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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Persistent PSA After Prostatectomy: Timing and Mortality Risk Implications - Journal Club
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Zachary Klaassen, MD, MSc, and Rashid Sayyid, MD, MSc
Rashid Sayyid is joined by Zachary Klaassen to discuss a study examining persistent PSA following radical prostatectomy and mortality risk.
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EMBARK Trial Reports Overall Survival Benefit for Enzalutamide with ADT in High-Risk Non-Metastatic Prostate Cancer
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Stephen Freedland, MD
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| Zachary Klaassen speaks with Stephen Freedland about EMBARK trial overall survival data. The trial enrolled patients with biochemical recurrence, PSA doubling time less than nine months, and non-metastatic disease on conventional imaging, randomizing them to enzalutamide plus ADT, ADT alone, or enzalutamide monotherapy for 37 weeks with treatment breaks if PSA fell below 0.2.
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The Co-PSMA Trial: Comparing PSMA PET Tracers in Biochemically Recurrent Prostate Cancer
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Louise Emmett, MD, MBChB, FRACP, FAANMS
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| Louise Emmett presents the Co-PSMA trial prospectively comparing 64Cu-SAR-bisPSMA versus gallium-68 PSMA-11 in 50 biochemically recurrent post-prostatectomy patients.
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| Overall Survival with Enzalutamide in Biochemically Recurrent Prostate Cancer
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| Neal Shore, MD, FACS
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| Neal Shore presents final EMBARK data showing that enzalutamide plus leuprolide significantly improved overall survival in men with high-risk biochemically recurrent prostate cancer, with 8-year OS of 78.9% versus 69.5% for leuprolide alone. Enzalutamide monotherapy improved several secondary endpoints but did not significantly improve overall survival versus leuprolide alone.
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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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| This EMBARK post-hoc analysis found that enzalutamide plus leuprolide improved metastasis-free survival versus leuprolide alone across prior definitive treatment groups, including radical prostatectomy, radiotherapy, and both modalities. Enzalutamide monotherapy also showed benefit in the radical prostatectomy + radiotherapy subgroup and a numerical benefit after radiotherapy alone, with no significant interaction by prior treatment, suggesting the overall EMBARK benefit was consistent regardless of prior local therapy.
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| Which Are the Prognostic Implications of a Negative PSMA-PET at the Time of Biochemical Recurrence in Prostate Cancer Patients Treated With Radical Prostatectomy? Selection of Salvage Therapies Candidates
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| Antony Pellegrino, MD
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| Antony Pellegrino reported that men with biochemical recurrence after radical prostatectomy who had a negative PSMA PET scan and then received salvage radiotherapy had lower metastatic progression than similar patients staged only with negative conventional imaging. In the matched analysis, 24-month metastasis incidence was 10% with negative PSMA PET versus 22% with conventional imaging, supporting PSMA PET for better selection of salvage radiotherapy candidates.
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| Impact of Previous Pelvic Radiotherapy on PSMA PET Outcomes in Patients Experiencing Biochemical Recurrence after Radical Prostatectomy. Implications for Optimal Timing of Restaging
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| Armando Stabile, MD
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| Armando Stabile reported that prior pelvic radiotherapy was associated with a higher likelihood of a positive PSMA PET scan in men with biochemical recurrence after radical prostatectomy, especially at lower predicted risks of positivity. The study suggested that PSMA PET may be most useful earlier in this subgroup, supporting restaging at lower PSA cutoffs when there is a history of pelvic radiotherapy.
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