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Highlights from the 2025 European Association of Urology Annual Meeting |
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| High-Volume De Novo Metastatic Hormone-Sensitive Prostate Cancer: Local Treatment Matters |
| Karim Fizazi, MD, PhD |
| Karim Fizazi emphasized the importance of local treatment in high-volume de novo metastatic hormone-sensitive prostate cancer (mHSPC) to manage and prevent severe local symptoms. Data from multiple studies, including PEACE-1, HORRAD, and STAMPEDE, show that upfront prostate radiotherapy reduces the need for interventions such as TURP, stents, and nephrostomy while improving progression-free survival. |
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| High-Volume De Novo Metastatic Hormone-Sensitive Prostate Cancer: Local Treatment Is Useless and Toxic |
| Gunhild von Amsberg, MD |
| Gunhild von Amsberg argued against local treatment for high-volume de novo metastatic hormone-sensitive prostate cancer (mHSPC), citing its lack of survival benefit and potential toxicity. She emphasized that systemic therapy with androgen receptor pathway inhibitors (ARPIs) and docetaxel remains the standard of care, while data from HORRAD and STAMPEDE failed to show an overall survival advantage for radiotherapy in high-volume cases. |
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| Patient with High-Volume Disease at HSPCA and with Good Response to Triple Therapy --Treatment De-Intensification in Good Responders: When to Stop Combined Treatments?
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| Karim Fizazi, MD, PhD
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| Karim Fizazi explored treatment de-intensification in high-volume mHSPC patients responding well to triple therapy. He emphasized that lifelong androgen deprivation therapy remains standard, but whether treatment can be safely stopped is unclear. Data from SWOG and GETUG-15 suggest potential risks with intermittent ADT, particularly in minimal metastatic disease.
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| Patient with High-Volume Disease at HSPCA and with Poor Response to Triple Therapy -- Treatment Options for Poor Responders |
| Ursula Vogl, MD
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| Ursula Vogl addressed treatment options for high-volume mHSPC patients with poor response to triplet therapy. A PSA nadir <0.2 is a key prognostic marker, but its clinical utility in guiding treatment remains uncertain. Genomic profiling suggests AR, TP53, PTEN, and RB1 alterations correlate with worse outcomes, but treatment decisions are not yet tailored to these findings.
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| Trial Update Intensified Approaches with Triple Therapy Other than Taxanes
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| Maria De Santis, MD
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| Maria De Santis presented updates on intensified triple therapy in mHSPC beyond taxanes, emphasizing the role of biomarkers like BRCA mutations and PTEN loss in guiding treatment. Key trials, including TALAPRO-3, AMPLITUDE, CAPItello-281, and PSMAddition, focus on targeted therapies, while PEACE-6 and STAMPEDE2 explore treatment de-escalation and intensification.
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| PSMA-Guided Ablation of the Prostate (P-GAP): A Multicenter Randomized- Controlled Trial
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| Patrick Albers, MD
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| The P-GAP trial, presented at EAU 2025 by Dr. Patrick Albers, is a multicenter randomized controlled study evaluating the use of ¹⁸F-PSMA-1007 PET/CT in improving cancer detection for focal therapy in unilateral localized prostate cancer. Enrolling 138 patients across three Canadian institutions, the study aims to determine whether PSMA-guided imaging reduces post-treatment detection of clinically significant prostate cancer compared to standard diagnostic methods.
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| Current Landscape of Peri-Operative Therapies in Localized Prostate Cancer: Biomarker-Directed Neoadjuvant Strategies
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| Martin Gleave, CM, MD, FRCSC, FACS
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| At EAU 2025, Dr. Martin Gleave discussed biomarker-driven neoadjuvant strategies in high-risk localized prostate cancer, emphasizing their role in improving cancer control, studying resistance mechanisms, and aiding drug development. While ARPI and ADT-based therapies show limited pCR rates, trials like PROTEUS and GUNS explore novel combinations, including PARP inhibitors, PSMA-targeted radioligand therapy, and AKT inhibitors, to enhance treatment depth.
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| Prostate Cancer: BRCA and Other Homologous Recombination (HR) Genes
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| David Olmos, MD, PhD
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| David Olmos discussed the role of BRCA and other homologous recombination repair gene alterations in prostate cancer, emphasizing their prognostic and therapeutic significance. While BRCA2 mutations are linked to worse outcomes across disease stages, HRR alterations are more prevalent in advanced prostate cancer than in early-stage disease, underscoring the need for genomic profiling.
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