Podcasts about mhspc

Two great international visitors recently led to two great sets of podcast chats!! Dr Kim Chi (Vancouver), and Dr Carmen Mir (Valencia) were in Melbourne to speak at the PROSPECT Meeting (see links below). We grabbed Kim along with Prof Arun Azad (Peter MacCallum Cancer Centre, Melbourne), and Dr Louise Kostos (also Peter Mac), to overlook some hot topics in mHSPC. And then a cracking chat with Carmen along with two Europeans doing Urology Fellowship training in Melbourne  - Dr Christa Babst (Peter MacCallum Cancer Centre/Switzerland), and Dr Marta Alves (Royal Melbourne Hospital/Barcelona). Carmen had also done a Fellowship in Melbourne at Austin Health so could give some great perspectives. This is a Themed Podcast supported by our Gold Partners, Johnson & Johnson, who also supported the recent PROSPECT meeting. Even better on our YouTube channelLinks:PROSPECT podcast Part 1PROSPECT Podcast Part 2

Dr. Neeraj Agarwal and Dr. Peter Hoskin discuss key abstracts in GU cancers from the 2025 ASCO Genitourinary Cancers Symposium, including novel therapies in prostate, bladder, and kidney cancer and the impact of combination therapies on patient outcomes. TRANSCSRIPT Dr. Neeraj Agarwal: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the director of the Genitourinary Oncology Program and professor of medicine at the Huntsman Cancer Institute at the University of Utah, and editor-in-chief of ASCO Daily News. Today, we'll be discussing practice-informing abstracts and other key advances in GU oncology featured at the 2025 ASCO Genitourinary Cancers Symposium. Joining me for this discussion is Dr. Peter Hoskin, the chair of this year's ASCO GU Symposium. Dr. Hoskin is a professor in clinical oncology in the University of Manchester and honorary consultant in clinical oncology at the Christie Hospital, Manchester, and University College Hospital London, in the United Kingdom. Our full disclosures are available in the transcript of this episode. Peter, thank you for joining us today. Dr. Peter Hoskin: Thank you so much, Neeraj. I am very pleased to be here. Dr. Neeraj Agarwal: The GU meeting highlighted remarkable advancements across the spectrum of GU malignancies. What stood out to you as the most exciting developments at the ASCO GU Symposium?  Dr. Peter Hoskin: The theme of this year's meeting was "Driving Innovation, Improving Patient Care," and this reflected ASCO GU's incredible milestone in GU cancer research over the years. We were thrilled to welcome almost 6,000 attendees on this occasion from over 70 countries, and most of them were attending in person and not online, although this was a hybrid meeting. Furthermore, we had more than 1,000 abstract submissions. You can imagine then that it fostered fantastic networking opportunities and facilitated valuable knowledge and idea exchanges among experts, trainees, and mentees. So, to start I'd like to come back to you for a second because the first day started with a focus on prostate cancer and some of the key clinical trials. And congratulations to you, Neeraj, on sharing the data from the TALAPRO-2 trial, which we were eagerly awaiting. I'd love to get your thoughts on the data that you presented. Could you tell us more about that trial, Abstract LBA18?  Dr. Neeraj Agarwal: Yes, Peter, I agree with you. It was such an exciting conference overall and thank you for your leadership of this conference. So, let's talk about the TALAPRO-2 trial. First of all, I would like to remind our audience that the combination of talazoparib plus enzalutamide was approved by the U.S. FDA in June 2023 in patients with metastatic castration-resistant prostate cancer harboring HRR gene alterations, after this combination improved the primary endpoint of radiographic progression-free survival compared to enzalutamide alone in the randomized, double-blind, placebo-controlled, multi-cohort phase 3 TALAPRO-2 trial. In the abstract I presented at ASCO GU 2025, we reported the final overall survival data, which was a key alpha-protected secondary endpoint in cohort 1, which enrolled an all-comer population of patients with mCRPC. So, at a median follow-up of around 53 months, in the intention-to-treat population, the combination of talazoparib plus enzalutamide significantly reduced the risk of death by 20% compared to enzalutamide alone, with a median OS of 45.8 months in the experimental arm versus 37 months in the control arm, which was an active control arm of enzalutamide. This improvement was consistent in patients with HRR alterations with a hazard ratio of 0.54 and in those with non-deficient or unknown HRR status, with a hazard ratio of 0.87. In a post hoc analysis, the hazard ratio for OS was 0.78 favoring the combination in those patients who did not have any HRR gene alteration in their tumors by both tissue and ctDNA testing. Consistent with the primary analysis, the updated rPFS data also favored the experimental arm with a median rPFS of 33.1 compared to 19.5 months in the control arm, and a hazard ratio of 0.667. No new safety signals were identified with extended follow-up. Thus, TALAPRO-2 is the first PARP inhibitor plus ARPI study to show a statistically significant and a clinically meaningful improvement in OS compared to standard-of-care enzalutamide as first-line treatment in patients with mCRPC unselected for HRR gene alterations. Dr. Peter Hoskin: Thank you, Neeraj. That's a great summary of the data presented and very important data indeed. There was another abstract also featured in the same session, Abstract 20, titled “Which patients with metastatic hormone-sensitive prostate cancer benefit more from androgen receptor pathway inhibitors? STOPCAP meta-analyses of individual participant data.” Neeraj, could you tell us more about this abstract? Dr. Neeraj Agarwal: Absolutely, I would be delighted to. So, in this meta-analysis, Dr. David Fischer and colleagues pooled individual participant data from different randomized phase 3 trials in the mHSPC setting to assess the potential ARPI effect modifiers and determine who benefits more from an ARPI plus ADT doublet. The primary outcome was OS for main effects and PFS for subgroup analyses. Prostate cancer specific survival was a sensitivity outcome. The investigators pooled data from 11 ARPI trials and more than 11,000 patients. Overall, there was a clear benefit of adding an ARPI on both OS and PFS, with hazard ratios of 0.66 and 0.51, respectively, representing a 13% and 21% absolute improvement at 5 years, respectively, with no clear difference by the class of agent. When stratifying the patients by age group, the effects of adding an ARPI on OS and PFS were slightly smaller in patients older than 75, than in those younger than 65, or aged between 65 and 75 years. Notably, in the trials assessing the use of abiraterone, we saw very little OS effects in the group of patients older than 75, however there was some benefit maintained in prostate-cancer specific survival, suggesting that other causes of death may be having an impact. The effects of the other ARPIs, or ‘lutamides' as I would call them, were similar across all three age subgroups on both OS and PFS. Therefore, the majority of patients with mHSPC benefit from the addition of ARPIs, and the benefits/risks of abiraterone and other ‘amides' must be considered in older patients.  Dr. Peter Hoskin: Thanks, Neeraj. Another great summary relevant to our day-to-day practice. Of course, there's ongoing collection of individual patient data from other key trials, which will allow robust comparison of ARPI doublet with triplet therapy (including docetaxel), guiding more personalized treatment.   Dr. Neeraj Agarwal: I agree with you, Peter, we need more data to help guide personalized treatment for patients with mHSPC and potentially guide de-escalation versus escalation strategies. Now, moving on to a different setting in prostate cancer, would you like to mention Abstract 17 titled, “Overall survival and quality of life with Lu-PSMA-617 plus enzalutamide versus enzalutamide alone in poor-risk, metastatic, castration-resistant prostate cancer in ENZA-p (ANZUP 1901),” presented by Dr. Louise Emmett? Dr. Peter Hoskin: Of course I will. So, ENZA-p was a multicenter, open-label, randomized, phase 2 trial conducted in Australia. It randomized 163 patients into adaptive doses (2 or 4 cycles) of Lu-PSMA-617 plus enzalutamide versus enzalutamide alone as first-line treatment in PSMA-PET-CT-positive, poor-risk, mCRPC. The interim analysis of ENZA-p with median follow-up 20 months showed improved PSA-progression-free survival with the addition of Lu-PSMA-617 to enzalutamide. Here, the investigators reported the secondary outcomes, overall survival, and health-related quality of life (HRQOL). After a median follow up of 34 months, overall survival was longer in the combination arm compared to the enzalutamide arm, with a median OS of 34 months compared to 26 months; with an HR of 0.55. Moreover, the combination improved both deterioration-free survival and health-related quality of life indicators for pain, fatigue, physical function, and overall health and quality of life compared to the control arm. Consistent with the primary analysis, the rPFS also favored the experimental arm with a median rPFS of 17 months compared to 14 months with a HR of 0.61. So, the addition of LuPSMA improved overall survival, and HRQOL in patients with high-risk mCRPC. Dr. Neeraj Agarwal: Thank you, Peter. Great summary, and promising results with Lu-177 and ARPI combination in first line treatment for mCRPC among patients who had two or more high risk features associated with early enzalutamide failure. Before we move on to bladder cancer, would you like to tell us about Abstract 15 titled, “World-wide oligometastatic prostate cancer (omPC) meta-analysis leveraging individual patient data (IPD) from randomized trials (WOLVERINE): An analysis from the X-MET collaboration,” presented by Dr. Chad Tang?  Dr. Peter Hoskin: Sure. So, with metastatic-directed therapy (MDT), we have a number of phase 2 studies making up the database, and the X-MET collaboration aimed to consolidate all randomized data on oligometastatic solid tumors. This abstract presented pooled individual patient data from all the published trials involving patients with oligometastatic prostate cancer who received MDT alongside standard of care (SOC) against SOC alone. The analysis included data from five trials, encompassing 472 patients with oligometastatic prostate cancer, and followed for a median of 41 months. Patients were randomly assigned in a 1:1 ratio to receive either MDT plus SOC or SOC alone. The addition of MDT significantly improved PFS. The median PFS was 32 months with MDT compared to 14.9 months with SOC alone, with an HR of 0.45. Subgroup analyses further confirmed the consistent benefits of MDT across different patient groups. Regardless of factors like castration status, receipt of prior primary treatment, stage, or number of metastases, MDT consistently improved PFS. In patients with mHSPC, MDT significantly delayed the time to castration resistance by nine months, extending it to a median of 72 months compared to 63 months in the SOC group with an HR of 0.58. In terms of OS, the addition of MDT improved the 48-month survival rate by 12%, with OS rates of 87% in the MDT+SOC group compared to 75% in the SOC alone group. Dr. Neeraj Agarwal: Thank you, Peter. These data demonstrate that adding MDT to systemic therapy significantly improves PFS, rPFS, and castration resistance-free survival, reinforcing its potential role in the treatment of oligometastatic prostate cancer. So, let's switch gears to bladder cancer and start with Abstract 658 reporting the OS analysis of the CheckMate-274 trial. Would you like to tell us about this abstract?  