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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Navigating mHSPC Treatment Selection: ADT-ARPI Backbone, Biomarker-Driven Optimization, and the Role of Docetaxel and Targeted Therapies
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Christopher Sweeney, MBBS
Christopher Sweeney discusses treatment evolution in metastatic hormone-sensitive prostate cancer, where 8-year overall survival has climbed to approximately 50% with ADT plus an ARPI.
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Analysis of the Phase III CAPItello-281 Trial: Capivasertib plus Abiraterone in PTEN-Deficient Metastatic Hormone-Sensitive Prostate Cancer
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Daniel George, MD
Neeraj Agarwal hosts Daniel George to discuss the CAPItello phase three trial examining capivasertib combined with abiraterone in PTEN-deficient metastatic hormone-sensitive prostate cancer.
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Practical Approaches to Genetic Testing in Metastatic Hormone-Sensitive Prostate Cancer
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Emmanuel Antonarakis, MD
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| Emmanuel Antonarakis recommends germline and somatic testing for all metastatic prostate cancer patients. Dr. Antonarakis orders germline testing pre-emptively, reserving genetic counseling for pathogenic variants when first-degree relatives face 50% inheritance risk.
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| Tumor Suppressor Genes in Prostate Cancer – Currently Prognostic, but Soon to Be Predictive?
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| Evan Yu, MD
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| Alterations in PTEN, TP53, and RB1 define aggressive prostate cancer biology with poor outcomes; PTEN loss predicts capivasertib/PARP/platinum benefit, while combined TP53/RB1 loss drives neuroendocrine features favoring carboplatin+cabazitaxel per NCCN aggressive variant guidelines.
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| Tailoring Therapy in Castration-Sensitive Prostate Cancer: Do Biomarkers Make the Cut?
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| Rahul Aggarwal, MD
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| Rahul Aggarwal discussed tailoring mCSPC therapy beyond volume/timing, appraising biomarkers from abstracts: IRONMAN confirmed PSA >0.2 ng/mL at 6-12mo post-ARPI predicts poor OS; ARANOTE showed darolutamide preserves HRQoL vs enzalutamide; STAMPEDE suggested transcriptomic PTEN loss enhances docetaxel OS benefit.
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| Metastatic Hormone-Sensitive Prostate Cancer – So Many Randomized Trials (Nine), yet Monotherapy Treatment Persists
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| Andrew Hahn, MD
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| Andrew Hahn highlighted persistent ADT monotherapy in mHSPC despite 9 RCTs proving doublet and triplet survival benefits, especially high-volume/de novo. Real-world data shows slow uptake, driven by age/race/comorbidities/rural/community factors/ARPI toxicity differences.
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| What Do You Need for Decision-Making in mHSPC in 2026?
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| Bertrand Tombal, MD, PhD
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| Bertrand Tombal argued mHSPC decisions extend beyond volume/genomics to access, age/frailty, comorbidities. Prioritized patient-centered factors: LHRH antagonists/relugolix for CV risk, darolutamide for cognition/falls, bone protection for abiraterone, DDI checks.
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