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Highlights from the 2025 APCCC Diagnostics Meeting
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| PSA Relapse: When Do You Need to Act? |
| Jochen Walz, MD |
| Jochen Walz highlighted that biochemical recurrence after prostate cancer treatment does not always require immediate intervention, as many patients have a prolonged, indolent disease course. Risk stratification based on factors like PSA doubling time, time to recurrence, and tumor characteristics is essential to guide decisions, with close monitoring recommended for low-risk patients and early salvage therapy preferred over routine adjuvant therapy in higher-risk cases. |
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| Genomic Classifiers at the Time of Biochemical Recurrence |
| Matthew R. Cooperberg. MD, MPH |
| Matthew Cooperberg discussed the evolving role of genomic classifiers in managing biochemically recurrent prostate cancer after radical prostatectomy. He highlighted how biomarkers like Decipher and PSMA PET imaging can guide treatment decisions, with tools like Decipher improving prognostic accuracy and potentially influencing the timing and intensity of salvage therapies. |
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| Biochemical Recurrence: When Do You Image? |
| Piet Ost, MD, PhD |
| Piet Ost emphasized that imaging in biochemical recurrence (BCR) should only be done if it will influence management, with PSMA PET/CT as the preferred tool due to its high sensitivity. Imaging timing depends on risk stratification and PSA levels — after radical prostatectomy, imaging is recommended once PSA exceeds 0.2 ng/ml, while after radiotherapy, imaging is typically triggered at nadir + 2 ng/ml. |
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| What Do You Do with a Negative Scan: Treat Now or Later with a Positive Scan? |
| Ganesh Palapattu, MD, FACS |
| Ganesh Palapattu highlighted that for biochemically recurrent prostate cancer patients with negative imaging, management should depend on risk stratification — high-risk patients should generally receive early salvage radiotherapy, while low-risk patients could be monitored with PSA surveillance and repeat imaging. |
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| What Can MRI Contribute in Biochemical Recurrence? |
| Hebert A. Vargas, MD |
| Hebert Vargas discusses the role of MRI in biochemically recurrent prostate cancer, particularly in cases of PSMA-negative recurrences, where MRI can detect soft tissue changes missed by PSMA PET. MRI can also help clarify PSMA findings, assess bone lesions, evaluate PSMA uptake in solid organs, and define target volumes for salvage radiotherapy and prostatectomy planning. Dr. Vargas emphasized MRI's value in these specific scenarios for improving management in the recurrent setting. |
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| New Fashion Blood Markers for Metastatic Prostate Cancer
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| Elena Castro, MD, PhD
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| Elena Castro highlighted the emerging role of liquid biopsy — including ctDNA and circulating tumor cells — as valuable tools in metastatic prostate cancer. These blood-based biomarkers provide prognostic and predictive information, allow for non-invasive serial monitoring of treatment response and resistance, and correlate well with tissue-based biomarkers.
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| What Do We Expect from Monitoring in Metastatic Prostate Cancer? |
| Bertrand Tombal, MD, PhD |
| Bertrand Tombal’s APCCC Diagnostics 2025 presentation emphasized the importance of better monitoring tools and criteria for metastatic prostate cancer, particularly in defining minimal residual disease and detecting progression. While PSA response is important, imaging—especially whole body MRI and PSMA PET/CT—provides complementary insights, though their concordance with PSA is limited, particularly in mCRPC. |
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| When to Assess Biology with a Re-Biopsy? |
| Himisha Beltran, MD |
| Himisha Beltran’s presentation at APCCC Diagnostics 2025 emphasized that mCRPC evolves over time, acquiring phenotypic changes (like neuroendocrine transformation) that affect therapy response and outcomes. Re-biopsy should be considered in cases of atypical progression, low PSA/PSMA expression, or aggressive disease, especially to assess for small cell/neuroendocrine differentiation. |
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| PCWG4 and SPARC - Including How to Define Progression on PSMA PET Imaging |
| Michael J. Morris, MD |
| Michael Morris presented on PCWG4 and SPARC, two efforts aimed at improving how PSMA PET imaging is used to monitor metastatic prostate cancer. SPARC focuses on standardizing how PSMA PET is reported and interpreted, while PCWG4 provides a clinical trial framework for integrating PSMA PET into drug and biomarker development. |
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| What Clinicians Need to Know from the PSMA RLT Selection PET? |
| A. Oliver Sartor, MD |
| Oliver Sartor’s APCCC Diagnostics 2025 presentation emphasized that PSMA PET is essential for selecting patients for PSMA radioligand therapy (RLT), but the decision also depends on factors like prior treatments, tumor burden, disease biology, and patient fitness. While criteria from trials like VISION help guide selection, advanced features like SUV metrics, lesion heterogeneity, and ctDNA levels may further refine decision-making in the future. |
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