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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Selecting Patients for Triplet Therapy in Metastatic Prostate Cancer
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Oliver Sartor, MD
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| Zachary Klaassen speaks with Oliver Sartor about treatment intensification in metastatic hormone-sensitive prostate cancer, focusing on triplet therapy selection.
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Prognostic Tool Evaluated For Early Treatment Decisions for Metastatic Hormone-Sensitive Prostate Cancer
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Soumyajit Roy, MD
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| Soumyajit Roy shares research on the NADIR prognostic model with Neeraj Agarwal. The tool predicts early PSA response in mHSPC patients receiving ADT plus ARPI.
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EMBARK Analysis: Testosterone Recovery Post-ADT in High-Risk Prostate Cancer Patients
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Stephen Freedland, MD
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| Zachary Klaassen hosts Stephen Freedland to discuss testosterone recovery data from a post hoc analysis of the EMBARK trial in high-risk biochemical recurrence prostate cancer.
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| Making Sense of Many Options: Metastatic Hormone Sensitive Prostate Cancer Treatment Selection
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| Christopher Sweeney, MBBS
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| Christopher Sweeney argues that today’s crowded mHSPC landscape can be rationalized by using decades of trial data plus biomarkers—especially early deep PSA responses—to move from “maximum for everyone” toward tailored intensification and de‑escalation. He emphasizes ADT plus an ARPI as the default backbone, with triplets and add‑ons like docetaxel, PARP inhibitors, LuPSMA, and AKT inhibitors reserved for biomarker‑defined subsets within cooperative group platforms that balance survival gains against toxicity and quality of life.
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| Addition of Androgen-Receptor Pathway Inhibitors to Standard of Care in Metastatic Hormone-Sensitive Prostate Cancer: A Systematic Review and Meta-Analysis - Beyond the Abstract
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| Brigida Anna Maiorano, MD, PhD, MSc
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| This meta-analysis confirms that adding any modern androgen receptor pathway inhibitor to ADT provides a consistent, substantial survival and progression benefit across >8,000 men with mHSPC, regardless of disease volume, metastatic timing, or docetaxel use. The authors argue ARPI+ADT should now be considered the default backbone in mHSPC, with future work focused on biomarker-guided decisions about which patients need further intensification rather than whether to use an ARPI at all.
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| Treatment Utilization Among Patients with mHSPC in Real-World US Settings: A Prostate Cancer Disease Observation (PRECISION) Data Platform Analysis
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| Daniel George, MD
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| In this large US real-world cohort of over 43,000 men with mHSPC, nearly 40% were still managed with ADT alone over their disease course, despite strong guideline support for upfront treatment intensification. Doublet therapy with ADT plus an AR pathway inhibitor has increased over time and is now the dominant intensified approach, while triplet use remains modest and is far more common in academic oncology than in community urology, highlighting persistent underuse of life‑prolonging combinations and a major opportunity to improve care delivery.
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| Integrating PARP Inhibitors in the Treatment of Prostate Cancer: Timing, Combination Approaches, and Beyond BRCA1/2
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| Wassim Abida, MD, PhD
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| PARP inhibitors are now a key standard for a subset of men with mCRPC, especially those with BRCA2 and related HRR alterations, based on strong single‑agent data (TRITON2, PROfound) and first‑line PARP+ARPI combinations (PROpel, MAGNITUDE, TALAPRO‑2) that deliver the largest rPFS gains in BRCA/PALB2‑mutated disease.
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| Baseline Features and MFS by Prior Definitive Treatment in Patients with High‑risk Biochemically Recurrent Prostate Cancer: EMBARK Post Hoc Analysis
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| Neal Shore, MD, FACS
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| In EMBARK’s post‑hoc analysis, adding enzalutamide to leuprolide improved metastasis‑free survival versus leuprolide alone across all prior definitive treatment groups—radical prostatectomy only, radiotherapy only, and RP + RT—with hazard ratios around 0.36–0.57. Enzalutamide monotherapy also improved or numerically improved metastasis‑free survival versus leuprolide in patients with prior RT or RP + RT, and showed no clear benefit in the smaller RP‑only subgroup.
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