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PEER-TO-PEER CLINICAL CONVERSATIONS
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Doublet Versus Triplet Therapy in Metastatic Hormone-Sensitive Prostate Cancer
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Neeraj Agarwal, MD, FASCO
Neeraj Agarwal discusses his personalized approach to doublet versus triplet therapy in metastatic hormone-sensitive prostate cancer, considering disease volume, symptoms, molecular features, and patient fitness when determining treatment intensity. He highlights scenarios in which he may favor adding docetaxel, including liver metastases, high-volume or symptomatic disease, and high-degree PTEN or RB1 loss.
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Treatment Intensification in Older and Comorbid Patients with Metastatic Hormone-Sensitive Prostate Cancer
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Alicia Morgans, MD, MPH
Alicia Morgans discusses treatment intensification in older and comorbid patients with metastatic hormone-sensitive prostate cancer. Dr. Morgans draws on clinical tools including the Mini-Cog and the G8, an eight-question frailty screen where a score below 14 is associated with increased non-cancer mortality. She does not withhold treatment based on age alone, anchoring intensification decisions to disease characteristics such as de novo presentation and volume.
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PSA Response as a Guide to Patient-Centered Treatment Decisions in Metastatic Hormone-Sensitive Prostate Cancer
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Tanya Dorff, MD
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| Tanya Dorff discusses PSA monitoring and treatment decisions in metastatic hormone-sensitive prostate cancer. Dr. Dorff checks PSA at four to six weeks after starting treatment, then every 12 weeks, using it alongside imaging and clinical status rather than as a standalone guide.
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| Which People with Metastatic Hormone-Sensitive Prostate Cancer Benefit More from ARPIs? STOPCAP Individual Participant Data Meta-Analysis
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| David Fisher
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| In this STOPCAP individual participant data meta-analysis of 7,778 patients from 7 trials, adding an ARPI to ADT improved 5-year overall survival by 13% and progression-free survival by 21%, with benefits consistent across disease volume, docetaxel use, Gleason score, performance status, and metastatic burden.
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| Al-Inferred Spatial Gene Expression from H&E Predicts Docetaxel Benefit in Metastatic Hormone-Sensitive Prostate Cancer (CHAARTED / E3805)
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| Sebastian Medina, MSc
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| Using AI to infer spatial gene expression from routine H&E slides, investigators developed a 26-gene virtual spatial transcriptomic biomarker that identified CHAARTED mHSPC patients who derived a significant overall survival benefit from adding docetaxel to ADT versus those who did not, with a significant treatment-by-biomarker interaction.
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| Classification Tree Phenotypes for Early Treatment-Limiting Toxicity After ARPI Initiation in mHSPC from the IRONMAN Registry
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| Alexandra Larkin, MPH
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| Alexandra Larkin disucsses using IRONMAN registry data. Investigators developed a 9-variable classification tree that stratifies mHSPC patients starting ARPIs into low-, intermediate-, and high-risk phenotypes for early treatment-limiting toxicity, with 1-year adverse outcome risks of 10.7%, 26.3%, and 69.1%, respectively.
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| Which Patients with Synchronous, mHSPC Benefit from Prostate Radiotherapy? STOPCAP Meta-Analysis of Individual Participant Data
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| Peter Godolphin, PhD
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| In this STOPCAP individual participant data meta-analysis of >99% of eligible patients from all three completed RCTs, adding prostate radiotherapy to ADT-based standard of care for synchronous mHSPC showed no clear overall survival benefit overall but improved progression-free survival and reduced symptomatic local events.
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| Real-World Outcomes of Triplet Intensification in High-Volume mHSPC in Japanese Patients from the Prospective YUSHIMA Registry
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| Yosuke Yasuda, MD
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| In the prospective YUSHIMA Registry of 140 Japanese patients with high-volume mHSPC, propensity-weighted analyses showed no statistically significant difference in time to CRPC between triplet therapy (ADT + docetaxel + ARPI) and ARPI-based doublet therapy using conventional methods.
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