Dr. Peter Hoskin: Yes, sure, Neeraj. This was presented by Dr. Matt Milowsky, and it was additional efficacy outcomes, including overall survival, from the CheckMate-274 trial which evaluated adjuvant nivolumab versus placebo in patients with high-risk muscle-invasive bladder cancer after radical surgery. The phase 3 trial previously demonstrated a significant improvement in disease-free survival with nivolumab. With a median follow-up of 36.1 months, disease-free survival was longer with nivolumab compared to placebo across all patients with muscle-invasive bladder cancer, reducing the risk of disease recurrence or death by 37%. Among patients who had received prior neoadjuvant cisplatin-based chemotherapy, nivolumab reduced this risk by 42%, whilst in those who had not received chemotherapy, the risk was reduced by 31%. Overall survival also favored nivolumab over placebo, reducing the risk of death by 30% in all patients with muscle-invasive bladder cancer and by 52% in those with tumors expressing PD-L1 at 1% or higher. Among patients who had received prior neoadjuvant chemotherapy, nivolumab reduced the risk of death by 26%, whilst in those who had not received chemotherapy, the risk was reduced by 33%. Alongside this, the safety profile remained consistent with previous findings. Dr. Neeraj Agarwal: Thank you, Peter, for such a nice overview of this abstract. These results reinforce adjuvant nivolumab as a standard of care for high-risk muscle-invasive bladder cancer, offering the potential for a curative outcome for our patients. Dr. Peter Hoskin: I agree with you Neeraj. Perhaps you would like to mention Abstract 659 titled, “Additional efficacy and safety outcomes and an exploratory analysis of the impact of pathological complete response (pCR) on long-term outcomes from NIAGARA.” Dr. Neeraj Agarwal: Of course. Dr. Galsky presented additional outcomes from the phase 3 NIAGARA study, which evaluated perioperative durvalumab combined with neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer. The study previously demonstrated a significant improvement in event-free survival and overall survival with durvalumab compared to chemotherapy alone, with a manageable safety profile and no negative impact on the ability to undergo radical cystectomy. Among the 1,063 randomized patients, those who received durvalumab had a 33% reduction in the risk of developing distant metastases or death and a 31% reduction in the risk of dying from bladder cancer compared to those who received chemotherapy alone. More patients who received durvalumab achieved a pathological complete response at the time of surgery with 37% compared to 28% in the chemotherapy-alone group. Patients who achieved a pathological complete response had better event-free survival and overall survival compared to those who did not. In both groups, durvalumab provided additional survival benefits, reducing the risk of disease progression or death by 42% and the risk of death by 28% in patients with a pathological complete response, while in those patients without a pathological complete response, the risk of disease progression or death was reduced by 23% and the risk of death by 16% when durvalumab was added to the chemotherapy. Immune-mediated adverse events occurred in 21% of patients in the durvalumab group compared to 3% in the chemotherapy-alone group, with grade 3 or higher events occurring in 3% compared to 0.2%. The most common immune-related adverse events included hypothyroidism in 10% of patients treated with durvalumab compared to 1% in the chemotherapy-alone group, and hyperthyroidism in 3% versus 0.8%. At the time of the data cutoff, these adverse events had resolved in 41% of affected patients in the durvalumab group and 44% in the chemotherapy-alone group. Dr. Peter Hoskin: Thank you, Neeraj, for the great summary. These findings further support the role of perioperative durvalumab as a potential standard of care for patients with muscle-invasive bladder cancer. Dr. Neeraj Agarwal: I concur with your thoughts, Peter. Before wrapping up the bladder cancer section, would you like to mention Abstract 664 reporting updated results from the EV-302 trial, which evaluated enfortumab vedotin in combination with pembrolizumab compared to chemotherapy as first-line treatment for patients with previously untreated locally advanced or metastatic urothelial carcinoma? Dr. Peter Hoskin: Yes, of course. Dr. Tom Powles presented updated findings from the EV-302 study, and in this abstract presented 12 months of additional follow-up for EV-302 (>2 y of median follow-up) and an exploratory analysis of patients with confirmed complete response (cCR). The study had a median follow-up of 29.1 months and previously demonstrated significant improvements in progression-free survival and overall survival with enfortumab vedotin and pembrolizumab. This is now the standard of care in global treatment guidelines. Among the 886 randomized patients, enfortumab vedotin and pembrolizumab reduced the risk of disease progression or death by 52% and the risk of death by 49% compared to chemotherapy. The survival benefit was consistent regardless of cisplatin eligibility or the presence of liver metastases. The confirmed objective response rate was higher with enfortumab vedotin and pembrolizumab at 67.5% compared to 44.2% with chemotherapy. The median duration of response was 23.3 months with enfortumab vedotin and pembrolizumab compared to 7.0 months with chemotherapy. A complete response was achieved in 30.4% of patients in the enfortumab vedotin and pembrolizumab group compared to 14.5% in the chemotherapy group, with the median duration of complete response not yet reached in the enfortumab vedotin and pembrolizumab group compared to 15.2 months in the chemotherapy group. Severe treatment-related adverse events occurred in 57.3% of patients treated with enfortumab vedotin and pembrolizumab compared to 69.5% in the chemotherapy group, while in patients who achieved a complete response, severe adverse events occurred in 61.7% of those treated with enfortumab vedotin and pembrolizumab compared to 71.9% with chemotherapy. Treatment-related deaths were reported in 1.1% of patients treated with enfortumab vedotin and pembrolizumab compared to 0.9% with chemotherapy, with no treatment-related deaths occurring in those who achieved a complete response. These findings clearly confirm the durable efficacy of enfortumab vedotin and pembrolizumab, reinforcing its role as the standard of care for the first-line treatment of patients with locally advanced or metastatic urothelial carcinoma, and no new safety concerns have been identified. Dr. Neeraj Agarwal: Thank you for this great summary. Moving on to kidney cancer, let's talk about Abstract 439 titled, “Nivolumab plus cabozantinib (N+C) vs sunitinib (S) for previously untreated advanced renal cell carcinoma (aRCC): Final follow-up results from the CheckMate-9ER trial.” Dr. Peter Hoskin: Sure. Dr. Motzer presented the final results from the phase 3 CheckMate-9ER trial, which compared the combination of cabozantinib and nivolumab against sunitinib in previously untreated advanced renal cell carcinoma. The data after more than five years follow-up show that the combination therapy provided sustained superior efficacy compared to sunitinib. In terms of overall survival, we see an 11-month improvement in median OS, 46.5 months for the cabo-nivo versus 35.5 months for sunitinib and a 42% reduction in the risk of disease progression or death, with median progression-free survival nearly doubling – that's 16.4 months in the combination group and 8.3 months with sunitinib. Importantly, the safety profile was consistent with the known safety profiles of the individual medicines, with no new safety concerns identified. Dr. Neeraj Agarwal: Great summary, Peter. These data further support the efficacy of cabo-nivo combination therapy in advanced renal cell carcinoma, which is showing a 11-month difference in overall survival. Dr. Peter Hoskin: Neeraj, before wrapping up this podcast, would you like to tell us about Abstract 618? This is titled “Prospective COTRIMS (Cologne trial of retroperitoneal lymphadenectomy in metastatic seminoma) trial: Final results.” Dr. Neeraj Agarwal: Sure, Peter. I would be delighted to. Dr Heidenrich from the University of Cologne in Germany presented the COTRIMS data evaluating retroperitoneal LN dissection in patients with clinical stage 2A/B seminomas. Seminomas are classified as 2A or B when the disease spreads to the retroperitoneal lymph nodes of up to 2 cm (CS IIA) or of more than 2 cm to up to 5 cm (CS 2B) in maximum diameter, respectively. They account for 10-15% of seminomas and they are usually treated with radiation and chemotherapy. However, radiation and chemo can be associated with long-term toxicities such as cardiovascular toxicities, diabetes, solid cancers, leukemia, particularly for younger patients. From this standpoint, Dr Heidenrich and colleagues evaluated unilateral, modified template, nerve-sparing retroperitoneal lymph node dissection as a less toxic alternative compared to chemo and radiation. They included 34 patients with negative AFP, beta-HCG, and clinical stage 2A/B seminomas. At a median follow-up of 43.2 months, the trial demonstrated great outcomes: a 99.3% treatment-free survival rate and 100% overall survival, with only four relapses. Antegrade ejaculation was preserved in 88% of patients, and severe complications such as grade 3 and 4 were observed in 12% of patients. Pathological analysis revealed metastatic seminoma in 85% of cases, with miR371 being true positive in 23 out of 24 cases and true negative in 100% of cases. It appears to be a valid biomarker for predicting the presence of lymph node metastases. These findings highlight retroperitoneal lymph node dissection is feasible; it has low morbidity, and excellent oncologic outcomes, avoiding overtreatment in 80% of patients and sparing unnecessary chemotherapy or radiotherapy in 10-15% of cases. Dr. Peter Hoskin: Great summary and important data on retroperitoneal lymphadenectomy in metastatic seminoma. These findings will help shape clinical practice. Any final remarks before we conclude today's podcast? Dr. Neeraj Agarwal: Before wrapping up this podcast, I would like to say that we have reviewed several abstracts addressing prostate, bladder, kidney cancers, and seminoma, which are impacting our medical practices now and in the near future. Peter, thank you for sharing your insights with us today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion and your leadership of the conference. Many thanks. Dr. Peter Hoskin: Thank you, Neeraj. Thank you for the opportunity to share this information more widely. I'm aware that whilst we have nearly 6,000 delegates, there are many other tens of thousands of colleagues around the world who need to have access to this information. And it was a great privilege to chair this ASCO GU25. So, thank you once again, Neeraj, for this opportunity to share more of this information that we discussed over those few days. Dr. Neeraj Agarwal: Thank you, Peter. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  Find out more about today's speakers:   Dr. Neeraj Agarwal    @neerajaiims    Dr. Peter Hoskin Follow ASCO on social media:      @ASCO on Twitter      ASCO on Bluesky  ASCO on Facebook      ASCO on LinkedIn      Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas Dr. Peter Hoskin: Research Funding (Institution): Varian Medical Systems, Astellas Pharma, Bayer, Roche, Pfizer, Elekta, Bristol Myers  

