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Highlights from the 2025 European Association of Urology Annual Meeting |
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PSA Responses with Darolutamide Plus ADT in the ARANOTE Trial
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Fred Saad, MD, FRCS, FCAHS
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| Neeraj Agarwal is joined by Fred Saad to discuss PSA responses in the ARANOTE trial of darolutamide plus ADT in metastatic hormone-sensitive prostate cancer. Dr. Saad explains how darolutamide triples the rate of patients achieving undetectable PSA compared to ADT alone, with these patients experiencing 90% reduction in progression risk.
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| Patient with High-Risk Localised Prostate Cancer - cT3bN0M0 ISUP Grade Group 5: The Urologist, Radiation Oncologist, and Medical Oncologist Perspectives
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| Alberto Briganti, MD, Piet Ost, MD, PhD, and Ursula Vogl, MD, MBA
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| At EAU 2025, experts debated treatment options for a 66-year-old patient with high-risk localized prostate cancer. Dr. Briganti advocated for radical prostatectomy with extended pelvic lymph node dissection to provide accurate staging and potentially avoid radiotherapy, while Dr. Ost supported radiotherapy with long-term ADT and possible systemic therapy intensification based on trials like STAMPEDE. Dr. Vogl emphasized the role of systemic therapy, particularly abiraterone, highlighting APCCC consensus favoring radiotherapy + long-term ADT + abiraterone for such high-risk cases.
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Optimising the Patient Journey: From Prehabilitation to Rehabilitation in Urologic Surgery -
Plenary Session
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| Prehabilitation: The Impact of Exercise, Personalized Programs, and Digital Devices
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| Sarah Psutka, MD, MSc
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| Sarah Psutka's presentation at EAU 2025 emphasized the importance of prehabilitation—improving patients' functional capacity before surgery or treatment through exercise, nutrition, and mental health support. Research shows that exercise benefits cancer patients by enhancing physical and mental well-being, yet uptake remains low due to barriers like lack of guidance and physical limitations.
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| Prehabilitation: Diet, Sleep and Psychological Preparation |
| Karl-Friedrich Kowalewski, MD |
| Karl-Friedrich Kowalewski’s EAU 2025 presentation highlighted the critical role of diet, sleep, and psychological preparation in prehabilitation, emphasizing their impact on reducing complications and improving surgical outcomes. He discussed evidence supporting nutritional interventions, sleep optimization, and psychological support strategies, noting that personalized approaches based on patient risk factors are essential. |
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Clinically Relevant Questions in the Management of Advanced HSPC - Thematic Session
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| Management of Locally Advanced Prostate Cancer: Intensified Approaches with Surgery
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| Brian F. Chapin, MD
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| Brian Chapin's EAU 2025 presentation focused on the management of locally advanced prostate cancer, emphasizing the role of surgery as part of a multimodal treatment approach. He discussed the challenges in distinguishing between high-risk and locally advanced disease and highlighted the importance of pathologic reclassification and PSMA PET in staging.
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| Management of Locally Advanced Prostate Cancer: What Is the Standard of Care in 2025? Intensified Approaches with Radiation Therapy
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| Noel Clarke, MBBS, FRCS, ChM
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| Noel Clarke discussed the enhanced effectiveness of combining radiation therapy (RT) with androgen deprivation therapy (ADT) and androgen receptor signaling inhibitors (ARSIs) like abiraterone in high-risk and locally advanced prostate cancer. He highlighted the benefits of RT in both M0 and low-volume M1 disease, with improved metastasis-free survival, but cautioned about the risks of long-term ADT, including bone loss and cardiovascular events.
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| High-Risk Biochemical Recurrence with Positive PSMA PET: Radiotherapy Still Matters
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| Valerie Fonteyne, MD, PhD
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| Valerie Fonteyne discussed the role of radiotherapy in managing high-risk, biochemically recurrent prostate cancer patients with positive PSMA PET scans. She emphasized that while intensified systemic therapy like enzalutamide may not always be necessary for these patients, metastasis-directed therapy (MDT) using stereotactic body radiotherapy (SBRT) offers a promising alternative.
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| PSA Response with Darolutamide plus ADT in Patients with mHSPC in ARANOTE
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| Fred Saad, MD, FRCS, FCAHS
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| Fred Saad presented post-hoc analyses from the ARANOTE trial, highlighting the deep PSA response achieved with darolutamide plus ADT in patients with mHSPC. Darolutamide significantly increased the proportion of patients achieving undetectable PSA, which correlated with a lower risk of radiological progression or death, longer time to mCRPC, and delayed PSA progression.
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| Discussant: PSA Response with Darolutamide plus ADT in Patients with mHSPC in ARANOTE
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| Elena Castro, MD, PhD
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| Elena Castro’s discussant presentation at EAU 2025 highlighted findings from ARANOTE, showing that mHSPC patients on darolutamide plus ADT who achieved an undetectable PSA had a significantly lower risk of progression or death. She emphasized that achieving an undetectable PSA at any point, rather than how quickly it occurs, is key for improved outcomes, as seen in trials like TITAN and ARASENS.
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| My Algorithm for Decision Making in mCRPC
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| Christopher Sweeney, MBBS
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| Christopher Sweeney’s presentation at EAU 2025 outlined a personalized approach to first-line mCRPC therapy based on biomarker profiling, including PTEN, RB1, BRCA1/2, and PSMA PET status. He emphasized the importance of choosing the most effective initial treatment, as many patients do not reach subsequent lines of therapy.
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| A Case of Progression After Triplet Therapy for mHSPC: Radium-223 Alone or in Combination |
| Fred Saad, MD, FRCS, FCAHS |
| Fred Saad’s presentation at EAU 2025 discussed the role of radium-223 alone or in combination for patients with bone-predominant mCRPC post-triplet therapy. Data from ALSYMPCA and PEACE-3 trials suggest that radium-223 improves survival and delays skeletal events, particularly when combined with bone-protecting agents. |
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| A Case of Progression After Triplet Therapy for mHSPC: Aggressive Variants |
| Himisha Beltran, MD |
| Himisha Beltran’s presentation at EAU 2025 focused on managing aggressive variants of mCRPC after triplet therapy for mHSPC, emphasizing the role of molecular markers like RB1, TP53, and PTEN loss in guiding treatment decisions. Platinum-based chemotherapy remains an option, particularly for aggressive variants, but there is potential cross-resistance with PARP inhibitors in BRCA-mutated cases. |
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