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PEER-TO-PEER CLINICAL CONVERSATIONS |
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PRESTO Trial Final Results for High-Risk Biochemically Recurrent Prostate Cancer
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Rahul Aggarwal, MD
Zachary Klaassen is joined by Rahul Aggarwal to discuss final results from the PRESTO trial evaluating treatment intensification for high-risk biochemically recurrent prostate cancer.
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PSA Control After Treatment Suspension: EMBARK Data at 36 Months
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Neal Shore, MD, FACS
Neal Shore discusses EMBARK trial exceptional responders who maintained PSA below 0.2 for approximately three years while recovering testosterone.
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Phase 3 INDICATE Trial for Patients with Biochemically Recurrent Prostate Cancer
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Neha Vapiwala, MD, FACR, FASTRO, FASCO
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| Neha Vapiwala discusses the INDICATE trial for biochemical recurrence after prostatectomy. The double-randomization design enrolled arms A and B through January. Arms C and D randomize patients with PET-positive lesions outside pelvis but negative conventional imaging to metastasis-directed radiotherapy versus observation.
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| Final Results from PRESTO (AFT-19): A Phase 3 Open-label Study of Combined Androgen Blockade in Patients with High-risk Biochemically Relapsed Prostate Cancer
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| Rahul Aggarwal, MD
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| Rahul Aggarwal presented final PRESTO (AFT-19) ph3 results in high-risk biochem recurrent CSPC, showing 52-week finite ADT+apalutamide and triplet +abiraterone improved key endpoints vs ADT, with no testosterone recovery detriment but higher gr3-4 AEs in triplet. No MFS/OS significance, though restricted mean MFS gain 2.4-2.9mo. Role uncertain amid PSMA imaging/MDTx era.
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| POSEIDON: Hormone Therapy Use and Duration with Post-Operative Radiotherapy for Recurrent Prostate Cancer – An Individual Patient Data Meta-Analysis
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| Amar Kishan, MD
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| Amar Kishan showed that in POSEIDON IPD meta-analysis, adding HT to post-op RT yielded no OS benefit overall, short-term or long-term, but significant PSA interaction. MFS improved, supporting short-term HT for select high-PSA cases amid biomarker/imaging evolution. Limitations: era before PSMA/Decipher, bicalutamide dominance.
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| PAM50 Intrinsic Subtyping and Decipher Genomic Classifier in BCR After Prostatectomy: Implications for ADT Selection
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| Jonathan Tward, MD, PhD, FASTRO
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| Jonathan Tward showed that in 123 BCR post-RP patients, PAM50 Luminal B subtype correlated with highest Decipher scores, yet 53-63% Non-Luminal B met ADT thresholds. ADT with salvage RT strongly reduced metastasis in Luminal B, trending better baseline for Non-Luminal B; no significant subtype-ADT interaction. Supports ADT use per Decipher regardless of PAM50, especially high-risk Luminal B.
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| Oncological Outcomes Following Prostate-specific Membrane Antigen PET/CT-guided Salvage Whole-pelvis Radiotherapy for Recurrent Prostate Cancer
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| Bernard Jansen, MD, PhD
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| Bernard Jansen showed that in 149 BCR post-RP patients treated with PSMA PET/CT-guided salvage whole-pelvis RT + 2-3yr ADT, 5yr outcomes were bPFS 69%, MFS 79%, TFS 79%, OS 92%, CSS 98%. In-field nodal control excellent, most recurrences out-of-field; higher pre-RT PSA worsened bPFS, longer ADT improved it. Supports PSMA-guided sWPRT+ADT for nodal relapse regardless of PSMA status.
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| Stereotactic Ablative Body Radiotherapy for PSMA-PET/CT Staged, Oligometastatic Prostate Cancer - A Multi-Centre Study - Beyond the Abstract
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| Isabelle Schupak and Michael Ng
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| Isabelle Schupak and Michael Ng showed that in the largest PSMA-PET-staged omPC retrospective series, SABR yielded median ADT-free survival ~42mo, with bFFS 46/26/19% at 12/24/36mo but higher cFFS, most lesions nodal/osseous and minimal concurrent ADT. SABR delays systemic therapy 3+ years in well-selected bone/nodal-only disease, though biochemical relapses common without immediate escalation. Supports metastasis-directed management pending randomized data on whole-body PET/PSMA-tracers/systemic integration.
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