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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Discussion on Patient Selection for Radioligand Therapy in Prostate Cancer
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Daniel Petrylak, MD, and A. Oliver Sartor, MD
Neeraj Agarwal speaks with Oliver Sartor and Daniel Petrylak about patient selection strategies for radioligand therapy. With multiple treatment options now available for metastatic castration-resistant prostate cancer, the experts emphasize that patient selection has become both an art and science.
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Results from the Phase 3 PSMAfore Trial in Metastatic Castration-Resistant Prostate Cancer
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Karim Fizazi, MD, PhD
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| Neeraj Agarwal speaks with Karim Fizazi about the PSMAfore trial, a phase three study examining Lutetium-177 PSMA-617 in metastatic castration-resistant prostate cancer patients who had exhausted one second-generation androgen receptor pathway inhibitor.
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Study Evaluates PSMA-PET-Based Nomograms for Prostate Cancer Prognosis
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Kambiz Rahbar, MD
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| Philip Koo speaks with Kambiz Rahbar to discuss risk stratification using PSMA-PET imaging through the PROMISE framework. Dr. Rahbar presents the PPP2 nomograms, developed from the international PROMISE Registry analyzing 6,128 patients across 20 hospitals in Europe, the US, and Australia.
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| Clinical Protocols to Monitor Efficacy of 177Lu-PSMA Radiopharmaceutical Therapy in mCRPC
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| Loic Djaileb, MD, PhD
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| Loic Djaileb discusses this study shows that interim post-therapy 177Lu-PSMA SPECT/CT scored with RECIP 1.0 after two cycles of 177Lu-PSMA-617 is prognostic for overall survival in men with mCRPC, with progressive disease on SPECT linked to significantly shorter survival than stable or partial responses. When combined with 12‑week PSA changes, SPECT/CT plus PSA achieved prognostic accuracy comparable to PSMA PET/CT plus PSA, despite SPECT alone detecting fewer progression events.
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| Emerging Evidence for Sequencing and Combining PSMA-Based Therapies in Prostate Cancer - Beyond the Abstract
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| Sola Adeleke, Ph.D., M.B.B.S., MRCP(UK)
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| Sola Adeleke reviews how the growing toolbox of PSMA-directed therapies—177Lu-PSMA-617, next-generation radioligands, ADCs, bispecifics, and CAR-T cells—is shifting prostate cancer care from single agents toward strategic sequencing and combinations across disease states. It highlights that PSMA expression is dynamic, suggesting benefits to earlier RLT and pairing it with agents that modulate PSMA or synergize biologically while emphasizing unresolved questions around survival benefit, optimal timing, toxicity, re-challenge, and cost.
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ESUR: Opportunities for PSMA-PET/CT and Whole-Body MRI in Advanced Prostate Cancer - Beyond the Abstract
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| Sungmin Woo, Luca Russo, Samuel J. Withey et al.
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| Woo et al. explains how PSMA-PET/CT and whole-body MRI have revolutionized imaging in advanced prostate cancer by dramatically improving detection, staging, treatment planning, theranostic selection, and biopsy targeting, compared with conventional CT and bone scans. they emphasize, however, that earlier and more sensitive detection has not yet been proven to improve survival or quality of life, raising concerns about stage migration and overtreatment and underscoring the need for prospective trials.
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European Registry of Next Generation Imaging in Advanced Prostate Cancer (RING): Protocol for an International, Prospective Registry Study - Beyond the Abstract
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| Daria Chernysheva, Stefano Fanti, Anders Bjartell et al.
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| This registry article describes how PSMA PET/CT and other next‑generation imaging are actually being used across Europe for men with advanced prostate cancer, both at initial staging and at biochemical recurrence. Early RING data from 102 patients show that NGI—especially PSMA PET/CT—has already become the default imaging strategy for most high‑risk and recurrent cases, is more often used in younger men with higher grade disease, and directly drives the majority of treatment decisions.
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| Visceral Metastases, Platelet Dynamics, and PSA Decline: From Biomarkers to Better Outcomes in [177Lu]Lu‑PSMA‑617 Therapy in Metastatic Castration-Resistant Prostate Cancer - Beyond the Abstract
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| Nathan Poterszman & François Somme
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| This retrospective, real-world study of 109 mCRPC patients treated with [177Lu]Lu‑PSMA‑617 identified three early biomarkers associated with outcomes: visceral metastases, a >25% platelet drop between cycles 1–2, and a >30% PSA decline after two cycles. Together, these factors stratified patients by prognosis and may help personalize treatment decisions early in the radioligand therapy course, although the authors stress that prospective, multi-center validation and mechanistic studies—particularly around platelet dynamics—are needed before routine clinical adoption.
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