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Highlights from the 2022 Advanced Prostate Cancer Consensus Conference (APCCC) |
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| Who Needs Early Salvage RT and Who Needs Adjuvant RT in 2022?
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| Kosj Yamoah, MD, Ph.D.
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| The 2022 Advanced Prostate Cancer Consensus Conference (APCCC) Hybrid Meeting included a session on biochemical recurrence, and a presentation by Dr. Kosj Yamoah discussing who needs early salvage radiotherapy and who needs adjuvant radiotherapy in 2022.
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| Who Needs Systemic Treatment With Salvage RT? |
| Brandon Mahal, MD |
| Brandon Mahal discussed who needs systemic treatment with salvage radiotherapy. Dr. Mahal highlighs several important trials that have passed, key take aways, as well as several ongoing clinical trials in this disease space. |
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| Biochemical Recurrence After Definitive Radiotherapy of the Prostate – What Are the Local Treatment Options? |
| Jochen Walz, MD |
| Jochen Walz discussed local treatment options for biochemical recurrence after definitive radiotherapy. Dr. Walz started his presentation by highlighting the frequency of local recurrence. Local failure rates after radiotherapy are ~17-40% if PSMA PET/CT is used for restaging, and thus we need to think about local salvage therapy options. Staging depends on the intended management, which may include MRI, PSMA PET/CT or biopsy. |
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| Debate: Imaging Directed Treatment for BCR |
| Nicholas D. James, BSc, MBBS, Ph.D., FRCP, FRCR |
| Nicholas James discussed imaging directed treatment for biochemical recurrence. Dr. James notes that in the pre-PSA era, data favored early versus deferred hormone therapy, given that many patients received treatment very late and ~10% of deferred patients died from prostate cancer and no treatment (with all patients having advanced disease at study entry). |
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| Debate: PSA Directed Treatment for BCR |
| Neha Vapiwala, MD, FACR, FASTRO |
| Neha Vapiwala discussed PSA directed treatment for biochemical recurrence. Dr. Vapiwala emphasized that it’s all about timing and noting that there are several instances when there is a problem: (i) locally advanced disease on initial staging (planned trimodal approach), (ii) high-risk features discovered on surgical pathology (adjuvant versus salvage radiation), and (iii) all of the above, but only if there is a concerning genomic classifier score. |
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| How Can Treatment Be Individualized By Using Genomic Classifiers? |
| Felix Feng, MD |
| Felix Feng discussed how treatment can be individualized by using genomic classifiers. Dr. Feng started by highlighting that genomic biomarkers are included in certain treatment guidelines for the management of PSA recurrences. In the NCCN guidelines, the Decipher molecular assay is recommended for risk stratification among men with PSA persistence or recurrence. |
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| Can Biology Help Inform Treatment Decisions in the Management of mHSPC? |
| Gert Attard, MD, Ph.D., FRCP |
| Gert Attard discussed whether we need more granularity in mHSPC and whether biology can help with treatment decisions. To start his presentation, Dr. Attard asked the question: Outside of a clinical trial, would the information on tumor genomic profiling (primary tumor or metastatic lesion) influence your first-line treatment decision of mHSPC? There are several mHSPC trials implementing molecular biomarkers that are either recruiting already or being planned. |
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| When Low-Volume on Conventional Imaging Goes into High-Volume on Next-Generation Imaging in mHSPC - How Frequent Is This Situation? |
| Michael Hofman, MBBS (Hons), FRACP, FAANMS, FICIS |
| Michael Hofman discussed how frequent low-volume disease on conventional imaging becomes high-volume on next-generation imaging. Dr. Hofman started his presentation by noting that there has been an explosion of PSMA PET publications per year from 2001 to 2021. Dr. Hofman concluded his presentation by suggesting that technological advances have outpaced “evidence base”. |
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| Treatment Intensification Strategies in mHSPC: Triplets and More
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| Christopher Sweeney, MBBS
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| Christopher Sweeney discussed treatment intensification strategies in mHSPC, specifically triplet therapies. Dr. Sweeney started by highlighting that there are several life-prolonging treatment options for men with mHSPC. Dr. Sweeney also emphasized that at this point in time there are several important points that we do not yet understand.
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| Treatment De-Escalation Strategies in mHSPC
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| Bertrand Tombal, MD, Ph.D.
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| Bertrand Tombal discussed de-escalation strategies in mHSPC. Dr. Tombal started his presentation by highlighting the current landscape of advanced prostate cancer as it stands in 2022. Dr. Tombal summarized his presentation and left with several take home messages, There is clearly an opportunity to optimize/de-escalate intensified treatment in selected patients.
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| The Uptake of New Treatment Options for mHSPC in Real Life -- Education, Access, Use, and Diversity
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| Andrew Armstrong, MD
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| Andrew Armstrong discusses the uptake of new treatment options for mHSPC in real life, including education, access, use, and diversity. Dr. Armstrong emphasized that there are unmet needs to potential steps to improve inclusion and treatments globally.
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