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The 2026 PSMA & Beyond Conference
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| PSMA PET: The Problem with Our Reports
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| Robert Reiter, MD
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| Robert Reiter highlights PSMA PET reporting challenges: clinicians need specificity, radiologists need sensitivity and clear communication of indeterminate findings like low-uptake nodes or discordant bone lesions. He advocates explicit lesion sizing/SUVs, suspicion levels, differentials, action suggestions, and structured templates (PRIMARY/PROMISE v2) with clinician education to standardize reports and guide management.
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| SPECT versus PET: Optimizing Response Biomarkers
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| Lisa Bodei, MD, PhD
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| Lisa Bodei compared SPECT and PET for PSMA theranostics response assessment, highlighting PET's superior sensitivity for small lesions and staging, while SPECT offers practical, cost-effective dosimetry during therapy workflow with comparable overall survival prediction. Key response biomarkers include baseline PSMA PET SUVmean ≥1, whole-body metrics like total lesion PSMA, and SPECT total tumor volume increases after cycle 2, which strongly correlate with progression and survival outcomes.
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| Does What We See on PSMA PET Matter?
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| Peter Choyke, MD, FACR
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| Peter Choyke argues that PSMA PET in biochemical recurrence often detects indolent lesions and prompts immediate intensive ADT + ARPI therapy, despite low prostate cancer–specific mortality risk and substantial long‑term toxicities. Established metrics like PSA doubling time remain the gold standard for deciding intervention, and prospective NCI data show minimal short‑term progression in monitored PSMA‑positive BCR, urging caution against overtreatment until survival benefits are proven.
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| PSMAddition
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| Oliver Sartor, MD
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| Oliver Sartor gives an update of the PSMAddition trial where adding 177Lu‑PSMA‑617 to ADT + ARPI significantly improved radiographic PFS in untreated/minimally treated PSMA‑positive mHSPC, with favorable trends in OS, higher complete responses, and better time to CRPC. Safety was consistent with known profiles, with minimal QoL impact, supporting frontline intensification pending mature survival data.
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| DORA and PEACE-3 – Evolving Role of Radium-223
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| Michael Morris, MD
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| PEACE-3's final analysis confirmed that adding Ra-223 to first-line enzalutamide in mCRPC with bone metastases significantly prolongs OS and rPFS, with manageable toxicity. The ongoing DORA trial tests Ra-223 + docetaxel vs docetaxel alone in mCRPC, with OS readout expected late 2026. Ra-223's unique bone microenvironment targeting and QoL preservation position it for continued frontline combinations beyond PSMA theranostics.
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| PEACE-6 PR Trial
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| Désirée Deandreis
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| Désirée Deandreis presents on the PEACE-6 PR phase 3 trial which randomizes 500 de novo mHSPC poor responders (PSA ≥0.2 ng/mL post 6-8mo SOC, non-progressive) to SOC vs SOC + 177Lu-PSMA-617 for OS/rPFS benefit; 99/500 enrolled in Europe (expanding 2026), PSMA+/- eligible, with ImDOSE dosimetry ancillary.
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| Chemotherapy versus PSMA Radioligand Therapy: The CCTG PR21 Trial
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| François Bénard, MD
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| François Bénard presents this phase 2 trial which showed no rPFS difference, but Lu-PSMA superior PSA50, response, lower gr3-4 AEs, fewer discontinuations. OS favored docetaxel, likely due to crossover; SUVmean prognostic not predictive.
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| STAMPEDE2 PSMA-Lu Comparison
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| Nicholas James, MBBS, FRCP, FRCR, PhD
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| Nick James discusses the STAMPEDE2 Comparison P which tests intensified 177Lu-PSMA-617 (all doses by week 13) + SOC vs SOC alone in polymetastatic mHSPC unsuitable for SABR, incorporating dosimetry and dual MRI/PET for response assessment. Early unpublished imaging/dosimetry data were shared, alongside a PCF-funded project biopsying residual disease to identify resistance drivers via radiomics, genomics, and immune analysis. European recruitment begins Q2 2026.
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New Radioligands and Radionuclides
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| Is Astatine the Way to Go?
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| Tadashi Watabe, MD, PhD
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| 211At is a "clean" cyclotron-produced alpha emitter with a 7.2-hour half-life, covalent binding, and SPECT imaging compatibility—offering intense therapeutic effects without daughter recoil toxicity. Osaka University's first-in-human phase I trial of 211At-PSMA-5 in post-chemo/ARPI mCRPC shows early efficacy and safety, with dedicated cyclotron production scaling up in Japan, Europe, US, and Canada to potentially rival 177Lu-PSMA availability.
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| Ac-PSMA: The Truth Should be Told
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| Matthias Eiber, MD, PhD
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| While 225Ac-PSMA shows potent anti-tumor activity in mCRPC, severe xerostomia remains the primary development barrier across multiple agents and trials. Newer ligands like 225Ac-PSMA-R2 and rhPSMA-10.1 aimed to reduce salivary uptake but faced setbacks, emphasizing that therapeutic window—not raw potency—will determine success through ligand engineering and strategic combinations. Phase III trials continue, but QoL impact remains the key hurdle for alpha-PSMA approval.
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Approaches to Combination Therapies
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| Lessons Learned from Radioligand Combination Therapies
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| Shahneen Sandhu, MD, PhD, MBBS, FRACP
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| Shahneen Sandhu presented the PSMAddition trial in which Lu-PSMA + SOC (ADT/ARPI) triples rPFS benefit in mHSPC vs SOC. LuPARP: Ph1 Lu-PSMA + olaparib yields 52% PSA90 in mCRPC with tolerable intermittent dosing. UpFrontPSMA: Frontline Lu-PSMA + docetaxel boosts undetectable PSA to 41% at 48w in high-vol mHSPC vs 16% docetaxel alone. Key: AR upregulation, radiosensitization, immuno-modulation deepen responses; sequencing/dosing optimizes window amid resistance/heterogeneity.
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| Immunotherapy with Checkpoint Inhibitors and Beyond
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| Lawrence Fong, MD
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| Lawrence Fong discussed single-cell profiling which reveals that SPP1hi-TAMs drive resistance to checkpoint inhibitors in mCRPC; adenosine A2A inhibition reduces TAMs, induces responses. Single-dose Lu-PSMA + pembro yields 56% ORR, low toxicity. T-cell engagers shine: xaluritamig 49% PSA50/24% ORR; VIR-5500 82% PSA50/53% PSA90/45% ORR at high doses in late-line mCRPC.
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