A breaking news podcast from ASCO GU in San Francisco! Prof Louise Emmett (St Vincent's, Sydney), has just read out the latest update from the ENZA-P trial (and simultaneous publication in Lancet Oncology), reporting that the combination of LuPSMA and enzalutamide improves overall survival when compared with enzalutamide alone, in men with poor prognosis mCRPC. Big news!! A 45% reduction in the risk of death in favour of the combination. Plus excellent quality of life for those receiving the combo. We are joined by Louise and co-author A/Prof Andrew Weickhardt (Austin Health, Melbourne), to discuss this exciting data from the ENZA-P trial, and what it means for the future of not just mCRPC, but also for similar combinations in mHSPC.ENZA-P is an investigator-initiated Phase II trial led by ANZUP in partnership with the Prostate Cancer Research Alliance, a join initiative between the Australian Government and Movember. Your co-hosts as ever are Professor Declan Murphy and Dr Renu Eapen. This is a Themed podcast supported by our Gold Partners, Astellas, and our Silver Partners, Novartis. Even better on our YouTube channelLinks:Lancet Oncology paperANZUP 

Treatment Intensification in Metastatic HSPC CME Available: https://auau.auanet.org/node/41733 ACKNOWLEDGEMENTS: Support provided by independent educational grants from:  Lantheus Medical Imaging Novartis Pharmaceuticals Corporation LEARNING OBJECTIVES: At the conclusion of this activity, participants will be able to: 1. Explain the rationale behind treatment intensification in metastatic hormone sensitive prostate cancer (mHSPC), based on its pathophysiology.  2. Analyze the rationale and clinical evidence supporting treatment intensification in mHSPC, including potential benefits and risks.  3. Select appropriate patients for treatment intensification, considering factors such as disease burden, patient comorbidities, and individual risk profiles.

Did you know that limiting genetic testing to castration-resistant disease is subpar to testing at the hormone-sensitive stage in prostate cancer?    Credit available for this activity expires: 01/09/26 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1002043?ecd=bdc_podcast_libsyn_mscpedu

Send us a textJoin us as we discuss the frontline therapy of metastatic hormone sensitive  prostate cancer with Professor Alison Birtle.Alison has been involved in many of the key trials in urological cancers and shares her take on selecting patients for triplet therapy.We also look at the factors that affect treatment choices for our mHSPC pateints.This area has changed so much in recent years and Alison brings those changes to life in this episode.You hope you enjoy!John & Mike

Did you know androgen deprivation monotherapy is no longer considered standard of care for metastatic hormone-sensitive prostate cancer (mHSPC) by experts? Credit available for this activity expires: 11/25/25 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1001957?ecd=bdc_podcast_libsyn_mscpedu

Part 2 Highlights from a GU Cast Live Event! Dr Kim Chi (Medical Oncologist, Vancouver) and Dr Carmen Mir (Urologist, Valencia) joined the PROSPECT meeting in Melbourne to discuss high-risk prostate cancer and mHSPC, along with many experts from around Australia. On the eve of the meeting over dinner, Declan Murphy led a GU Cast-themed panel discussion on five hot topics in prostate cancer, featuring snippets from GU Cast over the past few months.Part 2 today features controversies in PLND, the somewhat notorious ARPI switch control arm beloved of mCRPC trials, and teh importnt topic of de-escalation in advanced prostate cancer. Part 1 recently in your feeds included PSMA conundrums and triplet vs doublet therapy.Even better on our YouTube channelThis is a Themed Podcast supported by our Gold Partners, Johnson & Johnson, who also support the PROSPECT meeting. Special thanks to David Chen for help with videography

Highlights from a GU Cast Live Event! Dr Kim Chi (Medical Oncologist, Vancouver) and Dr Carmen Mir (Urologist, Valencia) joined the PROSPECT meeting in Melbourne to discuss high-risk prostate cancer and mHSPC, along with many experts from around Australia. On the eve of the meeting over dinner, Declan Murphy led a GU Cast-themed panel discussion on five hot topics in prostate cancer, featuring snippets from GU Cast over the past few months. Part 1 today features PSMA conundrums and triplet vs doublet therapy. Even better on our YouTube channel This is a Themed Podcast supported by our Gold Partners, Johnson & Johnson, who also support the PROSPECT meeting. Special thanks to David Chen for help with videography

Everything you need to know about treatment intensification in mHSPC!! Doublet vs Triplet. Who should have radiotherapy? PSMA PET/CT conundrums, e-escalation, case discussions and more. Featuring GU Cast Hosts Declan Murphy and Renu Eapen, Medical Oncologist Ben Tran, Nuclear Medicine Physician Louise Emmett, and Radiation Oncologist Amy Hayden. Plus lots of interaction from our live audience around Australia.Watch the full webinar including presentations on our YouTube channelThis GU Cast Live Event was an interactive educational webinar supported by our Gold Partners, Mundipharma.Learning objectives: 1. Provide an overview of the landscape of mHSPC today, with a particular focus on intensification of therapy2. Provide an overview of the role of novel and conventional imaging in diagnosis of mHSPC, both synchronous and metachronous3. To better understand options for intensification of systemic therapy in mHSPC4. To better understand the role of radiotherapy in mHSPC

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Elena Castro, MD, PhD - Innovation and Individualisation in mHSPC and nmCRPC: Optimising Patient Outcomes and Experiences

Today we celebrate one of our favourite clinical trials - ENZAMET! It is 10 years since ENZAMET opened and beyond its pivotal data establishing that adding enzalutamide to ADT improves survival for mHSPC patients, it continues to produce a very strong stream of high-quality findings that affect our practice today. ENZAMET also straddled an epochal era which included the advent of doectaxel upfront in mHSPC, and the introduction of PSMA PET/CT. Today we were very happy to speak to two of the principal architects of ENZAMET; Professor Ian Davis, Chair of the ANZUP co-operative trials group, and Professor Chris Sweeney. Director of the South Australian ImmunoGENomics Cancer Institute, who told us the extraordinary story of how this trial came about, the challenges and evolutions of its rollout, and the strong tail end of translational and other research which it continues to produce. It is a great example of how investigator initiated trials run by nimble and ambitious cooperative trial groups like ANZUP can do things a little differently.This is a Themed Podcast supported by our Gold Partners, Astellas. Een better on our YouTube channelLinks:ANZUP Previous podcast from #ANZUP24 Annual Scientific MeetingENZAMET 2019 paper NEJM ENZAMET 2023 paper Lancet Oncology

Treatment Intensification in Metastatic HSPC CME Available: https://auau.auanet.org/node/41733 ACKNOWLEDGEMENTS: Support provided by independent educational grants from:  Lantheus Medical Imaging Novartis Pharmaceuticals Corporation LEARNING OBJECTIVES: At the conclusion of this activity, participants will be able to: 1. Explain the rationale behind treatment intensification in metastatic hormone sensitive prostate cancer (mHSPC), based on its pathophysiology.  2. Analyze the rationale and clinical evidence supporting treatment intensification in mHSPC, including potential benefits and risks.  3. Select appropriate patients for treatment intensification, considering factors such as disease burden, patient comorbidities, and individual risk profiles.

