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PEER-TO-PEER CLINICAL CONVERSATIONS |
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AR Degraders, T-Cell Engagers, and EZH2 Inhibitors in Prostate Cancer Pipeline
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Maha Hussain, MD, FACP, FASCO
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| Maha Hussain surveys emerging prostate cancer therapies across disease states. Dr. Hussain notes that median survival in mCRPC has risen from approximately nine months in the late 1980s to more than three years currently.
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Patient Perspective on Radiographic Progression-Free Survival in Metastatic Prostate Cancer
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David Matheson, PhD, mED, BSc, DipEd, PGCE, FRSA, SFHEA
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| David Matheson discusses the patient perspective on rPFS as a clinical trial endpoint. Dr. Matheson argues that imaging-based progression is more tangible to patients than PSA because tumor size and location can be shown visually, but stresses that rPFS is only meaningful if quality of life as reported by the patient is preserved.
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Nutritional Counseling for Prostate Cancer Patients Receiving Systemic Therapy
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Maria De Santis, MD, PhD
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| Maria De Santis outlines nutritional management for prostate cancer patients on systemic therapy. ADT causes fat mass increase, muscle loss, insulin resistance, and fatigue, making body composition assessment more informative than weight alone.
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The 2026 Advanced Prostate Cancer Consensus Conference
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| Uptake of Doublet and Triplet Therapy for Men with De Novo Metastatic Castration Sensitive Prostate Cancer. A Population-Based Study
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| Paolo Zaurito, MD
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| Paolo Zaurito presents a population-based study from Sweden which found that use of upfront doublet and triplet therapy for men with de novo metastatic castration-sensitive prostate cancer rose sharply from 2016 to 2024, with 3-year overall survival improving alongside treatment intensification. The gains were especially notable in younger men, supporting the real-world benefit of the survival improvements already seen in randomized trials.
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| Does Triplet Therapy Improve Survival in Metastatic Hormone-Sensitive Prostate Cancer? A Bayesian Individual Patient Data Reanalysis
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| Soichiro Yoshida, MD
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| This Bayesian reanalysis presented by Soichiro Yoshida looked at overall survival advantages for triplet therapy over ADT plus an ARAT in the overall mHSPC population. The probability of a meaningful benefit was low overall, though a modest signal appeared in high-volume disease, where triplet therapy may still be selectively considered.
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| Dissecting Synergistic vs. Additive Contributions to Survival in the ARASENS Triplet Regimen: A Modeling Analysis
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| Shinro Hata, MD
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| Shinro Hata presented this modeling analysis which suggests the ARASENS triplet regimen may provide benefit beyond simple additivity, with observed overall survival and time to next therapy outperforming predictions from independent drug effects alone. This data can be interpreted as a possible signal of synergy between docetaxel and darolutamide, though they stressed the findings are exploratory and hypothesis-generating rather than definitive.
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| Monitoring in Metastatic Hormone-Sensitive Prostate Cancer
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| Channing Paller, MD
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| Channing Paller’s APCCC 2026 talk said PSA remains the main serial biomarker in mHSPC, but PSA alone is not enough because radiographic progression can occur without PSA rise. She emphasized adding prognostic blood markers like alkaline phosphatase and LDH, using PSMA PET within the new PCWG4 framework, and imaging more carefully in aggressive subgroups such as BRCA1/2-, PTEN-, TP53-, or RB1-altered disease.
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| Monitoring in mCRPC
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| Gunhild von Amsberg, PhD
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| Gunhild von Amsberg’s APCCC 2026 message was that monitoring mCRPC is moving beyond PSA alone: conventional imaging still matters, but PSMA PET/CT, whole-body MRI, and liquid biopsy tools can reveal progression that PSA misses. She highlighted that PSA-only treatment changes should be avoided, because up to about 30% of patients can have PSA-negative progression and newer imaging often shows occult resistant disease earlier.
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| Is There a Role for the Routine Use of ctDNA in Advanced Prostate Cancer?
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| Kim Chi, MD, FRCPC
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| Kim Chi's presentation concluded that ctDNA is promising but not ready for routine use in advanced prostate cancer because the evidence is still too limited and not yet standardized. Baseline ctDNA fraction is prognostic and on-treatment changes may help predict response earlier than PSA or imaging, but broader validation is needed before it can guide everyday treatment decisions.
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| How Can Electronic Tools Be Used for Monitoring of Patients with Advanced Prostate Cancer?
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| Alicia Morgans, MD, MPH
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| Alicia Morgans argued that electronic tools are already useful for monitoring advanced prostate cancer because telehealth, remote PSA/lab checks, ePROs, and wearables can catch problems earlier and reduce the burden of in-person visits. She highlighted virtual PSA clinics, remote symptom and activity tracking, and home-based monitoring models, while also stressing the need to address data ownership, patient opt-out rights, and safety guardrails for concerning remote results.
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| Emerging New Therapies --What Will Likely Be Available in the next 2 Years?
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| Maha Hussain, MD, FACP, FASCO
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| Maha Hussain’s APCCC 2026 message was that the next two years will likely bring more biomarker-directed intensification in both mCRPC and mHSPC, especially androgen receptor degraders like BMS-986365 and PARP-based combinations such as saruparib plus ARPI. She emphasized that the field is moving toward multi-targeted therapy earlier in the disease course, but the best sequencing and long-term resistance patterns still need well-designed phase 3 trials.
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| Are There Patients with mCRPC Who May Benefit from Immunotherapy?
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| Emmanuel Antonarakis, MD
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| Emmanuel Antonarakis’s APCCC 2026 message was that immunotherapy is not useful for unselected mCRPC, but a small biomarker-defined subset can benefit—especially patients with MSI-H/dMMR or TMB-high disease, for whom pembrolizumab is the key option. He also noted that CDK12, AR-V7, and other markers remain investigational, and most combination strategies have not yet changed routine practice.
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| Bone Protection in Patients with HSPC Starting on Long-Term ADT and in Patients with mCRPC
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| Matthew Smith, MD, PhD
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| Matthew Smith discussed that bone protection should be based on the clinical setting: men on long-term ADT should have fracture risk assessed and many should get denosumab or zoledronic acid in osteoporosis-prevention doses, while men with mCRPC and bone metastases generally need osteoclast-targeted therapy at skeletal-related-event-prevention doses.
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