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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Prognostic Tool Evaluated For Early Treatment Decisions for Metastatic Hormone-Sensitive Prostate Cancer
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Soumyajit Roy, MD
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| Soumyajit Roy shares research on the NADIR prognostic model with Neeraj Agarwal. The tool predicts early PSA response in mHSPC patients receiving ADT plus ARPI.
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Study on Metastatic Hormone-Sensitive Prostate Cancer Survival Trends
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Neeraj Agarwal, MD, FASCO
Neeraj Agarwal discusses a Flatiron database analysis examining treatment intensification in metastatic hormone-sensitive prostate cancer. Dr. Agarwal emphasizes the critical need for improved implementation strategies as the field moves toward triplet therapies incorporating PARP inhibitors, lutetium PSMA-617, or AKT inhibitors, stressing the importance of making practice-changing data accessible beyond paywalls.
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Prostate Cancer Treatment Intensification: From Clinical Evidence to Real-World Application
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Julian Chavarriaga, MD, and Luis Salgado, MD
Zachary Klaassen hosts Julian Chavarriaga and Luis Salgado to explore treatment intensification challenges in prostate cancer care. They emphasize that while ADT remains the cornerstone therapy, treatment intensification with ARPIs has become essential for metastatic disease, yet uptake remains disappointingly low at 30-50% in Colombia and 40-50% globally.
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| Emerging Frontiers in Metastatic Prostate Cancer: Approved, Advancing, and Ahead
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| Rana McKay, MD
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| Rana McKay highlighted rapid advances in metastatic prostate cancer, emphasizing universal somatic and germline genetic testing to guide therapy and family risk assessment. She reviewed key approved treatments, including PARP inhibitor combinations and expanded use of ^177Lu-PSMA-617, alongside promising phase III data and emerging agents such as androgen receptor degraders, antibody–drug conjugates, and T-cell engagers.
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| Comparison of PSA Response Among Patients with mCSPC Treated with Apalutamide or Abiraterone Acetate – A Real-World Study
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| Benjamin Lowentritt, MD, FACS
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| Ben Lowentritt presents a large real-world analysis showed that apalutamide was associated with significantly higher and earlier deep PSA responses than abiraterone acetate in ARPI-naïve patients with mCSPC. By 6 months, 61.4% of apalutamide-treated patients achieved a ≥90% PSA decline versus 45.9% with abiraterone, with a markedly shorter median time to PSA90.
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| TRIPLE-SWITCH(SWOG/CCTG-PR26): Randomized Phase III Clinical Trial of Docetaxel with Androgen Receptor Pathway Inhibitors for mCSPC Patients with a Suboptimal PSA Response
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| Alexandra Sokolova, MD
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| TRIPLE-SWITCH (SWOG/CCTG-PR26) is an international phase III trial evaluating whether adding docetaxel to ADT plus an androgen receptor pathway inhibitor improves overall survival in mCSPC patients with a suboptimal PSA response. The study tests an early, biology-driven intensification strategy—regardless of disease volume—against standard therapy alone, with overall survival as the primary endpoint.
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| De-Escalation Therapy in Metastatic Prostate Cancer: A Retrospective Study on Intermittent ARPI Treatment
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| Barak Talmor
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| This retrospective ESMO 2025 study suggests that planned de-escalation with intermittent ARPI therapy is feasible in selected metastatic prostate cancer patients who achieve a favorable initial response, yielding a median treatment-free survival of 25 months. Longer treatment-free intervals were associated with testosterone recovery, rapid PSA nadir, complete PSMA PET response, and prior prostate radiotherapy, and ARPI rechallenge was highly effective.
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| Relationship Between Undetectable PSA Nadir and Outcomes for Patients with mHSPC in IRONMAN, the International Registry for Men with Advanced Prostate Cancer
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| Hannah McManus, MD
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| In the IRONMAN real-world registry presented at ASCO GU 2025, achieving an undetectable PSA nadir within 6 months was consistently associated with lower relapse rates in patients with mHSPC, regardless of whether they received ADT alone, ADT + ARPI, or ADT + docetaxel. ADT + ARPI produced the highest rates of undetectable PSA at both 6 and 12 months, and while relapse-free survival differed across regimens, overall survival was similar between treatment groups.
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