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Highlights from the 2025 American Urological Association Annual Meeting
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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 presented a study showing that a history of pelvic radiotherapy in patients with biochemical recurrence after radical prostatectomy was associated with higher odds of a positive PSMA PET scan. The study suggests that PSMA PET should be performed at lower PSA thresholds in these patients, as prior pelvic radiotherapy increases the likelihood of detecting metastatic disease.
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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 Therapy Candidates
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| Antony Pellegrino, MD
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| Antony Pellegrino presented a study evaluating the prognostic impact of a negative PSMA PET scan at the time of biochemical recurrence in prostate cancer patients post-radical prostatectomy. The study found that patients with negative PSMA PET scans who received salvage radiotherapy had a significantly lower risk of metastatic progression compared to those with negative conventional imaging. These findings support using PSMA PET to refine patient selection for salvage therapy.
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| Biochemical Recurrence Management in 2025 – High-Yield Take Home Messages for the Practicing Clinician
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| R. Jonathan Henderson, MD
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| R. Jonathan Henderson summarized key principles for managing biochemically recurrent prostate cancer, emphasizing the importance of risk stratification and life expectancy in treatment decisions. Low-risk patients may be observed, while high-risk patients should be considered for timely salvage therapy, such as EBRT ± ADT or focal therapies. He underscored the value of shared decision-making and clinical trial participation.
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| Sub-Classification of CHAARTED and LATITUDE Risk Categories: Analysis of the Discrepancy Between High- and Low- Groups: A Multicenter Retrospective Study
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| Takaki Ichiyama, MD
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| Takaki Ichiyama presented a multicenter study examining the impact of discrepancies between CHAARTED and LATITUDE risk categories in mHSPC patients. The study found that while patients in the High-Low group had significantly better CRPC-free survival compared to the High-High group, there was no difference in overall survival. Dr. Ichiyama concluded that these findings suggest the need for further studies to determine whether treatment intensity should be adjusted based on this risk classification.
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| Oncologic Outcomes and Conditional Survival of Patients Receiving Metastases-Directed Therapy for Prostate Cancer Recurrence After Radical Prostatectomy Detected by a Positive PSMA PET
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| Leonardo Quarta, MD
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| Leonardo Quarta presented a study at AUA 2025 analyzing the outcomes of metastases-directed therapy (MDT) using PSMA PET imaging in prostate cancer patients with recurrence after radical prostatectomy. The study found that MDT significantly improved biochemical recurrence-free survival (BCR-free) and metastasis-free survival (MFS) compared to no MDT, with the addition of androgen deprivation therapy (ADT) further enhancing survival benefits. Conditional survival analysis showed that longer periods without progression after MDT strongly correlated with better long-term outcomes.
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| Systemic Treatment Prescription and Switch Patterns in mHSPC Based on Real World Evidence: Results from the PIONEER+ Big Data Consortium for Prostate Cancer
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| Alex Qinyang Liu
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| Alex Qinyang Liu presented real-world data from the PIONEER+ Big Data Consortium at AUA 2025, examining systemic treatment and switch patterns in metastatic hormone-sensitive prostate cancer (mHSPC) patients. The study found that most patients started on ADT monotherapy, with only a small percentage switching to combination therapies like ADT + chemotherapy or ARTA. Notably, patients initially on ADT + ARTA had the highest persistence and longest time-to-switch, highlighting the importance of real-world data in shaping personalized mHSPC treatment strategies.
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| Efficacy and Safety of Darolutamide Plus ADT in Black Patients with mHSPC from the Phase 3 ARANOTE Trial
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| Quoc-Dien Trinh, MD, MBA
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| Quoc-Dien Trinh presented findings from the ARANOTE trial at AUA 2025, focusing on the efficacy and safety of darolutamide plus ADT in Black patients with metastatic hormone-sensitive prostate cancer (mHSPC). Darolutamide significantly improved radiological progression-free survival (rPFS), delayed time to metastatic castration-resistant prostate cancer (mCRPC), PSA progression, and initiation of subsequent therapies compared to placebo, with a safety profile similar to the overall ARANOTE population.
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| Metastatic Hormone Sensitive Prostate Cancer – So Many Randomized Trials (Nine), yet Monotherapy Treatment Persists
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| Andrew Hahn, MD
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| Andrew Hahn highlighted the ongoing underuse of intensified therapy in metastatic hormone-sensitive prostate cancer, despite strong evidence from numerous randomized trials supporting ADT combined with androgen receptor pathway inhibitors, and in some cases, triplet therapy with docetaxel. Real-world data show a decline in ADT monotherapy use since 2023, yet barriers like physician specialty, patient demographics, and comorbidities still affect treatment patterns. Dr. Hahn emphasized the need for further research into toxicity risks and personalized treatment strategies.
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| Assessing the Optimal Duration of Androgen Deprivation Therapy in Node Positive Patients Receiving Postoperative Radiotherapy: Applicability of the RADICALS-HD
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| Francesco Barletta, MD
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| Francesco Barletta presented findings from a study evaluating the optimal duration of androgen deprivation therapy (ADT) in node-positive patients receiving post-operative radiotherapy. The study found that longer ADT use (up to 36 months) was associated with improved metastasis-free survival, with no plateau effect and no difference in benefit based on the number of positive nodes. These results suggest that extending ADT duration may provide a survival benefit in this patient population, supporting findings from the RADICALS-HD trial.
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| Testosterone Recovery Profiles after Cessation of Androgen Deprivation Therapy for Prostate Cancer: A Meta-Analysis of Prospective Trials
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| Lucas Amorim, MD
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| Lucas Amorim presented a meta-analysis of prospective trials evaluating testosterone recovery following cessation of androgen deprivation therapy in prostate cancer patients. The study found that 75.8% of patients overall recovered testosterone to normal levels, though recovery was significantly lower in those treated with GnRH agonists. The analysis also indicated no significant correlation between ADT duration and testosterone recovery, suggesting that while most patients recover, GnRH agonists may hinder this process.
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| PSMA-Targeted Actinium-225 Therapy in Metastatic Castration-Resistant Prostate Cancer: Comparative Outcomes Between Monotherapy vs. Combination Therapy |
| Valentina Marulanda Corzo, MD |
| Valentina Marulanda Corzo presented a study at AUA 2025 comparing PSMA-targeted Actinium-225 therapy as monotherapy versus combination therapy in metastatic castrate-resistant prostate cancer. The analysis found that combination therapy led to significantly improved progression-free survival and overall survival compared to monotherapy, with higher PSA50 response rates. |
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| Rucaparib Versus Docetaxel or Second-Generation Androgen Receptor Pathway Inhibitor Therapy for Metastatic Castration-Resistant Prostate Cancer Patients with BRCA Mutations with or Without Liver Metastases in TRITON3
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| David Morris, MD
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| David Morris presented exploratory results from the TRITON3 study, comparing rucaparib with physician’s choice of docetaxel or ARPI in BRCA-mutated mCRPC patients. The analysis showed that rucaparib significantly improved radiographic progression-free survival in both patients with and without liver metastases, with higher objective response rates, though overall survival was similar between the groups. However, these results should be interpreted cautiously due to the small number of patients with liver metastases.
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