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Highlights from the 2024 ASCO Genitourinary Cancers Symposium |
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| Systemic Treatment of High-Risk Biochemical Recurrence
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| Channing Paller, MD
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| Channing Paller discusses systemic treatment for high-risk biochemical recurrence in prostate cancer. She highlights the transformative impact of PSMA PET scans on treatment decisions, enabling more accurate disease localization. The presentation covered key trials, including the FDA-approved enzalutamide for nmCSPC based on the EMBARK trial, revealing improved metastasis-free survival and overall survival with enzalutamide.
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| Public Health Would Dramatically Improve if Gleason 6 (Grade Group 1) Weren’t Called Cancer |
| Scott Eggener, MD |
| Scott Eggener advocates for renaming Gleason 3+3 (Grade Group 1) prostate cancer, asserting that public health would significantly benefit if it weren't labeled as cancer. He argued that despite microscopic evidence, Gleason 6 disease behaves indolently, rarely posing a threat. Dr. Eggener proposed alternative terms and emphasized ongoing efforts to change the nomenclature, believing that reclassifying Gleason 6 as "benign" or "pre-cancerous" would reduce unnecessary treatments and improve overall health outcomes. |
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| Renaming Gleason 3+3 (Grade Group 1): Against |
| Martin Gleave, MD |
| Martin Gleave opposed the proposal to rename Gleason 3+3 (Grade Group 1) prostate cancer. He argued against reclassification, citing concerns about scientific accuracy, morphology, and molecular features resembling cancer, the non-benign natural history of Gleason pattern 3, and potential unintended consequences on pathology, active surveillance, and treatment decisions. |
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| Multicentre Prospective Evaluation of Cognitive Function in Patients with Metastatic Castrate-Resistant Prostate Cancer Treated with Abiraterone Acetate or Enzalutamide: The ACE Study
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| Amit Bahl, MD, FRCP, FRCR
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| The ACE study presented by Amit Bahl evaluated cognitive function in metastatic castrate-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide. The non-randomized, prospective study found no significant differences in mean composite cognitive outcomes between the two treatments at 3-4 and 6 months.
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| Differences in Genomic, Transcriptomic, and Immune Landscape of Prostate Cancer Based on Site of Metastasis
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| Umang Swami, MD, MS
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| Umang Swami presented on differences in the genomic, transcriptomic, and immune landscapes of prostate cancer based on the site of metastasis. The study utilized a large, multi-institutional, real-world dataset of patients with prostate cancer. DNA and RNA sequencing were performed for primary prostate cancer and unpaired metastatic sites.
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| Interim Results from a Phase 1/2 Study of HPN328, a Tri-Specific, Half-Life Extended DLL3-Targeting T-Cell Engager, in Patients with Neuroendocrine Prostate Cancer and Other Neuroendocrine Neoplasms |
| Himisha Beltran, MD |
| Himisha Beltran presented interim results from a phase 1/2 study of HPN328, a tri-specific, half-life extended DLL3-targeting T-cell engager, in patients with neuroendocrine prostate cancer (NEPC) and other neuroendocrine neoplasms. DLL-3 expression increases across the prostate cancer continuum, and HPN328 demonstrated promising clinical activity in neuroendocrine carcinomas, including GU subtypes. |
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| Stockholm3 Validation in a Multi-Ethnic Cohort for Prostate Cancer (SEPTA) Detection: A Multicentered, Prospective Trial |
| Scott E. Eggener, MD |
| Scott Eggener presented the SEPTA study, a multicenter, prospective validation trial of Stockholm 3 for prostate cancer in a multi-ethnic cohort. The study included 2,129 men, 55% of whom identified as racial/ethnic minorities, and found that a Stockholm3 cut-off of ≥15 reduced unnecessary biopsies by 45% compared to a PSA cut-off of ≥4 ng/ml, with attractive characteristics observed in diverse racial and ethnic subgroups. |
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| Total and Anatomically Contextualized Quantitative 18F-DCFPyL PET at Biochemical Recurrence to Predict Subsequent Biochemical Progression-Free Survival in Patients with Prostate Cancer |
| Hong Song, MD, Ph.D. |
| Hong Song presents a study on the utility of total and anatomically contextualized quantitative 18F-DCFPyL PET at biochemical recurrence to predict subsequent biochemical PFS in patients with prostate cancer. The study found that anatomically contextualized aPSMA score and total volume predicted subsequent biochemical progression-free survival in biochemical recurrent prostate cancer patients, offering valuable information for treatment decisions and follow-up strategies. |
