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Highlights from The 2025 Western Section AUA Annual Meeting |
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| PSA Response with Darolutamide + ADT in Patients with Metastatic Hormone-Sensitive Prostate Cancer in ARANOTE |
| E. David Crawford, MD |
| In ARANOTE, darolutamide + ADT led to far more patients achieving undetectable PSA compared to placebo, and those who reached undetectable PSA had markedly better outcomes (less radiologic progression, slower time to mCRPC, and less PSA progression). These benefits were consistent across baseline PSA levels, though patients starting with lower PSA were most likely to reach undetectable levels. |
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| Ultra-Low PSA Response in ARANOTE Correlates with Improved Clinical Outcomes
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| Jack Andrews, MD
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| In ARANOTE, patients on darolutamide + ADT who achieved ultra-low PSA had dramatically better outcomes — including major reductions in radiologic progression, time to mCRPC, and PSA progression — compared to those who did not reach these levels. These ultra-low responses became more common over time and occurred across all baseline PSA groups, showing the depth of response possible with darolutamide.
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| Darolutamide + ADT Therapy in Patients with Metastatic Hormone-Sensitive Prostate Cancer: Efficacy and Safety by Disease Volume in the Phase 3 ARANOTE Study
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| E. David Crawford, MD
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| In the phase 3 ARANOTE study, darolutamide + ADT improved radiological progression-free survival, delayed time to CRPC, and time to PSA progression versus placebo in patients with metastatic hormone-sensitive prostate cancer, regardless of disease volume. Low-volume patients saw the greatest benefit, with a 70% reduction in risk of radiological progression or death, while high-volume patients had a 40% risk reduction.
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| Efficacy and Safety of Darolutamide + ADT in Black Patients with Metastatic Hormone-Sensitive Prostate Cancer from the Phase 3 ARANOTE Trial
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| Quoc-Dien Trinh, MD, MBA
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| In this ARANOTE subgroup analysis of 65 Black patients with metastatic hormone-sensitive prostate cancer, darolutamide + ADT improved radiologic progression-free survival and significantly delayed time to mCRPC and PSA progression compared with placebo, with PSA <0.2 ng/mL achieved far more often. Safety in Black patients was similar to the overall ARANOTE population, with no new signals. Although sample size was small, benefit appeared consistent with the overall trial.
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| Integrating Genomic Prognostic and Hallmark Signatures from Decipher GRID to Predict Adverse Outcomes in Men on Active Surveillance for Prostate Cancer |
| Kevin Shee, MD, PhD |
| In a UCSF active surveillance cohort of 486 men, multiple Decipher GRID prognostic and hallmark signatures independently predicted biopsy upgrading and unfavorable histology even after adjusting for CAPRA clinical risk. Key signatures (including Long, Yu, Lapointe, PI3K/AKT/mTOR, and ROS pathways) added meaningful prognostic value beyond standard clinical metrics. These data support further validation to refine genomic-guided risk stratification in active surveillance. |
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| Genomic Classifier Scores and Risk of Histologic Upgrading on Confirmatory Biopsy During Active Surveillance
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| James Nie, MD-MBA
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| James Nie presented a study of 454 men on active surveillance, genomic classifier scores were significantly associated with risk of upgrading on confirmatory biopsy, particularly to Grade Group 3+. However, the low negative predictive value for upgrading to Grade Group 2+ indicates that genomic classifiers alone cannot reliably exclude higher-risk disease.
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| Adoption and Outcomes of Tissue Based Genomic Testing for Prostate Cancer in an Integrated Health System
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| Eric Robinson, MD
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| Eric Robinson presented a study of 195 men with localized prostate cancer, use of the Decipher genomic test significantly influenced management decisions. Patients with lower Decipher scores were more likely to remain on active surveillance, while higher scores led more often to treatment. Despite this, many intermediate-to-high genomic risk patients still chose surveillance, highlighting the complex, individualized nature of prostate cancer decision-making.
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| Impact of PSA Doubling Time and Absolute PSA on PSMA PET Positivity in Post-Prostatectomy Biochemical Recurrence
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| Mouneeb Choudry, MD
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| In this Mayo Clinic retrospective cohort of 405 men with post-prostatectomy biochemical recurrence, both higher PSA and shorter PSA doubling time were associated with higher PSMA PET positivity. Even at low PSA values (<1.0), fast PSA doubling time markedly increased the likelihood of a positive scan. These findings suggest PSA doubling time should be used alongside absolute PSA when deciding timing of PSMA PET.
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| Comprehensive Analysis of the Correlation Between Molecular Subtype and Multimodal Imaging Features of Prostate Cancer
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| Wayne Brisbane, MD
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| Wayne Brisbane presented data showing that specific molecular alterations in prostate cancer, including Decipher score, PTEN loss, SPOP mutation, PAM50, and ERG status, are significantly associated with multimodal imaging features across micro ultrasound, mpMRI, and PSMA PET/CT. These correlations suggest that imaging phenotypes may help predict underlying molecular subtypes, providing a potential non-invasive approach for early risk assessment and personalized care when genomic testing is not available.
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| Head-to-Head Comparison of Multimodal Imaging in the Detection of Prostate Cancer Using Whole Mount Histopathology as a Reference
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| Wayne Brisbane, MD
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| Wayne Brisbane presented a head-to-head comparison of micro ultrasound, mpMRI, and PSMA PET/CT for detecting prostate cancer and extraprostatic extension using whole-mount histopathology as the reference. Lesion-level detection rates for clinically significant prostate cancer were similar across modalities, with micro ultrasound showing comparable performance to mpMRI, while mpMRI outperformed other modalities in sector-level analysis and extraprostatic extension assessment.
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| Comparative Performance of UNFOLD AI, PSMA-PET, and mpMRI for Prostate Cancer Localization and Pathologic Staging
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| Austin Lee, MD
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| Austin Lee presented a comparison of Unfold AI, PSMA-PET, and mpMRI for prostate cancer localization and T-staging using whole-mount histopathology. Unfold AI demonstrated comparable accuracy to PSMA-PET and significantly outperformed mpMRI for detecting clinically significant cancer, while also exceeding both modalities in identifying extraprostatic extension. These results suggest AI-driven imaging platforms like Unfold AI could improve prostate cancer staging and guide treatment planning.
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| Impact of Bone Protecting Agents on Outcomes with Enzalutamide, with or without Radium-223, in Asymptomatic/mildly Symptomatic Patients with Bone mCRPC from PEACE-3
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| Murilo de Almeida Luz, MD
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| Murilo de Almeida Luz presented data from PEACE-3 evaluating bone-protecting agents with enzalutamide, with or without radium-223, in patients with bone mCRPC. Use of bone-protecting agents was associated with longer radiographic progression-free survival and overall survival, with benefits observed across both treatment arms.
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| Impact of Post-Traumatic Stress Disorder on Prostate Cancer Outcomes Following Radical Prostatectomy in a Veteran Population
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| Amana Liddell, BS
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| This VA cohort study of 7,133 veterans who underwent radical prostatectomy found that having PTSD was not associated with worse prostate cancer outcomes. In fact, there was a trend toward better overall survival among veterans with PTSD — potentially due to higher healthcare engagement. Further research is needed to confirm why PTSD patients may actually do better rather than worse after surgery.
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