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Highlights from the 2026 ASCO Genitourinary Cancers Symposium
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| Gaps in BRCA Mutation Testing Among mCRPC Patients: Insights from US Cancer Practices (2018–2024)
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| Rana McKay, MD
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| Between 2018 and 2024, BRCA1/2 testing in US mCRPC practice increased but plateaued at only about 55–57%, leaving nearly half of eligible patients without documented testing despite PARP inhibitor indications. Testing patterns were heterogeneous (somatic-only, germline-only, or both), and most care occurred in community oncology settings, underscoring system-level gaps that limit equitable access to biomarker-driven therapy.
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| Harnessing Caregiver Support to Improve Shared Decision-Making in Metastatic Prostate Cancer Treatment: A US-Based Quantitative Survey
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| Daniel George, MD
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| This US survey of 230 caregivers of men with metastatic prostate cancer found that caregivers are deeply embedded in care—most attend visits, provide emotional support, help manage medications, and participate in treatment decisions. Yet nearly one-quarter feel under-supported and over half are unsure the “right” resources exist, with notable gender differences showing women bearing more of the emotional and symptom‑monitoring load, highlighting a need for targeted caregiver education and psychosocial support to strengthen shared decision‑making.
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| Opening the Black Box: Biologic Pathways Underlying Multimodal Digital-Pathology Artificial Intelligence in Metastatic Prostate Cancer
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| Amol Shetty, PhD, MS
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| Artera’s multimodal digital‑pathology AI (MMAI) appears to be capturing real tumor biology rather than spurious image patterns in metastatic prostate cancer. Spatial transcriptomics showed that high MMAI scores map to regions enriched for MYC‑driven proliferation, DNA‑repair and cell‑cycle activation, EMT, angiogenesis, and TGF‑beta signaling, with higher fibroblast and lower T‑cell/NK‑cell signatures—linking the “black box” AI signal to established pathways of aggressive disease and potentially increasing clinician confidence in its use.
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| Obesity-Associated Epigenetic Remodeling Under ADT: Implications for Cardiometabolic Risk in Prostate Cancer
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| Harikrishan Kunhiraman, MBBS
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| This study suggests that obesity fundamentally alters how men’s immune and metabolic systems respond to ADT at the epigenetic level. Under ADT, obese patients showed chromatin changes consistent with activation of inflammatory and immune–metabolic pathways (TNF‑α/NF‑κB, IL2–STAT5, mTORC1, hypoxia, interferon‑γ), whereas lean patients showed suppression of many of these same programs, supporting a mechanistic link between obesity, ADT, and heightened cardiometabolic risk.
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| Examination of Decipher Prostate Genomic Classifier in Patients with De Novo Metastatic Disease from a Large Scale Real-World Clinical and Transcriptomic Data Linkage
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| Shalini Moningi, MD
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| In this large real‑world linkage of Decipher genomic data with clinical records, men presenting with de novo metastatic prostate cancer had markedly higher Decipher scores than clinically matched localized cases, indicating a more aggressive underlying biology. These de novo metastatic tumors were also enriched for adverse molecular features, including a higher prevalence of Luminal B subtype and PTEN inactivity, underscoring that genomic classifiers can help characterize the distinct biology and risk profile of de novo metastatic disease in routine practice.
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| The Diversity and Clinical Relevance of Germline DNA Damage Repair Gene Variants in 3005 Patients with Metastatic Prostate Cancer
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| Sofie Tolmeijer, MD
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| In this large germline sequencing study of 3,005 men with metastatic prostate cancer, pathogenic DNA damage repair variants were found in about 9% of patients, most commonly in BRCA2, ATM, and CHEK2. BRCA2 carriers showed frequent biallelic inactivation and particularly aggressive disease—higher-grade tumors, faster progression to castration resistance, and roughly half the overall survival—supporting routine, structurally inclusive germline DDR testing to avoid underdiagnosis and to guide prognosis and targeted therapy selection.
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| Patient Preferences for Treatment of nmHSPC: A Discrete Choice Experiment
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| Neal Shore, MD, FACS
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| In this international discrete choice experiment of 374 men with non‑metastatic hormone‑sensitive prostate cancer after definitive therapy, metastasis‑free survival was the single most important driver of treatment preference, followed by risk of hot flashes and maintenance of sexual interest. When hypothetical EMBARK‑like options were modeled, the vast majority of patients favored ARPI‑based strategies over ADT alone, indicating that most are willing to accept added toxicity for improved disease control and preserved sexual well‑being.
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| Association of a Post-Prostatectomy Digital Pathology-Based MMAI Biomarker with Nodal and Extrapelvic Metastasis on PET/CT at the Time of Biochemical Recurrence and Event-Free Survival Following Salvage Radiotherapy
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| Sagar A. Patel, MD
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| In this EMPIRE‑1/2 post‑prostatectomy cohort with early biochemical recurrence, a digital pathology‑based MMAI score from the RP specimen strongly predicted the pattern of PET‑detected recurrence and outcomes after PET‑guided salvage RT. Each standard‑deviation increase in MMAI score was associated with markedly higher odds of pelvic nodal and especially extrapelvic metastases at recurrence, and roughly a threefold higher risk of event‑free survival failure, suggesting MMAI adds biologic risk stratification beyond conventional pathology and PET alone.
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| An AI-Digital Pathology Algorithm to Predict Outcomes in a Cohort of Men Diagnosed with Prostate Cancer Within a Low Resource Setting
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| Samantha Webking, MD
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| This study shows that a digital pathology MMAI algorithm applied to routine biopsy H&E slides can powerfully predict biochemical recurrence and distant metastasis in native African men with localized prostate cancer, despite a low‑resource setting. Each standard deviation increase in MMAI score was associated with markedly higher risks of recurrence and metastasis, and because it relies only on digitized slides, this AI tool could help bring precision risk stratification to regions where genomic assays are not widely accessible.
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| Association Between Genomic Classifier Scores and Initial Management of Localized Prostate Cancer in a Population-Based Cohort in the United States
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| Michael Leapman, MD, MHS
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| In this SEER–Decipher population-based cohort of 2,547 men with low or favorable intermediate-risk prostate cancer, higher Decipher genomic classifier scores were strongly associated with choosing immediate treatment rather than active surveillance. Men with low genomic scores were much more likely to start on surveillance, whereas those with intermediate and especially high scores had progressively lower odds of surveillance, indicating that genomic risk information is influencing initial management beyond standard clinical factors.
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| Improving Delivery of Prostate Cancer Germline Testing at the Department of Veterans Affairs: A Cluster-Randomized Trial
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| Daniel Kwon, MD
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| This VA cluster-randomized implementation trial tests how best to boost germline testing for men with metastatic prostate cancer by targeting oncologist behavior rather than only patient factors. All oncologists first receive an educational guide; those whose testing rates remain low then get audit-and-feedback, and persistent low adopters are randomized to audit-and-feedback alone versus audit-and-feedback plus hands‑on facilitation, using CFIR and RE-AIM frameworks to measure reach, effectiveness, adoption, implementation, and long‑term sustainability of germline testing workflows.
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