Arun Azad describes this randomised phase II study of sequential 177Lu-PSMA-617 and docetaxel vs. docetaxel in mHSPC

A big day at ESMO in Barcelona today as our friend and colleague A/Professor Arun Azad presents the results of the UpFront PSMA trial for the first time. The data were revealed in the main prostate cancer session at ESMO and simultaneously published in Lancet Oncology. UpFront PSMA is a randomised controlled trial comparing ADT and docetaxel, with ADT + done + LuPSMA in men newly diagnosed high-volume mHSPC. This is a world-first readout of LuPSMA in a prospective randomised trial for mHSPC, and clearly shows a benefit.  We dive into the details today with Arun, and another friend and colleague, Professor Michael Hofman, nuc med lead for UpFront PSMA. This is a Themed Podcast supported by our Silver Partners, Novartis.Even better on our YouTube channelFull paper in Lancet Oncology here 

Dr. Neeraj Agarwal and Dr. Rana McKay discuss promising studies in GU cancers featured at the 2024 ASCO Annual Meeting that highlighted improved outcomes in urothelial carcinoma, improved survival in renal cell carcinoma, and the role of ctDNA as a potential biomarker for predicting outcomes.   TRANSCRIPT Dr. Neeraj Agarwal: Hello and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, your guest host of the ASCO Daily News Podcast today. I am the director of the Genitourinary Oncology Program, a professor of medicine at the University of Utah's Huntsman Cancer Institute, and editor-in-chief of the ASCO Daily News.  I am delighted to welcome Dr. Rana McKay, a GU medical oncologist and associate professor at the University of California San Diego. Today, we'll be discussing some key GU abstracts featured at the 2024 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode. Rana, we're thrilled to have you on the podcast today to share your insights on key advances in GU oncology from ASCO24. Dr. Rana McKay: Thank you so much, Neeraj; it's a pleasure to be here. Dr. Neeraj Agarwal: So, Rana, let's start with some bladder cancer abstracts. Could you tell us about Abstract 4503, titled “Impact of exposure on outcomes with enfortumab vedotin in patients with locally advanced or metastatic urothelial cancer”? Dr. Rana McKay: Of course, I would be delighted to. First, I would like to remind our listeners that enfortumab vedotin (EV) was approved as a monotherapy for the treatment of locally advanced or metastatic urothelial cancer based on the results of EV-201 and EV-301 trials. In these pivotal studies, EV was initiated at a dose of 1.25 mg/kg, and dose modifications, such as reductions and interruptions, were used to manage adverse events. In the abstract presented at ASCO 2024, Dr. Daniel Petrylak and colleagues conducted a post-hoc exploratory analysis to evaluate the association between EV plasma exposure and outcomes. They used multiple pharmacokinetic samples collected during the first two cycles and pre-dose samples from 3 EV monotherapy studies, namely EV-101, EV-201, and EV-301, that were conducted in patients with previously treated locally advanced or metastatic urothelial carcinoma. Dose reductions to 1 mg/kg were required in 42.1% and 35.1% of patients in the EV-201 and EV-301 trials, respectively, and reductions to 0.75 mg/kg were required in 13.6% and 11.1% in the EV-201 and EV-301 trials, respectively. Higher EV exposure during the first two cycles was associated with a higher objective response rate. The ORR was 21.4% for the dose of 0.75 mg/kg, while it was 18.5% for the dose of 1.0 mg/kg. Interestingly, increasing the dosage to 1.25 mg/kg improved the ORR, which ranged from 40 to 51.1% across various studies. In the EV-301 trial, when comparing the efficacy of EV to chemotherapy, EV improved PFS and OS across all dose quartiles, and there was no evidence that recommended dose modifications impacted long-term efficacy outcomes. Dr. Neeraj Agarwal: Thank you, Rana, for this great summary. I would like to add that the meticulously conducted pharmacokinetic studies demonstrated that serum levels of EV correlated with responses. Importantly, patients who had to decrease the dose did not experience compromised outcomes as EV improved PFS and OS outcomes vs chemotherapy in across all exposure quartiles in the EV-301 trial where EV was compared with chemotherapy. These findings highlight the need to start at the recommended dose of 1.25 mg/kg and reduce it, if necessary, however, clinicians should not start at a lower dose.  Dr. Rana McKay: I totally agree with you, Neeraj. Now, moving on to a different setting in bladder cancer, what can you tell us about LBA4517, titled “Perioperative sacituzumab govitecan alone or in combination with pembrolizumab for patients with muscle-invasive urothelial bladder cancer: SURE-01/02 interim results”? Dr. Neeraj Agarwal: Of course! So, SURE was a multicohort, open-label, phase 2 study in patients with muscle-invasive bladder cancer assessing sacituzumab govitecan as a neoadjuvant therapy either alone in SURE-01 or as a combination with pembrolizumab followed by adjuvant pembro in SURE-02 in a flexible design allowing a bladder-sparing approach. In the abstract presented at ASCO 2024, Dr. Antonio Cigliola and colleagues report interim results of the SURE-01 study. Patients with cT2-4N0M0 urothelial carcinoma who were ineligible for or refused cisplatin-based neoadjuvant chemotherapy were planned to receive 4 cycles of neoadjuvant sacituzumab govitecan at a dose of 10 mg/kg followed by radical cystectomy.  An extensive assessment was performed at baseline and after the 4 cycles for response assessment. Patients with clinical complete response defined with negative MRI, cystoscopy and ctDNA assays refusing radical cystectomy were offered redo transurethral resection of the bladder tumor or repeat TURBT followed by observation in the absence of viable high-grade tumor in the bladder. The primary endpoint was pathological complete response rate, while secondary endpoints included pathological downstaging rate and safety. After the first 8 patients were enrolled, the protocol was amended due to the occurrence of grade 3 and 4 neutropenia and diarrhea in 75% and 50% of patients, respectively, and 2 deaths – one of which was deemed to be treatment-related due to sepsis. Key protocol changes included the reduction of the dose of sacituzumab govitecan to 7.5 mg/kg, the introduction of G-CSF as primary prophylaxis, and the exclusion of patients at high risk of febrile neutropenia per ASCO guidelines.  Among 21 patients who received at least one cycle of sacituzumab govitecan and included in the intention-to-treat population, 47.6% had a complete pathological response, and 52.4% had pathological downstaging. 11 patients underwent radical cystectomy, while 7 received repeat-TURBT due to complete clinical response or patient preference. Regarding the safety profile, grade 3 or more adverse events occurred in 42.5% of patients. Treatment-related adverse events leading to dose interruptions or discontinuations were more common before the protocol amendment. It is noteworthy that 3 patients died after treatment discontinuation, with one deemed treatment-related, as previously mentioned. Dr. Rana McKay: Thank you, Neeraj, for a great summary. The pathological complete responses observed show promising activity for sacituzumab govitecan as a neo-adjuvant therapy and a window for bladder-sparing approaches, which is definitely exciting news for our patients! However, although the 3 deaths encountered in a neo-adjuvant setting could be concerning, the improvement of the safety profile after protocol amendments is reassuring and supports the continuation of the study. Dr. Neeraj Agarwal: Before wrapping up the bladder cancer section, would you like to share your insights with our listeners on Abstract 4518, titled “Quantitative circulating tumor DNA (ctDNA) assessment in patients with advanced urothelial carcinoma treated with pembrolizumab or platinum-based chemotherapy from the phase 3 KEYNOTE-361 trial”?  Dr. Rana McKay: Sure. So, the KEYNOTE-361 trial was a randomized phase 3 study with 3 arms that included pembrolizumab plus chemotherapy, pembrolizumab monotherapy, or chemotherapy alone in patients with previously untreated advanced urothelial carcinoma. The results showed that neither the combination of pembrolizumab plus chemotherapy nor pembrolizumab monotherapy improved survival outcomes compared to the chemotherapy arm. So, in this exploratory analysis presented at ASCO24, Dr. Tom Powles and colleagues sought to assess the role of ctDNA as a potential biomarker between the pembrolizumab monotherapy arm and the chemotherapy arm. Tumor tissue mutations were evaluated using whole exome sequencing, and plasma ctDNA was assessed with the Guardant 360 assay. Changes in ctDNA from pre-treatment cycle 1 to on-treatment cycle 2, so 3 weeks post-baseline assessment, were quantified by the maximum variant allele frequency of tumor tissue-specific mutations.  Results showed that lower baseline ctDNA levels were associated with improved clinical outcomes of response in the pembrolizumab arm but not in the chemotherapy arm. This improvement in the pembrolizumab arm was also robust to adjustment for tumor mutational burden and PD-L1. Additionally, chemotherapy led to a ctDNA clearance rate of 41% compared to 11% in the pembrolizumab arm. Patients who had a large ctDNA reduction with pembrolizumab had significantly improved outcomes compared to those achieving a large reduction with chemotherapy with a hazard ratio of 0.25. However, this did not replicate in patients who did not achieve a large reduction, as these patients had similar outcomes across both arms. Let's switch gears to kidney cancer and start with Abstract 4508, reporting the final OS analysis from the JAVELIN Renal-101 trial. Neeraj, what would you like to tell us about this abstract? Dr. Neeraj Agarwal:  Well, as a quick reminder, the JAVELIN Renal-101 was a randomized phase 3 trial where patients with previously untreated advanced or metastatic clear cell renal cell carcinoma were randomized to receive either the combination of avelumab plus axitinib or sunitinib. In previous analyses, the combination of avelumab and axitinib significantly improved PFS compared to sunitinib and was subsequently approved by the FDA for the first-line treatment of patients with advanced RCC in 2019. This superiority in PFS was maintained across the different analyses; however, OS data remained immature. In the abstract presented at ASCO24 by Dr. Robert Motzer from Memorial Sloan Kettering Cancer Center and colleagues, the authors reported OS results at a median follow-up of around 73 months and a minimum of 68 months for all patients, which is the longest follow-up for any ICI-TKI combination in RCC. The final analysis in the overall population favored the combination of avelumab plus axitinib with a median OS of 44.8 months compared to 38.9 months with sunitinib, however, this did not reach statistical significance with a hazard ratio of 0.88. The PFS results and safety profile were consistent with previous analyses.  Dr. Rana McKay: Thank you, Neeraj, for such a nice overview of this abstract. These new data could make this regimen less optimal than other ICI-TKI combinations in the first-line mRCC setting.   Dr. Neeraj Agarwal: I concur, Rana. Moving on to perhaps one of the most exciting GU abstracts featured, Abstract 4506, titled “Circulating kidney injury molecule-1 biomarker analysis in IMmotion010: A randomized phase 3 study of adjuvant atezolizumab vs placebo in patients with renal cell carcinoma at increased risk of recurrence after resection.” Rana, what are your thoughts on this abstract? Dr. Rana McKay: Well, first, I would like to take a step back and remind our audience that in the IMmotion010 trial, patients with resected intermediate to high-risk RCC with clear cell and/or sarcomatoid component were randomized in a 1:1 ratio to receive either atezolizumab or placebo. Investigator-assessed disease-free survival, which was the primary endpoint, favored the atezolizumab arm but did not reach statistical significance. In the abstract featured at ASCO24, Dr. Laurence Albiges and colleagues build on data previously reported in the ASSURE and CheckMate 914 trials and report provocative findings regarding a molecule known as kidney injury molecule 1 or KIM-1, which is a type 1 membrane glycoprotein that has been identified as a minimally invasive potential peripheral blood circulating biomarker. The KIM-1 level of 86 pg/ml was identified as the optimized threshold for defining post-nephrectomy KIM-1 high vs KIM-1 low subgroups in the IMmotion010 trial. KIM-1 levels were measured at baseline or pre-treatment, at cycle 4 day 1, and at disease recurrence or discontinuation without disease recurrence. Baseline characteristics were balanced between the KIM-1 high and KIM-1 low groups, except perhaps for a slightly higher pathological stage in the KIM-1 high subgroup.  