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HIGHLIGHTS FROM THE 2024 ADVANCED PROSTATE CANCER CONSENSUS CONFERENCE |
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Identification, Assessment and Management of Side Effects of Systemic Therapies
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| Cardiovascular Complications in Advanced Prostate Cancer – How to Prevent Them and How to Monitor Patients?
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| Thomas Suter, MD
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| Thomas Suter presented on how to prevent and monitor patients with cardiovascular complications in advanced prostate cancer. He started by emphasizing that the lifetime risk of cardiovascular disease significantly increases with more major risk factors, with a nearly 40% risk at 90 years of age for >= 2 major risk factors:
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Management of Metastatic CRPC
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| PARP Inhibition Dissected – in Which DNA Repair Gene Alterations Works Which PARP Inhibitor?
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| Johann de Bono, MD, MSc, PhD, FRCP, FMedSci
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| Johann De Bono presented on which DNA repair gene alterations work for which PARP inhibitor. He started by stating that what we think we know is that prostate cancer is not one disease. Rather, it is heterogeneous, with many subtypes, including (i) inter-patient heterogeneity (even in advanced disease) leading to many trials failing because they are treating prostate cancer as one disease, and (ii) intra-patient heterogeneity (with subclones evolving over time), with this evolution leading to treatment resistance.
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| The Best Use of PARP Inhibitors in mCRPC
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| Joaquin Mateo, MD
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| Joaquin Mateo presented on the best use of PARP inhibitors in mCRPC. The challenge of precision medicine is that PARP inhibitors are (mostly) in tumor cells deficient for HRR and we do not currently have tests to measure HRR function. As such, we use “proxy” biomarkers, which are different from targeting the oncogene.
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| Ideal Sequence After ADT plus ARPI plus Docetaxel for mHSPC
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| Karim Fizazi, MD, PhD
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| Karim Fizazi presented on the ideal sequence after ADT + ARPI + docetaxel for treatment in the metastatic hormone-sensitive prostate cancer (mHSPC) setting. There’s no question that based on data from PEACE-1 and ARASEN that triplet systemic therapy works in mHSPC.
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| How to Manage Side Effects of PARP Inhibitors?
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| Elena Castro, MD, PhD
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| Elena Castro presented on how to manage side effects of PARP inhibitors. Dr. Castro notes that in the PARP inhibitor monotherapy trials, there were frequent adverse events. Comparatively, there were also frequent adverse events in the ARPI + PARP inhibitor combination trials, although there were no differences in toxicity by HRR status.
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Global Access of Advanced Prostate Cancer in Low- and Lower-Middle Income Countries
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| Lancet Commission on Prostate Cancer– the Forthcoming Surge in Prostate Cancer Raises Very Different Issues to the Ones We Face Today
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| Nicholas D. James, MBBS, PhD
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| Nicholas James discussing the Lancet Commission on Prostate Cancer and the forthcoming surge in prostate cancer. Dr. James notes that the first meeting of the Lancet Commission on Prostate Cancer took place in September 2020, followed by a formal launch in May 2021, submission of the paper for peer review in Spring 2023, accepted for publication in November 2023, and formal launch of findings at the European Association of Urology in March 2024.
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| How to Deal with the Projected Rise of Prostate Cancer Cases in the Chinese Healthcare System
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| Dingwei Ye, MD
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| Dr. Dingwei Ye presented on how to deal with the projected rise of prostate cancer cases in the Chinese healthcare system. Prostate cancer incidence is increasing in China, now the 6th most common male cancer, with 18.61 cases per 100,000 men in 2022.
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| How Do We Maximize Use of Radiotherapy for Prostate Cancer in Africa?
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| Omolara Aminat Fatiregun, MBBS, MPH, FWACS
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| Omolara Aminat Fatiregun presented on how we can maximize the use of radiotherapy for prostate cancer in Africa. Dr. Fatiregun started by emphasizing that we are seeing a surge in prostate cancer secondary to an unpreventable increase despite other interventions such as lifestyle and public health initiatives. Importantly, men of African descent present at younger ages and with late-stage disease.
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| Dealing with Inequality – the Promise and Pitfalls for Social Media and AI for Prostate Cancer in Disadvantaged Populations
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| Stacy Loeb, MD
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| Stacy Loeb presented on the promise and pitfalls of social media and artificial intelligence for prostate cancer in disadvantaged populations. She highlighted the recent Lancet publication reporting the Lancet Commission on Prostate Cancer, which provides recommendations for addressing the surge in cases for low- and middle-income countries.
