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PEER-TO-PEER CLINICAL CONVERSATION
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| The Details Are in the Core: Advancing Prostate Tissue Collection |
| James Wysock, MD |
| James Wysock joins Zachary Klaassen to discuss improving prostate cancer diagnostics through better biopsy needle technology. Dr. Wysock highlights early experience with the SUREcore® Biopsy Needle from URO-1 Medical, which aims to enhance tissue collection quality, reduce core fragmentation, and improve diagnostic accuracy. |
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Highlights from the 2025 American Urological Association Annual Meeting |
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| COBRA: Assessment of 64Cu-SAR-bisPSMA and Standard of Care Prostate-Specific Membrane Antigen Positron Emission Tomography in Patients with Biochemical Recurrence of Prostate Cancer Following Definitive Therapy
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| Neal D. Shore, MD, FACS
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| The COBRA study evaluated the use of 64Cu-SAR-bisPSMA PET/CT imaging in detecting prostate cancer lesions in patients with biochemical recurrence (BCR) following definitive therapy. Results showed that next-day imaging with 64Cu-SAR-bisPSMA identified significantly more lesions and had a higher patient-level detection rate compared to same-day imaging and standard-of-care PSMA PET scans. This approach demonstrated the ability to detect lesions as small as 2mm, with a substantial impact on treatment decisions for 48% of patients.
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| Prostate Cancer Risk Groups by PSMA-PET PROMISE: Results from an International Multi-Center Registry Study
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| Claudia Verena Kesch, MD
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| Claudia Kesch's presentation at AUA 2025 introduced the PPP2 nomograms, a refined three-tier risk stratification model for prostate cancer patients based on PSMA PET/CT imaging. The study analyzed data from over 6,000 patients and showed that the PPP2 nomograms significantly outperformed the NCCN risk classification in predicting overall survival (OS), with superior accuracy and discriminatory ability across low-, intermediate-, and high-risk groups.
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| Who Still Needs a Lymph Node Dissection with a Negative PSMA-PET? Results from the Michigan Urological Surgery Improvement Collaborative |
| Ana Moser, MD |
| Ana Moser presented a study at AUA 2025 analyzing the concordance between clinical N stage (cN) from PSMA-PET and pathological N stage (pN) in men undergoing radical prostatectomy with pelvic lymph node dissection. The study found that while PSMA-PET had a high negative predictive value (91%), its positive predictive value was much lower than expected at 29%, suggesting limitations in detecting occult nodal metastases and raising questions about the quality of PSMA-PET imaging and lymph node dissection in real-world settings. |
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| Evaluating the Heterogeneity of Advanced Prostate Cancer by 18F-DCFPyL and 18F-FDG PET/CT in a Prospective Cohort
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| Shouzhen Chen, MD
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| Shouzhen Chen presented findings on the use of dual-tracer ¹⁸F-DCFPyL and ¹⁸F-FDG PET/CT imaging, combined with next-generation sequencing, to evaluate advanced prostate cancer heterogeneity. The study included 104 patients, with 92 showing positive lesions. It found that patients with DCFPyL⁻FDG⁺ lesions were more likely to have visceral metastases, be in the castration-resistant prostate cancer stage, and exhibit poor PSA responses. Additionally, TP53 and RB1 mutations were associated with the DCFPyL⁻FDG⁺ pattern.
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| BMS-986365 (CC-94676), A Dual Androgen Receptor Ligand-Directed Degrader and Antagonist, for Heavily Pre-Treated Patients with Metastatic Castration-Resistant Prostate Cancer: Results from Additional Exploratory Analyses |
| Manish Patel, MD |
| Manish Patel presented exploratory data on BMS-986365 (CC-94676), a dual androgen receptor degrader and antagonist, in heavily pretreated mCRPC patients. The study demonstrated promising anti-tumor activity, with dose-dependent PSA responses and a median radiographic progression-free survival of 6.3 months. Notably, the treatment was well-tolerated, with manageable side effects like asymptomatic prolonged QTc, and a pivotal phase III trial is underway. |
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| Phase II Trial of Image-Guided Oligometastatectomy and Radiation Therapy in Recurrent Prostate Cancer (SOAR) |
| Alejandro Sanchez, MD |
| Alejandro Sanchez presented results from the SOAR phase II trial, which evaluated image-guided oligometastatectomy and radiation therapy in recurrent prostate cancer patients. The trial found that 40% of patients experienced a ≥50% PSA reduction at 6 months, and at 12 months, 74.1% were free of PSA progression, with 71.4% off ADT. The treatment was safe, with no major complications, and ongoing analyses aim to refine patient selection and treatment outcomes. |
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| Testosterone Recovery Following Treatment Suspension of Enzalutamide plus Leuprolide or Leuprolide Alone in Patients with High-Risk Biochemically Recurrent Prostate Cancer: EMBARK Post Hoc Analysis |
| Stephen J. Freedland, MD |
| Stephen Freedland presented a post-hoc analysis of the EMBARK trial, which investigated testosterone recovery after treatment suspension in patients with high-risk biochemically recurrent prostate cancer. The analysis focused on patients treated with enzalutamide + leuprolide or leuprolide alone. It found that most patients (over 98%) recovered testosterone levels to >175 ng/dL, with a median recovery time of 8.3 months for the enzalutamide combination and 5.9 months for leuprolide alone. Younger patients had faster recovery, and testosterone recovery correlated with improvements in quality of life. |
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| 225Ac-J591 PSMA-Targeted Radionuclide Therapy in Metastatic Castration-Resistant Prostate Cancer Patients with Prior 177Lu-PSMA Therapy |
| Abdul Baseet Arham, MBBS |
| Abdul Baseet Arham presented the results of a post hoc analysis evaluating 225Ac-J591 PSMA-targeted radionuclide therapy in mCRPC patients who had previously received 177Lu-PSMA therapy. The study showed that 225Ac-J591, an alpha emitter, had efficacy in patients after prior beta emitter therapy. Among 37 patients, a PSA50 response was observed in 41%, with a PSA90 response in 8%. The median progression-free survival was 3.7 months, and median overall survival was 10.9 months. |
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| Real-World Time-to-Next-Treatment and Time-to-Castration-Resistance Among Patients with mCSPC Using ARPIs with and without Homologous Recombination Repair Alterations |
| Neal Shore, MD, FACS
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| Neal Shore presented the results of a real-world study evaluating time-to-next-treatment and time-to-castration resistance in metastatic castration-sensitive prostate cancer patients treated with androgen receptor pathway inhibitors (ARPIs), focusing on those with and without homologous recombination repair mutations.