I would like to highlight 3 key takeaways from this abstract. First, KIM-1 high level was associated with significantly worse DFS with a hazard ratio of 1.75. Second, patients in the KIM-1 high subgroup receiving atezolizumab had a 28% reduction in the risk of recurrence or death compared to those receiving placebo, while those in the KIM-1 low subgroup had comparable outcomes across both treatment arms. Third, patients in the KIM-1 high subgroup receiving atezolizumab were significantly less likely to experience an on-treatment increase in KIM-1 levels, which was associated with worse DFS in both high and low KIM-1 subgroups, regardless of treatment arm. Thus, these findings support the use of KIM-1 as both a predictive and prognostic biomarker in patients with RCC. Dr. Neeraj Agarwal: Yes, Rana, this is amazing data! I would like to add that these results warrant larger and, ideally, prospective studies to validate the utility of KIM-1 as a noninvasive biomarker for identifying minimal residual disease after nephrectomy and for predicting outcomes to immune checkpoint inhibitors. Dr. Rana McKay: Also, in the field of biomarkers, 2 abstracts interrogating different biomarkers in a different setting, so in patients with advanced or metastatic RCC were presented. Neeraj, could you tell us more about these abstracts? Dr. Neeraj Agarwal: Of course! I think you are referring to Abstracts 4504 and 4505. In abstract 4504, Dr. Toni Choueiri and colleagues sought to assess the clinical implications of different biomarkers in the CLEAR trial, which was a randomized phase 3 trial that led to the approval of the combination of pembrolizumab plus lenvatinib in the first-line mRCC setting. On the other hand, in abstract 4505, Dr. Brian Rini presented biomarker results in KEYNOTE-426, which was also a randomized phase 3 trial based on which the combination of pembrolizumab plus axitinib was approved in patients with mRCC. The authors in both trials sought to investigate the role of biomarkers in predicting treatment outcomes from 3 different angles. Starting with PD-L1 expression, the superiority of the combination arms over sunitinib was not impacted by PD-L1 status in both trials. Moving on to RCC driver gene mutations on whole exome sequencing, such as VHL, SETD2, PBRM1, and BAP1, ICI combination therapies improved outcomes regardless of mutation gene status, and this improvement was statistically significant with PBRM1 mutations in KEYNOTE-426 compared to wild-type PBRM1, but this did not replicate in the CLEAR trial. Finally, using transcriptomic signatures derived from RCC trials, especially the IMmotion 151 and JAVELIN Renal 101 trials, where 7 clusters or molecular subtypes were identified, the combination arms outperformed sunitinib in all clusters in both trials and the magnitude of this benefit differed across clusters.  Dr. Rana McKay: Thank you for this very interesting summary and comparison of the results of these 2 abstracts. These findings support the use of ICI-based combinations in all patients with mRCC as a first-line option. Although these abstracts could not identify specific biomarkers that could guide us clinicians in treatment selection, they provide very interesting biological insights on these molecular biomarkers that are, however, not yet clinically actionable. Dr. Neeraj Agarwal: Very interesting point, Rana. Moving on to prostate cancer, let's start with abstract LBA5000 titled, “Cabazitaxel with abiraterone versus abiraterone alone randomized trial for extensive disease following docetaxel: The CHAARTED2 trial of the ECOG-ACRIN Cancer Research Group (EA8153).” Rana, what is your takeaway on this abstract? Dr. Rana McKay: As a reminder to our audience, the CHAARTED2 trial was a randomized open-label phase 2 study that compared the combination of cabazitaxel and abiraterone to abiraterone alone in patients with mCRPC previously treated with ADT plus docetaxel in the hormone-sensitive setting. The primary endpoint was progression-free survival. After a median follow-up of 47.3 months, Dr. Christos Kyriakopoulos and colleagues reported in LBA5000 that patients receiving the combination of cabazitaxel plus abiraterone had a 27% reduction in the risk of progression or death. However, there was no significant difference in overall survival between the two arms, with a median OS of 25 months in the cabazitaxel+abiraterone arm and 26.9 months in the abiraterone arm, although the study was underpowered for this endpoint. Regarding the toxicity profile, the combination of cabazitaxel and abiraterone was overall well tolerated with more cytopenias, as expected.  Dr. Neeraj Agarwal: Very nice summary of this abstract, Rana. I would like to add that the treatment landscape of patients with mHSPC has evolved since the design of the study and now includes combination therapies of ADT + ARPI with or without docetaxel, and ADT + docetaxel is no longer a standard of care, which limits the applicability of these results in clinical practice today.  Dr. Rana McKay: Excellent point, Neeraj. Let's discuss Abstract 5001, titled “CYCLONE 2: A phase 3 study of abemaciclib with abiraterone in patients with metastatic castration-resistant prostate cancer”. Dr. Neeraj Agarwal: Sure! In the abstract featured at ASCO24, Dr. Matthew Smith and colleagues report the primary results of the CYCLONE 2 trial, which was a randomized phase 2/3 study that investigated the combination of abemaciclib plus abiraterone versus abiraterone monotherapy in patients with mCRPC. Stratification factors included radiographic progression at study entry, presence of measurable disease, and prior docetaxel for mHSPC. Part 1 of the study established the recommended phase 2 dose of abemaciclib at 200 mg twice daily. In part 2, patients were randomized to placebo or abemaciclib, and an adaptive interim analysis using prespecified criteria was performed and recommended the expansion of the study to part 3. The primary endpoint was investigator-assessed radiographic progression-free survival by RECIST 1.1 and PCWG3 criteria in the intention-to-treat population. At the time of the primary analysis, adding abemaciclib to abiraterone did not improve rPFS, with a hazard ratio of 0.83. The median rPFS was 22 months for the combination arm and 20.3 months for the abiraterone arm. The combination was well tolerated, and the safety profile was consistent with the known adverse events. Dr. Rana McKay: So, the addition of abemaciclib to abiraterone did not improve outcomes in patients with mCRPC. These findings suggest that no further investigation is warranted for abemaciclib or CDK4/6 inhibitors in biomarker-unselected patients with prostate cancer.  Dr. Neeraj Agarwal: Rana, what's your take-home message on Abstract 5006, titled “Health-related quality of life results from PRESTO (AFT-19), a phase 3 randomized trial of intensification of androgen blockade in patients with high-risk biochemically relapsed castration sensitive prostate cancer”? Dr. Rana McKay: So, as a reminder to our audience, the PRESTO trial was a randomized phase 3 study that assessed the effects of intensified androgen receptor blockade in patients with biochemically recurrent prostate cancer following local therapies. Patients with a PSA doubling time of less than 9 months and no evidence of metastatic disease were randomized to receive either 52 weeks of ADT alone, ADT plus apalutamide, or ADT plus apalutamide plus abiraterone. In their paper published earlier this year in the Journal of Clinical Oncology, the authors showed that patients receiving ADT plus apalutamide with or without abiraterone had significantly longer PSA-progression-free survival than those receiving ADT alone. In the oral presentation featured at ASCO24, Dr. Ronald Chen and colleagues report health-related quality of life outcomes that were assessed using various questionnaires or scales at baseline, at cycle 7, which is around 6 months on treatment, and at the end of treatment. Results showed that this intensified approach with apalutamide did not significantly increase severe adverse events, did not lengthen the time to testosterone recovery, and did not meaningfully increase common treatment-related symptoms such as hormonal symptoms, sexual dysfunction, hot flash interference, and fatigue. Importantly, additional intensification with abiraterone did not further improve PSA-PFS but did increase the rate of serious adverse events, lengthened the time to testosterone recovery, and increased hot flash interference.  Dr. Neeraj Agarwal: So, in conclusion, the PRESTO trial supports using intensified androgen blockade with apalutamide to improve PSA-PFS in patients with high-risk biochemically recurrent prostate cancer without compromising health-related quality of life. However, adding abiraterone did not offer additional benefits and increased side effects.  Dr. Rana McKay: Let's move on to LBA5002 titled, “A randomized, double-blind, placebo-controlled trial of metformin in reducing progression among men on expectant management for low-risk prostate cancer: The MAST (Metformin Active Surveillance Trial) study.” Would you like to share your insights on this abstract with our listeners? Dr. Neeraj Agarwal: Absolutely. MAST was a randomized, double-blinded, placebo-controlled trial that investigated the impact of metformin on the progression of low-risk localized prostate cancer in patients choosing to undergo active surveillance. Eligible patients had biopsy-proven, low-risk, localized prostate cancer diagnosed within the past 6 months, characterized by a Gleason score of less than 6 observed in less than one-third of the total cores, less than 50% positivity in any one core, a PSA level of less than 10 ng/ml, and a clinical-stage between T1c and T2a. Patients were randomized in a 1:1 ratio to receive either metformin 850 mg twice daily or placebo for three years. All patients underwent repeat prostate biopsy at 18 and 36 months. The primary endpoint was time to progression, defined as the earliest occurrence of primary prostate cancer therapy, such as prostatectomy, radiation, hormonal therapy, or pathological progression on subsequent biopsies, which was defined as more than 1/3 of total cores involved, at least 50% of any one core involved, or Gleason pattern 4 or higher. The study included 407 patients, with 204 receiving metformin and 203 receiving a placebo. Results presented by Dr. Anthony Joshua showed no statistically significant difference in progression-free survival, including therapeutic and pathologic progression, with an unadjusted hazard ratio of 1.08.  Interestingly, there was a signal that patients with a BMI more than 30 had a detriment to taking metformin with a higher risk of progression compared to those receiving placebo with an unadjusted HR of 2.39 and a p-value of 0.01. Dr. Rana McKay: I would like to add that this study showed that metformin use does not prevent the progression of low-risk localized prostate cancer on active surveillance and could represent a potential detriment for patients with high BMI at study entry. Dr. Neeraj Agarwal: Yes, Rana, I concur. Any final remarks before we conclude today's podcast? Dr. Rana McKay:  Thank you, Neeraj; it's been wonderful being here with you today and you having me on the podcast to highlight these important advances and the amazing work that many investigators are conducting and the patients who were involved in the context of these trials. It's really excellent to see these updated results.   Dr. Neeraj Agarwal: Before we wrap up this podcast, I would like to say that we have reviewed a selection of abstracts addressing prostate, bladder, and kidney cancer, which are significantly impacting our medical practices now and in the near future. Rana, thank you for sharing your insights today. These updates are undoubtedly exciting for the entire GU oncology community, and we greatly appreciate your valuable contribution to the discussion. Many thanks. And thank you to our listeners for joining us today. You will find links to the abstracts discussed today on the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Find out more about today's speakers:    Dr. Neeraj Agarwal   @neerajaiims   Dr. Rana McKay  @DrRanaMcKay     Follow ASCO on social media:      @ASCO on Twitter      ASCO on Facebook      ASCO on LinkedIn         Disclosures:        Dr. Neeraj Agarwal:         Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences     Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas      Dr. Rana McKay:   Consulting or Advisory Role: Janssen, Novartis, Tempus, Exelxis, Pfizer, Bristol-Myers Squibb, Astellas Medivation, Dendreon, Bayer, Sanofi, Merck, Vividion, Calithera, AstraZeneca, Myovant, Caris Life Sciences, Sorrento Therapeutics, AVEO, Seattle Genetics, Telix, Eli Lilly, Pfizer, Bayer, Tempus

