doubling Time Receiving Early Secondary Treatment
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| Stephen Freedland, MD
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| The objective of this study was to assess real-world outcomes in men with nmCSPC and short PSADT who experienced BCR following definitive treatment, as compared to men with longer PSADT and historical controls. In this study, the investigators reviewed the Veterans Health Administration (VHA) database between January 2006 and June 2020 to identify men with nmCSPC and BCR post-definitive treatment.
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| Use of Decipher Prostate Biopsy Test in Men With Favorable Risk Disease Undergoing Conservative Management in the SEER Registry
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| Alec Zhu, MD
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| Alec Zhu presents the results of an analysis evaluating the use of Decipher® prostate biopsy testing in men with favorable-risk prostate cancer undergoing conservative management in The Surveillance, Epidemiology, and End Results (SEER) registry.
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