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| Early Oncological Outcomes of Very High-Risk Prostate Cancer Patients According to the STAMPEDE Trial Definition in the PSMA-PET Era: Implication for the Selection of the Optimal Surgical Candidate |
| Alessandro Viti, MD |
| Alessandro Viti presented a study at AUA 2025 showing that men with very high-risk prostate cancer staged with PSMA PET had improved early oncological outcomes compared to those staged with conventional imaging. The study found a lower incidence of early biochemical recurrence (eBCR) in the PSMA PET cohort (15%) versus the conventional imaging cohort (29%), suggesting that PSMA PET may better identify patients who could benefit from radical prostatectomy and extended pelvic lymph node dissection. |
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| Trends In Use of Pelvic Lymph Node Dissection During Radical Prostatectomy |
| Minh Nguyen |
| Minh Nguyen presented findings at AUA 2025 showing that following the 2007 AUA guideline revision, which recommended a more selective approach to pelvic lymph node dissection (PLND), PLND rates during radical prostatectomy significantly increased from 79% to 88%, with the median number of lymph nodes examined rising from 3 to 5. The increase in PLND was most notable in intermediate- and high-risk prostate cancer groups, while low-risk patients saw no significant change, likely influenced by broader shifts in patient selection and surgical practices. |
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| 5-Year Outcomes Following a Negative MRI or Negative Biopsy for Suspected Prostate Cancer: Results from 1285 patient in the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) Pathway |
| Chase Ng, MBChB MRCS |
| Chase Ng presented a study at AUA 2025 showing that the RAPID pathway, an MRI-based diagnostic tool for prostate cancer, achieved high 5-year cancer-free survival (92.3%) and treatment-free survival (94.3%) rates in a cohort of 1,285 patients. This suggests that the RAPID pathway is effective in minimizing redundant testing and overdiagnosis, confirming its safety and efficacy for streamlining prostate cancer screening and diagnosis. |
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| Challenges and Unmet Needs of Caregivers for Patients with Prostate Cancer: A US-Based Quantitative Survey |
| Zachary Klaassen, MD, MSc |
| Zachary Klaassen presented a survey at AUA 2025 on the challenges faced by caregivers of prostate cancer patients, highlighting significant unmet needs. The study found that caregivers, especially those of metastatic patients, often had to alter their work and personal lives to meet caregiving demands, with many being deeply involved in the treatment process. Key recommendations included greater caregiver inclusion in decision-making, tailored educational support, and the need for accessible caregiver resources to enhance shared decision-making. |
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| Are Veterans with Prostate Cancer Scientifically Underserved? Describing Access to Prostate Cancer Clinical Trials in the VA |
| Madison Krischak, MD |
| Madison Krischak presented findings at AUA 2025 on the limited access to prostate cancer clinical trials for veterans within the VA healthcare system. Only 6% of prostate cancer trials included a VA site, with significant regional variations in trial availability, highlighting a need to improve access, especially for phase 3 trials. The study emphasized that veterans may be scientifically underserved, with fewer than half of VA facilities offering prostate cancer trials, and recommended strategies to increase trial availability within the VA system. |
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| Recovery of Urinary Continence after Robotic-Assisted Radical Prostatectomy: A Multicenter Comparison of Retzius-Sparing, Hood and Standard Techniques |
| Gal Wald, MD |
| Gal Wald presented a multicenter comparison at AUA 2025 on the recovery of urinary continence after robotic-assisted radical prostatectomy (RARP) using standard, retzius-sparing, and hood techniques. The study found that both retzius-sparing and hood RARP improved early continence recovery compared to the standard technique, with retzius-sparing showing the most significant improvement at 3, 6, and 12 months. However, retzius-sparing was associated with higher positive surgical margins, prompting ongoing investigation through a randomized trial to further assess oncological and functional outcomes. |
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