In the first of our special episodes focussing on GU Oncology in China, we are delighted to welcome our inaugural GU Cast China Editor. Professor Yao Zhu, to the GU Cast studio. Yao is a Urologist at Fudan University Shanghai Cancer Centre,  and is well known to all of us at GU Cast and Peter MacCallum Cancer Centre. As part of our Gold Partnership with Bayer Pharmaceuticals in China, Yao will help us put together some Themed Podcasts focussing on GU Oncology in China. This first episode focuses on one of our favourite topics, metastatic hormone-sensitive prostate cancer (mHSPC). We chat with Yao and special guest, Professor Ning Zhang (Beijing Anzhen Hospital, affiliated to Capital Medical University), and learn a lot about prostate cancer in China! Even better on our YouTube channel 

Axel Merseburger (Chief and Professor of Urology, Lubeck, Germany) was in Australia recently and popped into the GU Cast studio for a chat. Axel was at the USANZ ASM recently and also on a speaker tour supported by Janssen Pharmaceuticals, so we put together this Themed Podcast to pick his brains on high-risk prostate cancer and mHSPC in 2024. This Themed Podcast is supported by Janssen Pharmaceuticals, Gold Partners of GU Cast.  Even better on our YouTube channel

It has becoming a familiar refrain around the world , and is certainly good news for the prostate cancer community! This week, another androgen receptor pathway inhibitor (ARPI) became reimbursed for men with hormone-sensitive metastatic prostate cancer (mHSPC) in Australia. Darolutamide is already available for men with non-metastatic castration-resistant prostate cancer, and is now also available for men with mHSPC in combination with androgen deprivation therapy and chemotherapy. Therefore we continue on our mission at GU Cast to educate ourselves about the use of ARPIs in mHSPC. And yes, even simple urologists like us can get up to speed with these drugs!Declan and Renu are joined by fellow Urologist Associate Professor Joseph Ischia, one of our favourite prostate cancer experts. And a great podcaster himself! Check out the back catalogue of "Talking Urology" using the links below. Plus what is a "jiffy stent"??? This Themed Podcast is supported by Bayer, Silver Partners of GU Cast. Even better on our YouTube channel Link: https://www.talkingurology.com.au/

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/what-is-the-pharmacists-role-in-managing-mhspc-doublet-and-triplet-regimens/16221/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/what-can-i-do-to-improve-care-of-prostate-cancer-patients-at-risk-for-inequities/16223/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/what-is-the-current-state-of-disparities-in-prostate-cancer-care/16222/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/how-nurses-and-advanced-practice-clinicians-can-help-patients-navigate-a-new-mhspc-diagnosis/16220/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/expert-panel-how-can-we-integrate-patient-preference-data-to-support-shared-decision-making-conversations-in-mhspc/16219/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/expert-panel-how-does-adt-intensification-for-mhspc-affect-future-therapy-options/16218/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/expert-panel-selecting-treatment-in-mhspc-which-treatment-for-which-patient/16217/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

CME credits: 1.00 Valid until: 29-09-2024 Claim your CME credit at https://reachmd.com/programs/cme/choosing-between-doublets-and-triplets-in-mhspc-what-is-the-data/16216/ This program increases awareness of androgen deprivation therapy (ADT) as a mainstay of treating patients with metastatic hormone-sensitive prostate cancer (mHSPC) and leads to new opportunities to improve patient care. Recent developments create a need for a greater understanding of practice-changing clinical trial data and guideline recommendations to treat patients with mHSPC.This program provides information on the most effective implementation of androgen receptor inhibitors (ARIs) to change the disease trajectory for mHSPC. In addition, this education addresses both the challenges of and the need for an interdisciplinary care model that includes oncology pharmacists and nurses who provide patient support and education. Effective interdisciplinary care improves adherence management of adverse effects (AEs) and helps reduce the barriers to access, care, and treatment that contribute to racial and ethnic disparities in prostate cancer treatment. Finally, a patient education solution completes the curriculum, providing clinician-developed videos tethered to and accessible via the HCP education to answer questions frequently faced by patients with prostate cancer. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

Incorporating the AUA/SUO Guideline on Advanced Prostate Cancer into Practice CME Available: https://auau.auanet.org/node/39292 After participating in this educational activity, participants will be able to: 1. Cite recommendations within the newly amended AUA/SUO Advanced Prostate Cancer Guideline. 2. Assess the impact of newly approved agents on the management of men with Advanced Prostate Cancer. 3. Define M0 CRPC and the treatment options. 4. Identify clinically meaningful endpoints in clinical trials of patients with M0 CRPC. 5. Describe gaps in the knowledge for treatment and sequencing of agents in the management of CRPC. 6. Discuss treatment intensification in mHSPC. 7. Discuss challenges in incorporating AUA/SUO Advanced Prostate Cancer Guideline and management of advanced mHSPC and CRPC into community practice. ACKNOWLEDGEMENTS This educational series is supported by independent educational grants from: • Astellas and Pfizer, Inc. • Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC • Lantheus Medical Imaging • Merck & Co., Inc. • Pfizer, Inc.

Urologie, Podcast, Runkel, Krankenhausreform, Lauterbach, PD Dr. Angelika Borkowetz, PARP-Inhibitoren, Prostatakarzinom, mHSPC

With approvals and reimbursement increasing all the time for the use of AR pathway inhibitors (ARPIs) in metastatic hormone-sensitive prostate cancer (mHSPC), we chat today about how front-line clinicians need to make sure we are making the most of these opportunities for our patients. Urologists in particular are the clinicians who most frequently diagnose men with metastatic prostate cancer, and who therefore need to be aware of the changing opportunities to improve outcomes for our patients. Today in this Themed Episode supported by our Gold Partner, Janssen, we chat with Professor Fred Saad, Chair and Professor of Urology at the University of Montreal, who says it is "unethical to treat newly diagnosed metastatic prostate cancer with ADT alone"! We are also joined by Dr Ciara Conduit, Medical Oncologist at Peter MacCallum Cancer Centre, who helps us understand management options for these patients. Also available as a video podcast on our YouTube channel 

In this podcast, Prof. Igor Tsaur (DE), chief editor of the UROONCO PCa editorial board talks with Dr. Craig Jones (GB),  from Salford Royal and Christie Hospitals, about his recent presentation at AUA2023, "Clinical fracture incidence in metastatic hormone-sensitive prostate cancer (mHSPC) and risk-reduction following addition of zoledronic acid to androgen deprivation therapy (ADT) with or without docetaxel (Doc): Long-term results of two phase 3 trials from the STAMPEDE platform protocol."Mr. Craig Jones answers the following questions: Could you distinguish osteoporotic from pathological fractures in your analysis based on routinely-collected healthcare data? Would a higher rate of pathological fractures explain the higher incidence of clinical fracture events in the M1 as compared to M0 subgroup?Are there data on symptomatic skeletal events as opposed to skeletal related events as a more relevant endpoint for health related quality of life?Risk of osteoporosis when utilising ADT+Docetaxel as compared to ADT+NHA?Denosumab outperformed Zoledronic acid for prevention of SRE in mCRPC. How would you compare both drugs in mHSPC? To keep up to date with prostate cancer developments, you can also visit our educational platform, UROONCO Prostate Cancer.

