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Highlights from the 2025 American Society of Clincial Oncology Genitourinary Cancers Symposium |
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| Prospective Monitoring of Prostate Specific Membrane Antigen (PSMA) –Positive Recurrent Prostate Cancer: Preliminary Data from 6 Months PSMA Follow-Up. |
| Ravi A. Madan, MD |
| Preliminary data from the ongoing prospective study (NCT05588128) monitoring PSMA-positive recurrent prostate cancer (PSMArpc) suggest an indolent disease course, with minimal progression over six months. Among 73 evaluable patients, 48 had PSMA-positive metastases, and only two progressed to metastatic disease at follow-up. These findings highlight the need for refined risk stratification in PSMArpc and may help guide treatment strategies and future clinical trials. |
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| Impact of PSMA-PET and Conventional Imaging on Contemporary Management in Patients with Biochemical Recurrence After Radical Prostatectomy
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| Lufan Wang, MSc
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| A study presented at ASCO GU 2025 assessed the impact of PSMA PET vs. conventional imaging on the management of biochemical recurrence (BCR) after radical prostatectomy. PSMA PET had a higher detection rate (53% vs. 10%), leading to earlier initiation of salvage therapy at lower PSA levels, with more targeted radiation therapy but no significant difference in hormonal therapy utilization or second BCR rates.
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| Association of Baseline and On-Treatment ctDNA Fraction with Clinical Outcomes in Patients with mCRPC in the PSMAfore Study of 177Lu-PSMA-617
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| Johann De Bono, MD, MSc, PhD, FRCP, FMedSci
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| The PSMAfore study of 177Lu-PSMA-617 in mCRPC patients showed that higher baseline and on-treatment ctDNA fraction was associated with shorter radiographic progression-free survival (rPFS) and overall survival (OS), with stronger associations at cycle 2 day 1 than at baseline. ctDNA clearance from baseline to cycle 2 day 1 correlated with longer rPFS and OS, providing additional prognostic value beyond PSA50 response.
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| Clinical Protocols to Monitor Efficacy of [177Lu]Lu-PSMA Radiopharmaceutical Therapy in Metastatic Castration-Resistant Prostate Cancer
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| Johann De Bono, MD, MSc, PhD, FRCP, FMedSci
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| A study presented at ASCO GU 2025 evaluated clinical protocols for monitoring [177Lu]Lu-PSMA radiopharmaceutical therapy in mCRPC using SPECT/CT and PET/CT imaging with RECIP 1.0 criteria. PSMA-PET/CT identified more patients with progressive disease than SPECT/CT, but a composite system combining SPECT/CT and PSA showed similar prognostic accuracy to PET/CT + PSA for assessing treatment response.
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| Barriers to and Facilitators of First-Line Treatment Intensification in Metastatic Castration-Sensitive Prostate Cancer (mCSPC) by Practice Setting and Intensification Frequency: A Sub-Analysis of IMPLEMENT
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| Neeraj Agarwal, MD
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| A sub-analysis of IMPLEMENT, presented at ASCO GU 2025, examined barriers and facilitators of first-line treatment intensification in mCSPC by practice setting and intensification frequency. Low intensifiers and non-academic physicians reported more barriers, including knowledge gaps, cost concerns, and reluctance to intensify early, while high intensifiers and academic physicians cited better clinical support and confidence in managing treatment.
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| Clinical Use and Outcomes of Androgen-Receptor Pathway Inhibitors Triplet Therapy for Metastatic Hormone-Sensitive Prostate Cancer (ARAAT)
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| Rana McKay, MD
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| In a real-world analysis of triplet therapy for metastatic hormone-sensitive prostate cancer (mHSPC), darolutamide combined with ADT and docetaxel demonstrated superior outcomes compared to abiraterone in terms of PSA response, treatment discontinuation, and progression to mCRPC. At 18 months, patients on darolutamide had a lower probability of treatment discontinuation and progression to mCRPC, along with a higher survival rate.
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| Real World Comparison of Time-to-next-Treatment, Time-to-Castration-Resistance, and Overall Survival Among Patients with BRCA1/2 Positive and Homologous Recombination Repair (HRR) Negative Metastatic Castration-Sensitive Prostate Cancer
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| Heather Cheng, MD, PhD
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| A real-world comparison of patients with BRCA1/2-positive and HRR-negative metastatic castration-sensitive prostate cancer found that BRCA1/2+ patients had significantly shorter time-to-next-treatment and time-to-castration-resistance than HRR-negative patients. After 24 months, more BRCA1/2+ patients required subsequent treatments and progressed to castration resistance.
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| Age-Related Efficacy and Safety of Darolutamide + ADT and Docetaxel in Patients with mHSPC: A Subgroup Analysis of ARASENS
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| Joan Carles
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| A subgroup analysis of the ARASENS trial, presented by Dr. Joan Carles, examined the age-related efficacy and safety of darolutamide + ADT + docetaxel in patients with metastatic hormone-sensitive prostate cancer (mHSPC). The results showed consistent improvements in overall survival, time to metastatic castration-resistant prostate cancer (mCRPC), and time to subsequent therapy for both younger (<75 years) and older (≥75 years) patients, with darolutamide well tolerated in both age groups.
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| Final Overall Survival with Talazoparib + Enzalutamide as First-line Treatment in Patients with HRR-deficient mCRPC in the Phase 3 TALAPRO-2 Trial
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| Karim Fizazi, MD
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| Karim Fizazi presented the final overall survival results from the TALAPRO-2 trial, which evaluated talazoparib + enzalutamide as first-line treatment for HRR-deficient metastatic castration-resistant prostate cancer. The trial demonstrated that talazoparib + enzalutamide significantly improved OS, with a median of 45.1 months compared to 31.1 months for placebo + enzalutamide, establishing it as a new standard of care for HRR-deficient mCRPC.
