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Evolving Strategies in Localized Prostate Cancer: From Diagnosis to Recurrence and Future Directions
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Neal Shore, MD, FACS
Neal Shore discusses localized prostate cancer unmet needs with advances in PSMA PET imaging correlating with MRI for treatment selection.
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| PRIMARY2 – Impact of 68Ga-PSMA-11 PET/CT in the Diagnosis of Prostate Cancer in Men with Equivocal or Non-Suspicious Findings on mpMRI: A Multi-Center, Phase III, Randomized Trial
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| James Buteau, MD
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| The PRIMARY2 phase 3 trial showed that adding 68Ga-PSMA-11 PET/CT to the workup of men with equivocal or non-suspicious mpMRI findings safely cut biopsies by about half. It remained non-inferior for detecting significant prostate cancer while also reducing detection of insignificant disease, supporting a broader role for PSMA PET/CT in the diagnostic pathway.
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| Pathways for Prostate Cancer Evaluation: Guidelines, Tools, and Best Practices to Optimize PSA Based Screening
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| Sanoj Punnen, MD
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| Sanoj Punnen emphasized that PSA screening still reduces prostate cancer mortality, and its benefit becomes clearer with longer follow-up. He also highlighted how mpMRI, biomarkers, and emerging imaging such as PSMA PET/CT can improve biopsy selection and reduce overdiagnosis, while newer pathways aim to make screening more precise and less invasive.
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Rectal Spacers in Prostate Radiotherapy: Balancing Efficacy, Safety, and Patient Experience
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Michael Greenberg, MD, and Daniel Welchons, MD
Zachary Klaassen speaks with Michael Greenberg and Daniel Welchons about rectal spacing before prostate cancer radiotherapy.
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| Ultra-Hypofractionated versus Conventionally Fractionated Radiotherapy for Localised Prostate Cancer (HYPO-RT-PC): 10-Year Outcomes of an Open-Label, Randomised, Phase 3, Non-Inferiority Trial - Beyond the Abstract
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| Per Nilsson and Adalsteinn Gunnlaugsson
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| The 10-year HYPO-RT-PC results show that ultra-hypofractionated prostate radiotherapy remained non-inferior to conventional fractionation for failure-free survival, with 10-year rates of 72% vs 65% and an adjusted HR of 0.84. Late grade 2+ genitourinary and gastrointestinal toxicity was also similar between arms, supporting the 7-fraction regimen as a safe, effective long-term option for localized prostate cancer.
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POSEIDON Meta-Analysis Re-Examines the Role of ADT with Salvage Radiation for Prostate Cancer
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Amar U. Kishan, MD
Amar Kishan discusses the POSEIDON meta-analysis which pooled individual patient data from 6,057 patients across six randomized trials with nine-year median follow-up.
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| Biochemical Recurrence Management in 2025 – High-Yield Take Home Messages for the Practicing Clinician
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| R. Jonathan Henderson, MD
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| Jonathan Henderson discusses that biochemical recurrence should be managed by risk stratification, life expectancy, and shared decision-making rather than a one-size-fits-all approach. Low-risk patients may be observed, while high-risk recurrence should prompt timely salvage treatment such as EBRT ± ADT or select local salvage options, with clinical trial enrollment encouraged when available.
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