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The 2026 European Association of Urology (EAU) Annual Meeting
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| Potential for Drug-Drug Interactions with Novel ARTAs and Concomitant Medications: Analysis Based on the mHSPC Patients in the RWE RECOmmEnD Study
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| Amit Bahl, MBBS, FRCR
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| This real‑world UK analysis from the RECOmmEnD study found that among mHSPC patients on triplet therapy, darolutamide had substantially fewer potential drug–drug interactions with baseline concomitant medications than apalutamide or enzalutamide, with far fewer situations requiring avoidance or dose adjustment. These data suggest darolutamide may be a preferable ARPI in polypharmacy patients, though clinically relevant interactions still need proactive management and careful monitoring.
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| Oncological Outcomes Following PSMA PET/CT-guided Salvage Whole-pelvis Radiotherapy for Recurrent Prostate Cancer
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| Bernard Jansen, MD, PhD
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| Bernard Jensen presents this single-center series of 149 men with biochemical recurrence after prostatectomy found that PSMA PET/CT–guided salvage whole‑pelvis radiotherapy plus 2–3 years of ADT produced encouraging 5‑year outcomes, with biochemical progression‑free survival ~69%, metastasis‑free survival 79%, and overall survival ~92%. In‑field nodal control was excellent, most recurrences were out‑of‑field, and higher pre‑sWPRT PSA and shorter ADT duration independently predicted worse biochemical control, supporting this approach as a robust option for pelvic nodal relapse after surgery.
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| Biochemical Recurrence and Safety in Patients with High-Risk Localised Prostate Cancer Treated with [¹⁷⁷Lu]Lu-PSMA-617 Prior to Prostatectomy: Follow-Up of the LuTectomy Trial
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| David Hennes, MD, BSc, DipSurgAnat
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| LuTectomy is a phase I/II trial testing 1–2 cycles of neoadjuvant [¹⁷⁷Lu]Lu‑PSMA‑617 before radical prostatectomy in men with high-risk localized prostate cancer; with a median 45.6‑month follow-up, 50% developed biochemical recurrence and median BCR‑free survival was 32.1 months. Treatment was very well tolerated, with no grade 3–4 treatment-related toxicities and only one possible grade 2 event, supporting the safety and feasibility of preoperative PSMA radioligand therapy while randomized trials determine its impact on long-term cure rates.
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| Disconnect Between Evidence and Real-World Data in Metastatic Prostate Cancer
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| Christopher Sweeney, MBBS
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| Chris Sweeney discussed that although trials show ADT plus an ARPI should be the standard backbone for mHSPC, many real‑world patients—especially older, frail, or socially complex—still receive ADT alone or non‑guideline therapy, with worse outcomes than in trials. He emphasized using pooled and biomarker data to target docetaxel and other intensification to those most likely to benefit, and called for better access and clearer global messaging so routine practice aligns with the evidence.
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| Who Benefits from Intensification with Docetaxel?
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| Gero Kramer, MD
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| Gero Kramer presented on ADT + ARPI being now the default standard for mHSPC, however the added benefit of docetaxel is most compelling in biologically aggressive, high‑burden disease, where triplet therapy improves survival. Triplet use is best reserved for fit patients in this high‑risk group, with emerging biomarkers such as Decipher, PTEN status, and AI-based APIC scoring being explored to predict who truly benefits, and modified schedules like biweekly docetaxel aiming to reduce toxicity while preserving efficacy.
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| What Evidence Do We Have from Intensification with SBRT?
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| Valerie Fonteyne, MD, PhD
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| Valerie Fonteyne summarized that stereotactic body radiotherapy (SBRT)–based metastasis-directed therapy (MDT) in oligometastatic prostate cancer consistently improves progression-free and radiographic progression-free survival and delays castration resistance in randomized phase 2 trials like STOMP/ORIOLE, RADIOSA, WOLVERINE, and ARTO, especially when combined with short-course ADT or systemic therapy, with minimal added toxicity.
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| Radiotherapy to Primary Tumor, What For?
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| Alberto Bossi, MD
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| Alberto Bossi argued that prostate radiotherapy in de novo mHSPC is justified less for pure overall-survival gain and more for its consistent benefits on radiographic progression-free survival, delay of castration resistance, and reduction of severe local GU complications, especially in men with low-volume disease. He noted that trials like HORRAD, STAMPEDE, and PEACE‑1 plus IPD meta-analyses support offering prostate RT to most low‑volume mHSPC patients.
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| PARPi in mHSPC or Should We Wait Until mCRPC?
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| Gunhild von Amsberg, MD
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| Gunhild von Amsberg argued that for men with BRCA1/2‑mutated mHSPC, earlier PARP inhibitor use (for example niraparib + abiraterone in AMPLITUDE) is reasonable because these patients have poor prognosis on standard ARPI/docetaxel alone and show the clearest rPFS and time‑to‑symptoms benefit from PARP‑based combinations, with emerging but not yet definitive OS signals and generally low rates of serious long‑term toxicities such as MDS/AML.
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| Other Intensification Strategies in mHSPC
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| Declan Murphy, MB, BCH, BaO, FRACS, FRCS, Urol
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| Declan Murphy reviewed emerging data showing that adding 177Lu‑PSMA‑617 to standard mHSPC therapy improves PSA responses and radiographic progression‑free survival without major added toxicity, but has not yet demonstrated an overall survival benefit. He concluded that, for now, Lu‑PSMA intensification in mHSPC remains hypothesis‑generating rather than standard of care, and broader adoption should await mature OS data and more refined, imaging‑guided dosing strategies.
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