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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Selecting Therapy in Metastatic Hormone-Sensitive Prostate Cancer: A Multi-Step Approach
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Pedro C. Barata, MD, MSc, FACP
Pedro Barata discusses therapy selection and patient goals in metastatic hormone-sensitive prostate cancer. Dr. Barata describes framing treatment decisions around tumor volume using CHAARTED criteria, timing of metastatic disease, and performance status, with ADT plus an ARPI as the standard backbone.
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Patient Selection for Intermittent Therapy: The Role of PSA Nadir and Disease Volume
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Maha Hussain, MD, FACP, FASCO
Neeraj Agarwal speaks with Maha Hussain about the evolving role of intermittent therapy and treatment holidays in metastatic hormone-sensitive prostate cancer. Drawing on SWOG 9346, she notes that intermittent ADT did not clearly demonstrate non-inferiority to continuous therapy.
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Quality of Life and Treatment Intensification in mHSPC
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Fred Saad, CQ, MD, FRCS, FCAHS
Fred Saad discusses the ARANOTE and ARASENS trial experience in metastatic hormone-sensitive prostate cancer. ARASENS enrolled over 80% high-volume disease with ADT plus darolutamide plus docetaxel.
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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 argued that the growing number of treatment options for metastatic hormone-sensitive prostate cancer should be organized around ADT plus an AR pathway inhibitor as the backbone for most patients, with further intensification tailored by disease volume, presentation, age, fitness, and emerging biomarkers. He emphasized that while newer approaches such as docetaxel, PARP inhibitors, LuPSMA, and AKT inhibitors show promise, the future lies in biomarker-directed personalization and selective de-escalation, so patients get the right therapy without unnecessary toxicity.
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| Treatment Intensification in the mCSPC Landscape: Real-World Evidence from 4,559 Patients in the CAPRI-3 Registry
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| Kim Van der Velden, BSc
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| In the CAPRI-3 registry of 4,559 men with mCSPC, treatment intensification was used in only 42% overall and remained much more common in high-volume than low-volume disease. The survival benefit of intensification was concentrated in high-volume patients, while low-volume disease was the strongest predictor of better overall survival, supporting a volume-stratified approach to treatment.
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| De-Escalation Therapy in Metastatic Prostate Cancer: A Retrospective Study on Intermittent ARPI Treatment
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| Barak Talmor, MD
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| This retrospective study of 60 men with metastatic prostate cancer found that intermittent ADT + ARPI after a favorable response was feasible, with a median treatment-free survival of 25 months. Testosterone recovery, a rapid PSA nadir, complete PSMA PET response, and prior prostate radiotherapy were associated with longer treatment breaks, and most rechallenged patients responded again.
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| Health-Related Quality of Life Outcomes with Darolutamide in the Phase 3 ARANOTE Trial
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| Alicia Morgans, MD, MPH, FASCO,
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| Alicia Morgans presents the ARANOTE quality-of-life analysis which showed that darolutamide plus ADT not only improved radiographic progression-free survival, but also delayed pain progression and preserved patient-reported quality of life. Compared with placebo, it extended time to FACT-P deterioration by 5.1 months and improved social/family, functional, and urinary symptom outcomes, with the clearest benefits seen in patients achieving deep PSA responses.
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| Prevalence of Major Adverse Cardiac Events in Men with Prostate Cancer Receiving ADT in Real-World Clinical Practice
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| Andrew Hahn, MD
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| In this real-world analysis of 17,336 men starting ADT for prostate cancer, the overall prevalence of MACE was low, at 3.5 per 100 person-years for 2-point MACE and 4.0 per 100 person-years for 3-point MACE. Event rates were higher in men with baseline cardiovascular disease and numerically lower with GnRH antagonists, especially relugolix, supporting careful cardiovascular risk assessment when choosing ADT.
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