Live from AUA2023: Highlights in Advanced Prostate Cancer is a panel discussion filmed during the 2023 AUA Annual Meeting! CME Available: https://auau.auanet.org/node/38002 This activity is designed to increase the urologist's understanding of how to translate the latest scientific advances into their routine clinical practice, improving the care of patients with advanced prostate cancer. Faculty will review the latest advances in prostate cancer including the many new FDA-approved agents, as well as existing standard therapies. Urologists will gain the ability to translate the latest scientific advances into their routine clinical practice, improving the care of men with advanced prostate cancer. At the conclusion of the activity, participants will be able to: 1. Describe recent developments in the medical management of advanced prostate cancer. 2. Identify the active agents and their mechanism of action in the management of mHSPC, nmCRPC and mCRPC. 3. Discuss clinical investigations in the treatment of advanced prostate cancer. 4. Analyze the risks and benefits of treatment for advanced prostate cancer. 5. Identify the criteria for genetic and genomic testing and utilize the results to improve outcomes among patients with advanced prostate cancer. ACKNOWLEDGEMENTS This educational activity is supported by independent educational grants from: Astellas and Pfizer, Inc. AstraZeneca Merck & Co., Inc.

Hoje falamos de cancro da próstata em doentes jovens. O Dr. André Mansinho e a Dra. Joana Febra explicam-nos como gerir o impacto que a terapêutica tem nestes doentes, desde a componente sexual, fertilidade, incontinência e também a deteriorização cognitiva. E porque o tratamento da doença metastática nestes doentes é muito desafiante, fique para ouvir qual o papel que o rastreio desempenha. Assista já!Dr. André Mansinho Médico Oncologista no Centro Hospitalar Lisboa Norte - Hospital Santa Maria Joana FebraMédica Oncologista no Centro Hospitalar Universitário de Santo AntónioOlho Clínico é um Podcast da MSD de atualização científica, direcionado exclusivamente a Profissionais de Saúde. O conteúdo do mesmo não tem por objetivo induzir qualquer alteração de comportamento na prescrição ou toma de medicamentos. PT-NON-02400 - 04/2023

Alicia K. Morgans, MD, MPH - What Would You Do Next? Exploring Expert Perspectives on Clinical Cases and Compelling Questions in mHSPC and nmCRPC

Alicia K. Morgans, MD, MPH - What Would You Do Next? Exploring Expert Perspectives on Clinical Cases and Compelling Questions in mHSPC and nmCRPC

Featuring perspectives from Dr Emmanuel Antonarakis, Prof Karim Fizazi, Dr Maha Hussain and Dr Matthew Smith, moderated by Dr Alan Bryce, including the following topics: •       Management Approaches for Nonmetastatic Prostate Cancer — Dr Bryce o   Introduction (00:00) o   Case: A man in his early 70s with Gleason 8 prostate cancer after EBRT and leuprolide/enzalutamide, now receiving leuprolide/darolutamide with focal prostate uptake on PSMA PET — Priya Rudolph, MD, PhD (3:04) o   Case: A man in his late 60s who underwent prostatectomy for Gleason 4 + 3 = 7 prostate cancer, now with increasing PSA levels — Nataliya Mar, MD (8:35) o   Faculty presentation: Dr Bryce (15:12) •       Optimizing the Care of Patients with Metastatic Hormone-Sensitive Prostate Cancer (mHSPC) — Dr Hussain o   Cases: A man in his early 70s with de novo mHSPC and a man in his mid 90s with de novo mHSPC — Georges Azzi, MD and Swati Vishwanathan, MD (23:29) o   Case: A man in his early 70s with atrial fibrillation and rapid ventricular response who is diagnosed with de novo mHSPC (PSA 180,000 ng/mL) — Eric H Lee, MD, PhD (32:37) o   Faculty presentation: Dr Hussain (37:34) •       Current Therapeutic Options for Patients with Newly Diagnosed Metastatic Castration-Resistant Prostate Cancer (mCRPC) — Dr Smith o   Case: A man in his early 60s with de novo metastatic prostate cancer — Lai (Amber) Xu, MD, PhD (48:49) o   Case: A man in his late 70s with mCRPC — Dr Rudolph (53:36) o   Faculty presentation: Dr Smith (58:37) •       Best Practice Management of mCRPC for Patients Harboring HRR Gene Alterations — Dr Antonarakis o   Case: A man in his mid 70s with mCRPC with an ATM mutation who receives olaparib — Dr Vishwanathan (1:06:38) o   Case: A man in his mid 70s with de novo mCRPC with a BRCA2 mutation who received multiple treatments and is now responding to olaparib but with transfusion-dependent neutropenia — Sunil Gandhi, MD (1:17:00) o   Faculty presentation: Dr Antonarakis (1:21:30) •       Current and Emerging Strategies for Patients with Recurrent mCRPC — Prof Fizazi o   Case: A robust man in his mid 80s with mCRPC and rapid, symptomatic progressive disease through multiple treatments, now with extensive liver and bone metastases and small cell transformation — Vignesh Narayanan, MD (1:32:58) o   Case: A man in his mid 70s with BRCA wild-type mHSPC who enrolls on a clinical trial of ADT/enzalutamide with or without a PD-1 inhibitor — David S Morris, MD (1:37:50) o   Faculty presentation: Prof Fizazi (1:45:18) CME information and select publications

CME credits: 1.00 Valid until: 03-03-2024 Claim your CME credit at https://reachmd.com/programs/cme/recent-progress-in-the-treatment-of-metastatic-hormone-sensitive-prostate-cancer-mhspc/15730/ The ASCO Genitourinary (ASCO GU) and the Annual ASCO meetings are the leading educational and scientific events for oncologists, urologists, and the cancer team, providing the latest clinical and scientific data from clinical trials and basic and translational research in GU cancer. Thousands of abstracts summarizing state-of-the-art treatment modalities and novel therapies for patients with Prostate Cancer will be presented and it will be critical that educational programing provide learners with not only key data, but interpretation by faculty as to how best to incorporate into clinical practice.

Featuring perspectives from Prof Karim Fizazi and Prof Stéphane Oudard, including the following topics: Introduction: Journal Club — Karim Fizazi, MD, PhD and Stéphane Oudard, MD, PhD (0:00) Case: A man in his late 50s with Gleason 7 prostate cancer after prostatectomy/radiation therapy/androgen deprivation therapy (ADT) experiences biochemical recurrence 2 years later (PSA 0.5; doubling time 9 months) — Philip L Brooks, MD (10:58) Case: A man in his early 70s with a pacemaker presents with de novo metastatic hormone-sensitive prostate cancer (mHSPC) after cerebrovascular accident — Nasfat Shehadeh, MD (28:50) Case: A man in his late 40s with multiple medical comorbidities presents with de novo mHSPC (PSA 19.4) and responds to ADT/docetaxel — Gurveen Kaur, MD (47:00) Case: A man in his mid 60s with de novo mHSPC receives leuprolide, and PSA levels decrease from 865 ng/mL to 1.34 ng/mL — Joanna Metzner-Sadurski, MD (50:38) Case: A man in his late 50s with mHSPC receives leuprolide, experiences disease progression 1.5 years later and responds to abiraterone/prednisone but on liquid biopsy is found to have an AR T878 mutation — Niyati A Nathwani, MD (54:30) Case: A man in his mid 60s presents with de novo metastatic prostate cancer and experiences disease progression on ADT + docetaxel, now with progressive disease on abiraterone/prednisone; germline CHEK2 mutation — Syed F Zafar, MD (56:51) CME information and select publications  

Systemic Therapies for Metastatic Hormone Sensitive Prostate Cancer and Castrate Resistant Prostate Cancer Host: Jay D. Raman, MD, FACS Co-Host: Alicia Morgans, MD, MPH and Kelly Stratton, MD CME Available: auau.auanet.org/node/37317 At the conclusion of this activity, participants will be able to: 1. Evaluate treatment plans including the sequencing and combination of treatment options for individual patients. 2. Prioritize or stratify treatment options for metastatic prostate cancer. 3. Describe the mechanism of action and role of immune checkpoint inhibitors for advanced prostate cancer. 4. Identify management of side effects and adverse events that patients experience for systemic therapies for advanced prostate cancer. ACKNOWLEDGEMENTS: This series is supported by independent educational grants from: Astellas AstraZeneca Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC Lantheus Medical Imaging Merck & Co., Inc. Pfizer, Inc. Sanofi Genzyme

In this edition, Dr. Constance Thibault (FR), associate editor of the UROONCO PCa educational platform, discusses triplet therapy for the treatment of metastatic hormone-sensitive prostate cancer (mHSPC). In the last decade, the outcome of metastatic prostate cancer has been improved by intensifying the systemic therapy with the addition of docetaxel and/or new hormonal therapies. Clinicians now have several treatment options to offer their patients with mHSPC. This raises the issue of the optimal choice? Dr. Thibault answers questions about why triplet therapy (ADT + DOCETAXEL + NHT) is recommended to mHSPC patients, and do all patients benefit from a triplet therapy or only specific subgroups?Lastly, Dr. Thibault talks about which triplet therapy is recommended to use in clinical practice assuming that abiraterone and darolutamide are both approved in combination with ADT + DOCETAXEL for mHSPC patients. 

