|
|
|
|
|
|
|
PEER-TO-PEER CLINICAL CONVERSATIONS
|
|
|
|
|
|
| Phase 2 EXTEND Trial of Metastasis-Directed Therapy with Continuous Hormone Therapy |
Alexander Sherry, MD, and Bilal Siddiqui, MD
Alexander Sherry and Bilal Siddiqui present EXTEND trial results, demonstrating metastasis-directed therapy benefits when combined with continuous androgen deprivation for oligometastatic prostate cancer. |
|
|
|
|
|
|
|
|
|
|
|
|
|
The 2025 American Society for Radiation Oncology (ASTRO) Annual Meeting |
|
|
|
|
| 177Lu-PSMA Neoadjuvant to Ablative Radiotherapy for Oligorecurrent Prostate Cancer: Primary Endpoint Analysis of the Phase II LUNAR Randomized Trial |
| Amar Kishan, MD |
| The phase II LUNAR trial showed that adding two cycles of 177Lu-PSMA PNT2002 before stereotactic body radiotherapy significantly prolonged median progression-free survival in men with oligorecurrent prostate cancer (17.6 vs 7.4 months) without added toxicity. Most progressions were due to new lesions, highlighting the challenge of occult disease. Immune-related biomarkers, including T-cell receptor rearrangements and germline variants, were associated with outcomes, suggesting potential for further personalization of therapy. |
|
|
|
|
|
| Quality of Life Results from NRG-GU005: A Phase III Trial of SBRT vs. Hypofractionated IMRT for Localized Intermediate Risk Prostate Cancer |
| James Yu, MD, FASTRO, MHS |
| The NRG-GU005 Phase III trial compared SBRT vs. hypofractionated IMRT in men with localized intermediate-risk prostate cancer, focusing on quality of life outcomes. Results showed that SBRT patients had significantly fewer clinically meaningful declines in bowel and sexual function at 1 year and urinary incontinence at 2 years, with overall better patient-reported urinary outcomes. |
|
|
|
|
|
| Long-Term Toxicity and Patient-Reported Quality of Life after Prostate IMRT with or without Biodegradable Balloon Rectal Spacer: Analysis of a Pivotal Randomized Trial
|
| Daniel Song, MD
|
| The pivotal randomized phase III trial of a biodegradable balloon rectal spacer in prostate IMRT showed that spacers significantly reduced long-term rectal and urinary toxicities, with grade ≥2 rectal toxicity dropping to 5.9% vs. 21.3% at 48 months. Patient-reported outcomes confirmed better bowel, urinary irritative, and sexual quality of life with spacers, with benefits becoming more pronounced over time.
|
|
|
|
|
|
|
|
|
|
|
| Intermittent ADT + Comprehensive Stereotactic Body Radiotherapy for Hormone Sensitive Oligometastatic Prostate Cancer (CROP): Mature Results of a Prospective Trial |
| Patrick Cheung, MD |
| The CROP trial tested intermittent ADT combined with comprehensive stereotactic body radiotherapy (SBRT) in hormone-sensitive oligometastatic prostate cancer and showed promising long-term outcomes. With over 6 years of follow-up, treatment was well tolerated, and many patients achieved deep PSA nadirs, which strongly predicted survival and disease control. Importantly, a substantial proportion of patients remained alive and off ADT, supporting SBRT + 1 year of ADT as a viable strategy to delay continuous systemic therapy while maintaining favorable efficacy. |
|
|
|
|
|
| The Role of Stereotactic Body Radiotherapy in Oligoprogressive Prostate Cancer: A Site-Specific Analysis of the Prospective, Phase II RADIANT Trial |
| Kara Ruicci, MD, PhD |
| The phase II RADIANT trial showed that stereotactic body radiotherapy (SBRT) for oligoprogressive prostate cancer is safe, maintains quality of life, and can delay the need for next-line systemic therapy, with a median time of 13.4 months before therapy change. At 1 year, overall survival was 92.6%, PSA responses occurred in most patients, and no grade ≥3 toxicities were reported. |
|
|
|
|
|
| Early Results from a Randomized Phase II Trial Testing Apalutamide and Stereotactic Body Radiation Therapy for Low-Burden Metastatic Hormone Sensitive Prostate Cancer |
| Giulio Francolini, MD |
| Giulio Francolini presented a randomized phase II trial which tested apalutamide + ADT with or without stereotactic body radiotherapy (SBRT) in low-burden mHSPC. Early results showed similar overall biochemical response rates (~92%) between arms, but SBRT significantly improved outcomes in patients with fewer than three metastases (OR 5.88, p=0.03). Toxicity was mild and comparable between groups, supporting the safety of combining SBRT with systemic therapy while suggesting a potential benefit in carefully selected oligometastatic patients. |
|
|
|
|
|
| A Dynamic Treatment Strategy for Oligometastatic CSPC: Integrating Molecular Imaging and SBRT to Personalize Systemic Therapy Intensification and De-Intensification |
| Piero Bettoli, MD, MS |
| Piero Bettoli presented a novel dynamic treatment strategy for oligometastatic castration-sensitive prostate cancer (OM-CSPC), combining PSMA PET imaging, intermittent ADT, and SBRT, with systemic intensification reserved for disease progression. In a cohort of 33 patients (median follow-up 25 months), this adaptive approach achieved 97% CRPC-free survival, with 81% of patients remaining on intermittent ADT and a median off-ADT time of 30 months, while avoiding significant toxicity. |
|
|
|
|
|
| Evaluating Molecular Response Using 68Ga-PSMA-PET/CT in Prostate Cancer Patients with Pelvic Lymph Node Metastasis Undergoing Definitive Radiotherapy: Clinical Significance and Implications |
| H. Cem Onal, MD |
| H. Cem Onal presented a retrospective study of 107 prostate cancer patients with pelvic lymph node metastases treated with radiotherapy and ADT, evaluating molecular response using 68Ga-PSMA-PET/CT. Patients achieving complete metabolic response in primary tumors or lymph nodes had significantly better 5-year outcomes, including distant metastasis-free survival, progression-free survival, and prostate cancer-specific survival. |
|
|
|
|
|
|
|
|
|
|
