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PEER-TO-PEER CLINICAL CONVERSATIONS |
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PSMACare: Early Lutetium RLT in High-Risk nmCRPC
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Fred Saad, CQ, MD, FRCS, FCAHS
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| Fred Saad discusses the PSMACare trial, a randomized phase 2 study exploring lutetium PSMA radioligand therapy in non-metastatic castration-resistant prostate cancer.
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Incorporating PSMA PET in Registrational Trials
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Alicia Morgans, MD, MPH
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| At the 2026 UCSF-UCLA PSMA Conference, Alicia Morgans discusses the role of PSMA PET in registrational trial design, including ARASTEP, a trial evaluating patients with high-risk biochemical recurrence and PSMA PET-positive disease following metastasis-directed SBRT.
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Prostate Cancer Working Group 4 Addresses PSMA PET as a Clinical Trial Endpoint
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Michael 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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| Trial Design and Objectives for Prostate Cancer: Recommendations from the Prostate Cancer Clinical Trials Working Group 4 (PCWG4)
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| Andrew Armstrong, MD, MSc
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| Andrew Armstrong discusses PCWG4 updates in prostate cancer trial design guidance to reflect the modern era of PSMA PET, molecular subtyping, and biomarker-driven care. The recommendations standardize disease-state definitions, imaging and response criteria, and endpoint assessment so trials can better measure benefit in both ADT-sensitive and ADT-resistant advanced prostate cancer.
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| The Diversity and Clinical Relevance of Germline DNA Damage Repair Gene Variants in 3005 Patients with Metastatic Prostate Cancer
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| Sofie Tolmeijer, PhD
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| Sofie Tolmeijer reported that germline DDR variants were found in about 9% of 3,005 men with metastatic prostate cancer, with BRCA2 the most common and most clinically significant alteration. BRCA2 carriers had more aggressive disease and markedly shorter survival, and the analysis emphasized that testing should include structural variants to avoid missing pathogenic germline changes.
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Therapeutic Targeting of Prostate-Specific Membrane Antigen Could Limit Its Potential as Benchmark Imaging - Beyond the Abstract
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| Melissa Abel, Adam Sharp, Edwin Posadas et al.
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| This commentary argues that PSMA PET may be less reliable as a long-term benchmark imaging tool once PSMA-targeted therapies like 177Lu-PSMA-617 are used earlier and more often in prostate cancer. The concern is that treatment could reduce or eliminate PSMA expression itself, creating heterogeneous “PSMA-dark” disease and potentially lowering the sensitivity of future PSMA-based scans.
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| Emerging Evidence for Sequencing and Combining PSMA-Based Therapies in Prostate Cancer - Beyond the Abstract
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| Sola Adeleke, PhD
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| In this review, Sola Adeleke discusses how PSMA-targeted therapies are changing prostate cancer care while highlighting the need for stronger evidence on optimal sequencing and combination strategies. The article notes that PSMA expression is dynamic, suggesting that earlier use of radioligand therapy or combinations that increase PSMA expression may improve outcomes, although a clear survival benefit has not yet been established.
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