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| Patient Characteristics and Overall Survival with Lutetium (Lu177) Vipivotide Tetraxetan (177Lu-PSMA-617): A Real-World Analysis of Early Adopters
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| Daniel J. George, MD
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| A real-world study of 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC) involved 643 patients, most aged ≥65, with a median overall survival (OS) of 15.3 months, aligning with VISION trial results. Patient subgroups, including age, race, and provider specialty, showed no significant survival differences, confirming 177Lu-PSMA-617 as effective in clinical practice.
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| Time from Medication Order to Administration of Cabazitaxel vs. Lutetium Lu-177 Vipivotide Tetraxetan in Patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC)
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| Yeonjung Jo
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| A real-world analysis comparing cabazitaxel and lutetium Lu-177 vipivotide tetraxetan for patients with metastatic castration-resistant prostate cancer (mCRPC) found that lutetium had a significantly longer time from medication order to administration. On average, lutetium took 22 days (IQR 12-43) versus cabazitaxel, which took only 7 days (IQR 3-14). This delay was consistent across both academic and community practices, as well as commercial and Medicare insurance types.
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| Safety Evaluation of Stereotactic Body Radiation Therapy (SBRT) During Lutetium-177-PSMA-617 (177Lu-PSMA-617) Treatment for Patients with Metastatic Prostate Cancer
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| Adam Kessel, MD
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| A retrospective study assessed the safety of combining stereotactic body radiation therapy (SBRT) with lutetium-177-PSMA-617 (177Lu-PSMA-617) in 31 patients with metastatic prostate cancer. The results showed low toxicity, with 6.5% experiencing fractures and 3.2% developing neuropathy, while 84% completed the full treatment regimen. Dr. Kessel emphasized the need for further research to evaluate long-term oncologic efficacy and potential late side effects.
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| Docetaxel Rechallenge Versus Cabazitaxel in Patients Previously Treated with Docetaxel for Metastatic Castrate-Resistant Prostate Cancer (mCRPC)
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| Pedro C. Barata, MD, MSc
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| Pedro Barata presented a population-based study comparing docetaxel re-challenge versus cabazitaxel switch in metastatic castrate-resistant prostate cancer (mCRPC) patients previously treated with docetaxel. The study, based on the VA healthcare system database, found that docetaxel re-challenge led to superior overall survival (12.3 vs. 9.6 months) and better PSA responses (PSA30, PSA50, PSA90) compared to cabazitaxel switch. These findings suggest that docetaxel re-challenge may offer better outcomes and cost-effective treatment for patients in this setting.
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| Cabozantinib ± Atezolizumab in Patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC): Expansion Cohorts from the Open-Label Phase 1b COSMIC-021 Study
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| Neeraj Agarwal, MD
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| Neeraj Agarwal presented results from the COSMIC-021 study, evaluating cabozantinib ± atezolizumab in patients with metastatic castration-resistant prostate cancer (mCRPC). The combination of cabozantinib and atezolizumab showed promising clinical activity, especially in patients with liver metastases, where it significantly improved progression-free survival (PFS) and overall survival (OS) compared to cabozantinib alone.
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| Rucaparib Versus Docetaxel or Second-Generation Androgen Pathway Inhibitor Therapy for Metastatic Castration-Resistant Prostate Cancer: TRITON3 Final Overall Survival and Safety
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| Alan Bryce, MD
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| Alan Bryce presented the final overall survival and safety data from the TRITON3 study, comparing rucaparib (a PARP inhibitor) versus docetaxel or second-generation androgen receptor pathway inhibitors (ARPIs) for metastatic castration-resistant prostate cancer with BRCA1/2 or ATM mutations.
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| Real-World Use and Outcomes of Darolutamide, Enzalutamide, and Apalutamide for Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC): Race Subgroup Analysis.
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| Daniel J. George, MD
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| Daniel George presented a race subgroup analysis of the DEAR-EXT study, which assessed the use and outcomes of darolutamide, enzalutamide, and apalutamide (APA) for nonmetastatic castration-resistant prostate cancer . The study found that DARO was associated with lower discontinuation rates and better metastasis-free survival compared to ENZA and APA in both Black and White patient cohorts, suggesting DARO offers superior clinical benefits in terms of treatment duration and progression outcomes across both races.
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| Real-World Comparison of Cost and Adherence Between Patients Receiving Low-Dose Versus Standard-Dose Abiraterone Acetate in a Safety-Net Hospital
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| Michael Weinfeld, PhD
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| A retrospective analysis at ASCO GU 2025 compared low-dose (LDAA) vs. standard-dose abiraterone (SDAA) in a diverse, safety-net hospital population. Patients on LDAA had lower financial burden (7.3% vs. 19.6% with monthly copays ≥$100, p=0.04), similar adherence, and comparable adverse event rates.
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| Effects of Integrating Palliative Care on the Uptake of Advanced Care Planning Among Elderly Patients with Advanced Genitourinary Cancers |
| Phichai Chansriwong, MD, MSc |
| A study presented at ASCO GU 2025 evaluated the impact of integrating palliative care on advanced care planning among elderly patients with advanced genitourinary cancers. Patients receiving palliative care had a 100% uptake of advanced care planning (vs. 79% in usual care) and were significantly less likely to require emergency visits, hospitalizations, or aggressive treatments near end-of-life. The findings suggest that early palliative care improves patient-centered decision-making and reduces unnecessary interventions, aligning care with patient preferences. |
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