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| A Convolutional Neural Network Model Using Intraprostatic Patterns of 18F-DCFPyL Uptake in PSMA PET Images to Predict Synchronous Metastases |
| Jesus Juarez, MD |
| Jesus Juarez presents a study on a convolutional neural network model using intraprostatic patterns of 18F-DCFPyL uptake in PSMA PET images to predict synchronous metastases in prostate cancer patients. The study demonstrated that the convolutional neural network model, based on 18F-DCFPyL imaging, can predict synchronous metastases with a predictive accuracy comparable to published models based on clinicopathologic features. This suggests the potential for using 18F-DCFPyL convolutional neural network-based models for prognosticating metastatic progression in prostate cancer. |
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| Survival and Fracture Risk with Radium-223 Therapy in mCRPC: A Real-World Analysis |
| Hanbo Zhang, MD, FRCPC |
| Hanbo Zhang presented a real-world analysis of survival and fracture risk with radium-223 therapy in mCRPC. The results showed that concurrent use of bone-protective agents was associated with a significant reduction in the risk of pathologic fractures in patients receiving radium-223. The study suggests that the administration of bone-protective agents should be considered for mCRPC patients undergoing radium-223 therapy. |
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| Clinical and Patient Factors Associated with Treatment Intensification for mHSPC |
| Sreevalsa Appukkuttan, MPH, MBBS |
| Sreevalsa Appukkuttan presented a study on clinical and patient factors associated with treatment intensification for mHSPC. The study, based on electronic health records from OPTUM, identified 1,123 mHSPC patients who received ADT between 2020 and 2022. The results showed that just over half of eligible patients received treatment intensification following ADT. |
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| Real-World Utilization Patterns of Radium-223 in Metastatic Prostate Cancer in the United States: An Administrative Claims Database Study |
| Amit D. Raval, Ph.D. |
| Sreevalsa Appukkuttan presented a study on clinical and patient factors associated with treatment intensification for metastatic mHSPC. The results showed that just over half of eligible patients received treatment intensification following ADT. Factors associated with receiving intensified therapy included younger age, the presence of bone/bone marrow metastasis at baseline, region, and lower modified Charlson Comorbidity Index score. |
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| Real-world Analyses of Mortality Risk After ADT Initiation in Black vs White Patients with Prostate Cancer |
| Judd Moul, MD |
| Judd Moul presented a study on real-world analyses of mortality risk after ADT initiation in Black vs. White patients with prostate cancer. The analysis found that overall, mortality risk was higher in White vs. Black patients. Both unadjusted and adjusted mortality risks were higher for White patients. Potential hypotheses for higher mortality in White patients were discussed, including survival bias and the protective effects of higher BMI in Black patients. |
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| Preliminary Data from a Dose-Escalation Phase 1 Study with HP518, an AR PROTAC Degrader: Safety, Tolerability, Pharmacokinetics, and First Assessment of Anti-Tumor Activity in Patients with mCRPC
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| Arun Azad, MD, Ph.D.
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| Arun Azad presented preliminary data from a dose-escalation phase 1 study with HP518, an oral proteolysis targeting chimera (PROTAC) protein degrader designed to target androgen receptor mutations for the treatment of mCRPC. HP518 was well-tolerated, and no dose-limiting toxicity was observed. Preliminary results showed a PSA50 response and radiographic responses in some patients, with evidence suggesting that the presence of androgen receptor ligand-binding domain mutations may predict benefit from HP518.
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| Prostate Cancer Foundation (PCF) Screening Guidelines for Prostate Cancer in Black Men in the United States |
| Isla Garraway, MD, Ph.D. |
| The Prostate Cancer Foundation screening guidelines for prostate cancer in Black men in the United States were presented by Dr. Isla Garraway. Given the higher risk of prostate cancer and aggressive disease in Black men, the PCF assembled a multidisciplinary panel of experts to conduct a comprehensive literature review and generate guidelines. |
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| Patient-Provider Rurality and Outcomes in Older Men with Prostate Cancer |
| Avirup Guha, MPH, MBBS |
| Arvip Guha presented a study on the association between patient-provider rurality and outcomes in older men with prostate cancer. The study utilized the SEER-Medicare-linked database to identify males aged 66 years and older with a new primary diagnosis of prostate cancer between 2009 and 2017. |
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