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| Who Should Undergo Germline Testing?
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| Heather Cheng, MD, PhD,
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| Heather Cheng presented on who should undergo germline testing, Highlights of this presentation include the prevalence of variation across disease stages, clinical actionability, and ongoing trials. She emphasizes role of family history and dedicated germline testing.
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| How Do Non-DDR Genomic Alterations Influence Management of Patients with Advanced Prostate Cancer?
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| Ana Aparicio, MD
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| Ana Aparicio discussed how non-DNA Damage Response (DDR) genomic alterations influence the management of patients with advanced prostate cancer. There are currently numerous predictive markers for FDA-approved tumor-agnostic drugs. She noted that the prevalence of such alterations (MSI-H and/or TMB-H) is ~3-5% and the rate of response is as high as 50%, with durable responses observed in ~25% of patients receiving pembrolizumab monotherapy. Significantly, the response rate improves as the tumor mutational burden increases.
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| How to Identify Aggressive Variant Prostate Cancer?
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| Himisha Beltran, MD
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| Himisha Beltran presented on identifying aggressive variant prostate cancer. Castrate-resistant prostate cancer has diverse genomic subtypes (e.g., BRCA2), phenotypic variants (e.g., neuroendocrine PC), and resistance mechanisms. This heterogeneity affects the clinical phenotype spectrum of mCRPC, with some patients showing more aggressive disease.
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| Who Should Undergo Germline Testing?
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| Heather Cheng, MD, PhD,
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| Heather Cheng presented on who should undergo germline testing, Highlights of this presentation include the prevalence of variation across disease stages, clinical actionability, and ongoing trials. She emphasizes role of family history and dedicated germline testing.
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| How to Treat Men with Aggressive Variant or Neuroendocrine Prostate Cancer
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| Andrew Armstrong, MD, ScM, FACP
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| Andrew Armstrong presented on how to treat men with aggressive variant or neuroendocrine prostate cancer. To date, there is no level 1 evidence to inform the choice of systemic therapy for these men with aggressive variant/neuroendocrine prostate cancer. Currently, the National Comprehensive Cancer Network (NCCN) guidelines recommend the following options in the 1st line and subsequent treatment settings:
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| Who Should Undergo Germline Testing?
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| Heather Cheng, MD, PhD,
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| Heather Cheng presented on who should undergo germline testing, Highlights of this presentation include the prevalence of variation across disease stages, clinical actionability, and ongoing trials. She emphasizes role of family history and dedicated germline testing.
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| PSMA Radioligand Therapy – State of the Art
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| Ken Herrmann, Professor, MD
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| Ken Herrmann presented a state-of-the-art lecture discussing next-generation prostate radioligand therapies and theranostics during the PSMA for Diagnostic and Treatment session.
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PSMA for Diagnostic and Treatment
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| How to Utilize Presence or Absence of CT Findings on a PSMA PET/CT?
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| Stefano Fanti, MD, IRCCS
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| Stefano Fanti presented on how to utilize the presence or absence of CT findings on a PSMA PET/CT. To start, Dr. Fanti emphasized an important philosophy of science: “If you conclude with A on the basis of good evidence, you cannot use B obtained with less good evidence to confirm A.” Based on multiple studies and reviews, PSMA PET/CT has higher detection rates than any other imaging modality, especially in patients with low PSA values.
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| Alternative PSMA Ligands for Diagnostics and Treatment – Are They Interchangeable?
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| Michael Hofman, MBBS, FRACP, FAANMS, FICIS, GAICD,
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| Michael Hofman presented on the interchangeability of alternative PSMA ligands for diagnostics and treatment. He highlighted that there are currently four common radiotracers: 68Ga-PSMA-11, 18F-DCFPyL, 18F-PSMArh7.3, and 18F-PSMA-1007, with the aforementioned first three being FDA-approved.
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| Who Should Receive Chemotherapy Before PSMA Radioligand Therapy?
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| Matthew R. Smith, MD, PhD
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| Matthew Smith discussed the patients that should receive chemotherapy before PSMA radioligand therapy. Docetaxel, cabazitaxel, and 177Lu-PSMA-617 improve overall survival in mCRPC, however, there is limited information about the comparative effectiveness of taxanes and PSMA radioligand therapy. Thus, the optimal sequencing of taxanes and PSMA radioligand therapy is undefined. Dr. Smith notes that studies from 20 years ago (TAX3271and SWOG 99162) suggest that docetaxel improves overall survival in mCRPC.
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