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PEER-TO-PEER CLINICAL CONVERSATIONS |
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Prostate Cancer Working Group 4 Addresses PSMA PET as a Clinical Trial Endpoint
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Michael J. Morris, MD
Michael Morris discusses the Prostate Cancer Working Group 4 imaging recommendations, published in JCO. Dr. Morris outlines the group's call for serial longitudinal imaging in clinical trials, adding PSMA PET to conventional bone and cross-sectional scans at pre-specified on-study timepoints.
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Selecting Therapy in Metastatic Hormone-Sensitive Prostate Cancer: A Multi-Step Approach
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Pedro Barata, MD, MSc, FACP
Pedro Barata discusses therapy selection and patient goals in metastatic hormone-sensitive prostate cancer. Dr. Barata describes framing treatment decisions around tumor volume using CHAARTED criteria, timing of metastatic disease, and performance status, with ADT plus an ARPI as the standard backbone.
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Patient Selection for Intermittent Therapy: The Role of PSA Nadir and Disease Volume
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Pedro Barata, MD, MSc, FACP
Pedro Barata discusses therapy selection and patient goals in metastatic hormone-sensitive prostate cancer. Dr. Barata describes framing treatment decisions around tumor volume using CHAARTED criteria, timing of metastatic disease, and performance status, with ADT plus an ARPI as the standard backbone.
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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 that mHSPC decision-making in 2026 must go beyond tumor factors like disease volume and biomarkers and also account for access, age, frailty, cognition, cardiovascular risk, skeletal health, and drug interactions. His practical takeaway was that older or medically complex patients often benefit less from intensification and may need different ARPI or ADT choices, plus proactive screening for toxicity and comorbidity management.
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| Clinical Outcomes Among Patients with mHSPC in Contemporary Real-World US Clinical Practice: A Prostate Cancer Disease Observation (PRECISION) Data Platform Analysis
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| A. Oliver Sartor, MD
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| In this large U.S. real-world cohort of 43,415 men with mHSPC, nearly half still received ADT alone, and that group had shorter castration resistance-free survival and overall survival than patients treated with doublet or triplet therapy. Triplet therapy was used in only 2.5% of patients but was associated with the longest survival, underscoring that guideline-recommended treatment intensification remains underused in routine practice.
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| Treatment Intensification in the mCSPC Landscape: Real-World Evidence from 4,559 Patients in the CAPRI-3 Registry
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| Kim J. Van der Velden, BSc
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| In the CAPRI-3 registry of 4,559 men with mCSPC, treatment intensification was still underused, with ADT monotherapy given to 62% overall and intensification used much more often in high-volume than low-volume disease. Survival benefit from intensification was seen mainly in high-volume disease, while low-volume patients did not show a clear overall survival advantage, reinforcing the importance of disease burden in choosing therapy.
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PSA Kinetics and Predictors of PSA Response in Metastatic Hormone-Sensitive Prostate Cancer Treated with Androgen Receptor Signaling Inhibitors - Beyond the Abstract
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| Rocío Martínez-Corral, Pedro De Pablos-Rodríguez, Celia Bardella-Altarriba et al.
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| SWOG and TITAN thresholds offer contrasting perspectives on PSA response: while SWOG classifies the majority as good responders, TITAN applies a more demanding and balanced approach. This study shows that not all PSA declines are created equal, and that features such as low baseline PSA and metachronous disease make a significant difference. In the ARPI era, reaching the right threshold at the right time can redefine a patient’s prognosis.
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Prostate-Specific Antigen Response as a Prognostic Factor for Overall Survival in Patients with Prostate Cancer Treated with Androgen Receptor Pathway Inhibitors - Beyond the Abstract
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| Marcin Miszczyk, MD, PhD, and Shahrokh F. Shariat, MD
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| This review found that early PSA declines on ADT plus an ARPI are strongly associated with better overall survival across advanced prostate cancer settings, including mHSPC and mCRPC. The practical message is that PSA is a widely available, low-cost way to identify patients doing well versus those who may need earlier treatment escalation or, in good responders, consideration of de-escalation strategies.
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