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Highlights from the 2025 European Association of Urology Annual Meeting |
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| ARASENS Trial Analysis Investigates Impact of Initial PSA Values on Treatment Response in mHSPC |
| Alicia Morgans, MD, MPH |
| Neeraj Agarwal is joined by Alicia Morgans to discuss an analysis of baseline PSA levels and clinical outcomes from the ARASENS trial in metastatic hormone-sensitive prostate cancer. Dr. Morgans explains how the study stratified patients into low (<4.8), middle (4.8-27.55), and high (>27.55) PSA quartiles to assess the impact of adding darolutamide to ADT plus docetaxel. |
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| Bone-Protective Agents and Survival Benefits in PEACE-3 Trial Subgroup Analysis |
| Fred Saad, MD, FRCS, FCAHS |
| Fred Saad joins Zachary Klaassen to discuss a subgroup analysis of the PEACE-3 trial, which evaluated enzalutamide with or without radium-223 in metastatic castration-resistant prostate cancer. |
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| A Phase I/II Study of Neoadjuvant, Intra-Arterial Administration of (177Lu) Lutetium Vipivotid Tetraxetan in Subjects with High-Risk, Localised or Locally Advanced Prostate Cancer (LUPUS)
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| Claudia Verena Kesch, MD
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| The LUPUS trial is a phase I/II study evaluating the feasibility and safety of intra-arterial (¹⁷⁷Lu)-Lutetium vipivotide tetraxetan as neoadjuvant therapy in men with high-risk, localized, or locally advanced prostate cancer before radical prostatectomy. The study consists of two stages, escalating the treatment dose based on initial safety outcomes, with feasibility determined by surgical delays or significant adverse events.
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| How to Optimize Outcomes in Men with Biochemical Recurrence After Local Treatment with Curative Intent |
| Bertrand Tombal, MD, PhD |
| This was a comprehensive presentation by Dr. Bertrand Tombal on optimizing outcomes for men with biochemical recurrence (BCR) after local treatment. His key takeaways reinforce the importance of risk stratification, early intervention for high-risk patients, and the growing role of advanced imaging and genomic tools in guiding treatment decisions. |
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| Debate: De Novo Low-Volume Metastatic Hormone-Sensitive Prostate Cancer: Total Eradication Is the Way to Go
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| Alberto Bossi, MD
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| Alberto Bossi argued that total eradication is the optimal approach for de novo low-volume metastatic hormone-sensitive prostate cancer, emphasizing intensified local treatment and metastasis-directed therapy. He highlighted data from PEACE-1, STAMPEDE, and HORRAD, which support the role of radiotherapy in improving progression-free survival, delaying castration resistance, and reducing urinary obstruction events, though its impact on overall survival remains uncertain.
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| Debate De Novo Low-Volume Metastatic Hormone-Sensitive Prostate Cancer: ADT + ARPI Does It All
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| Elena Castro, MD, PhD
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| Elena Castro argued that androgen deprivation therapy plus androgen receptor pathway inhibitors is sufficient for treating de novo low-volume metastatic hormone-sensitive prostate cancer, questioning the role of metastasis-directed therapy.
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| Metastatic Hormone Sensitive Prostate Cancer with a Deep Response to ADT plus ARPI: The Pros and Cons of De-escalation of Systemic Therapy
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| Karim Fizazi, MD, PhD, and Bertrand Tombal, MD, PhD
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| Karim Fizazi and Bertrand Tombal debated the pros and cons of de-escalating systemic therapy in mHSPC patients with a deep response to ADT + ARPI. Dr. Fizazi argued against de-intensification, citing the oncogenic addiction of prostate cancer to androgen signaling and survival benefits from continuous therapy, particularly in high-volume disease. Dr. Tombal, however, highlighted the risks of long-term systemic therapy, including cardiovascular side effects, and suggested that some patients with excellent PSA responses could safely discontinue treatment, advocating for personalized decision-making.
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| Impact of Baseline PSA on Clinical Outcomes in Patients with mHSPC Treated with Darolutamide Triplet Therapy in ARASENS
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| Alicia Morgans, MD, MPH
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| Alicia Morgans presented a post-hoc analysis of ARASENS at EAU 2025, evaluating the impact of baseline PSA on outcomes in mHSPC patients treated with darolutamide triplet therapy. The study found that lower baseline PSA was associated with higher undetectable PSA rates, longer time to PSA progression, and longer time to castration-resistant prostate cancer (CRPC).
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| A Phase 3 Study with Standard of Care with and Without 177Lu-Rosopatamab (TLX591) for Patients with Metastatic Castration-Resistant Prostate Cancer Progressing Despite Treatment with a Novel Androgen Axis Drug (ProstACT GLOBAL)
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| Martina Sollini, MD
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| The ProstACT GLOBAL trial is a phase 3 study evaluating [¹⁷⁷Lu]Lu-rosopatamab, a PSMA-targeted radiolabeled antibody-drug conjugate, in patients with mCRPC who have progressed despite prior ARPIs. The trial, enrolling 520 patients, consists of a dosimetry and safety lead-in phase followed by a randomized treatment expansion phase comparing standard of care with or without [¹⁷⁷Lu]Lu-rosopatamab.
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| Sub-Group Analysis from EORTC-GUCG 1333/PEACE-3, an EORTC/CTI/CUO |
| Fred Saad, MD, FRCS |
| Fred Saad presented a subgroup analysis from the PEACE-3 trial at EAU 2025, evaluating the impact of bone-protecting agents on enzalutamide with or without radium-223 in bone metastatic mCRPC. The use of bone-protecting agents significantly improved radiological progression-free survival and overall survival, with the enzalutamide + radium-223 + bone-protecting agent arm achieving the longest survival. |
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