Cancer de Prostate: Pourquoi un traitement antiandrogène de première génération seul ne suffit pas au stade mHSPCQui sont les patients pris en charge au stade mHSPC ?Quelle prise en charge pour les patients au stade mHSCP ?Quel traitement pour intensifier la prise en charge ?Qu'en est-il des patients à qui l'on prescrivait une chimiothérapie ?Cet épisode a été réalisé grâce au soutien institutionnel des laboratoires JANSSENL'orateur n'a pas reçu de rémunération pour la réalisation de cet épisode.Docteur Gaelle Fiard, chirurgien urologue au CHU de Grenoble répond à toutes vos questions !Certaines données publiées peuvent ne pas avoir été validées par les autorités de santé françaises. La publication de ce contenu est effectuée sous la seule responsabilité de l'éditeur et de son comité scientifique.Musique du générique : Via AudioNetworkResponsable projet AFUF : Dr Benjamin PradèreProduction : La Toile Sur Ecoute Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

Treatments for metastatic hormone-sensitive prostate cancer have remained the same for seventy years – until now. Scientists have created a medication, called Nubeqa, that pairs with the original treatments and helps lengthen the lifespan of patients. An expert discusses why this is an optimistic time for MHSPC patients. Learn more: https://radiohealthjournal.org/a-new-hope-for-men-with-advanced-prostate-cancer/

Contemporary Management of Prostate Cancer: Updated Approaches for Improved Outcomes in nmCRPC and mHSPC

Contemporary Management of Prostate Cancer: Updated Approaches for Improved Outcomes in nmCRPC and mHSPC

Contemporary Management of Prostate Cancer: Updated Approaches for Improved Outcomes in nmCRPC and mHSPC

Contemporary Management of Prostate Cancer: Updated Approaches for Improved Outcomes in nmCRPC and mHSPC

CME Available: https://auau.auanet.org/node/35710 Course Director: Stephen A. Boorjian, MD Faculty: Leonard G. Gomella, MD, FACS; David F. Jarrard, MD; Alicia K. Morgans, MD, MPH ACKNOWLEDGMENTS: This educational activity is supported by independent education grants from: Astellas AstraZeneca Merck & Co., Inc. Pfizer, Inc. At the conclusion of the activity, participants will be able to: LEARNING OBJECTIVES: 1. Describe recent developments in the medical management of advanced prostate cancer. Identify the active agents and their mechanism of action in the management of mHSPC, nmCRPC and mCRPC. 2. Discuss clinical investigations in the treatment of advanced prostate cancer. 3. Analyze the risks and benefits of treatment for advanced prostate cancer. 4. Identify the criteria for genetic and genomic testing and utilize the results to improve outcomes among patients with advanced prostate cancer.

CME Available: https://auau.auanet.org/node/35401 Learning Objectives: After participating in this educational series, participants will be able to: 1. List advanced prostate cancer disease states (mHSPC); M0 CRPC and M1 CRPC) and be able to identify these patients in urologic practice. 2. Identify available approved therapies and outcomes for each of these disease states: MHSPC, M0 CRPC, M1 CRPC. 3. Demonstrate the appropriate indications, unique mechanisms of action and side effects of new and existing androgen axis agents, immunotherapies, chemotherapeutic agents and bone targeted therapies. 4. Explain the sequencing of available therapies, as well as identifying adverse events that might occur when considering combination therapy. 5. Review the evidence and outcomes on androgen deprivation treatment alone and in combination as outlined in the newly released Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline. Acknowledgements: Support provided by independent educational grants from: AstraZeneca Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC Merck

Place de la radiothérapie dans le mHSCPQuel est l'intérêt global en cancérologie de traitement du primitif en cas de maladie métastatique ? Quelles sont les données sur la RadioThérapie dans le cancer de la prostate métastatique hormonosensible ? Quelles sont les modalités pratiques de la RadioThérapie en situation oligométastatique ?La chirurgie a-t-elle une place dans cette situation ? Faut il traiter les métastases par radiothérapie stéréotaxique dans cette situation oligométastatique ?Pr Pierre Blanchard, professeur oncologie-radiotherapie à l'institut Gustave Roussy à Villejuif répond à toutes vos questions ! L'orateur n'a pas reçu de rémunération pour la réalisation de cet épisode. Cet épisode a été réalisé grâce au soutien institutionnel des Laboratoires Bayer.Certaines données publiées peuvent ne pas avoir été validées par les autorités de santé françaises.La publication de ce contenu est effectuée sous la seule responsabilité de l'éditeur et de son comité scientifiqueMusique du générique : Via AudioNetwork Responsable projet AFUF : Dr Benjamin PradèreProduction : La Toile Sur Ecoute Voir Acast.com/privacy pour les informations sur la vie privée et l'opt-out.

Dr. Neeraj Agarwal, ASCO Daily News editor-in-chief, and director of the Genitourinary Cancers Program at the University of Utah's Huntsman Cancer Institute, shares key takeaways from the practice-changing ARASENS trial in mHSPC, featured at the 2022 ASCO Genitourinary Cancers Symposium.   Transcript: ASCO Daily News: Hello, and welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. Today in our continuing coverage of the 2022 ASCO Genitourinary (GU) Cancer Symposium. Dr. Neeraj Agarwal, the editor in chief of the ASCO Daily News will share key takeaways from the practice-changing ARASENS trial, which showed promising results in metastatic hormone-sensitive prostate cancer. Dr. Agarwal has no conflicts relating to the topic of this episode and his full disclosures are available in this show notes. Disclosures of all guests on the podcast can be found in our transcripts at asco.org/podcasts. Dr. Neeraj Agarwal: Hello and welcome to the ASCO Daily News podcast. I'm Dr. Neeraj Agrawal, the director of the Genitourinary Cancers Program and professor of medicine at the University of Utah Huntsman Cancer Institute. Let's discuss the results of the practice-changing ARASENS trial in patients with metastatic castration-sensitive prostate cancer as presented at the 2022 ASCO GU Symposium. This abstract, Abstract 13, was presented by Dr. Matthew Smith from the Massachusetts General Hospital and Hartford Medical School. ARASENS is a randomized phase 3 trial evaluating the efficacy and safety of darolutamide, a novel hormonal therapy, plus ADT (antiandrogen therapy) plus docetaxel versus placebo plus ADT plus docetaxel in patients with metastatic castration-sensitive prostate cancer. Randomization was stratified by the extent of disease and alkaline phosphatase levels, below versus upper limit of normal or above. It is important to know that this study only included patients that were eligible for ADT and docetaxel chemotherapy, to begin with. The primary endpoint was overall survival with multiple secondary endpoints, including time to CRPC (castration-resistant prostate cancer), time to pain progression, time to first symptomatic skeletal event, and time to start off the next anti-neoplastic therapy, and safety. A total of 1,306 patients were randomly assigned to triplet therapy with darolutamide plus ADT plus docetaxel versus placebo plus ADT plus docetaxel. Baseline characteristics were well balanced between the treatment arms. Analysis of the primary endpoint was pre-specified. After, 533 events had occurred results show the primary endpoint of this study was met with a significant improvement in overall survival and a 32.5% reduction in risk of death for patients on the triplet therapy on for darolutamide plus ADT plus docetaxel versus placebo plus ADT plus docetaxel. It is important to know that the triplet therapy improved overall survival, despite 76% of patients in the control arm having received the next life-prolonging therapy. Subgroup analysis indicates consistent benefit across the 3 specified groups. Secondary endpoints also were favored by the triplet therapy combination over the control arm. While this study offers an additional excellent option for our patients with metastatic cancer-sensitive prostate cancer in older populations, the use of docetaxel may be a significant limitation to this triplet combination. In addition, and importantly, this study did not answer the question of whether adding docetaxel chemotherapy to the ADT plus novel hormonal therapy backbone will also improve survival. With the advent of multiple doublets and triplet combinations in recent years, as we saw in the form of ADT plus enzalutamide ADT plus apalutamide in the recent years, it is very important to find biomarkers that may predict response to these treatment options, which will allow personalization of therapy with that. I would like to conclude this podcast on the ARASENS trial. Thank you very much for your kind attention. ASCO Daily News: You've been listening to Dr. Neeraj Agarwal of the University of Utah's Huntsman Cancer Institute. Thanks for joining us today. If you're enjoying the content on the podcast, please take a moment to rate and review us wherever you get your podcasts. Disclosures: Dr. Neeraj Agarwal: Consulting or Advisory Role: Pfizer, Medivation/Astellas, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Merck, Novartis, lily, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, ORIC Pharmaceuticals, CRISPR therapeutics, and Arvinas Disclaimer: The purpose of this podcast is to educate and to inform this is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In this episode, Daniel W. Lin, MD; Alicia K. Morgans, MD, MPH; and David F. Penson, MD, answer audience questions from a live CCO webinar focused on current best practices and emerging strategies in androgen deprivation therapy, with questions including:How to select between GnRH agonists and antagonists for initial androgen deprivation therapy?How should androgen receptor inhibitors be incorporated into treatment paradigms for nonmetastatic castration-resistant prostate cancer and metastatic hormone-sensitive prostate cancer?How should patients with prostate cancer and bone density issues be managed?How should nonmetastatic and metastatic prostate cancer be classified in light of novel imaging modalities, and how does this affect treatment?Presenters:Daniel W. Lin, MDProfessor and Chief of Urologic OncologyDepartment of UrologyUniversity of WashingtonSeattle, WashingtonAlicia K. Morgans, MD, MPHGenitourinary Medical OncologistDana-Farber Cancer InstituteBoston, MassachusettsDavid F. Penson, MDProfessor and ChairDepartment of UrologyVanderbilt University School of MedicineNashville, Tennessee Content based on an online CME program supported by educational grants from Astellas, Bayer HealthCare Pharmaceuticals Inc., Myovant Sciences Ltd, and Pfizer, Inc.  Link to full program:https://bit.ly/3iFCis5    

CME Available: https://auau.auanet.org/node/33093 At the conclusion of the activity, participants will be able to: 1. Describe recent developments in the medical management of advanced prostate cancer. 2. Identify the active agents and their mechanism of action in the management of mHSPC, nmCRPC and mCRPC. 3. Discuss clinical investigations in the treatment of advanced prostate cancer. 4. Analyze the risks and benefits of treatment for advanced prostate cancer. 5. Identify the criteria for genetic and genomic testing and utilize the results to improve outcomes among patients with advanced prostate cancer. Acknowledgements This educational activity is supported by independent educational grants from Astellas, AstraZeneca, Merck, Pfizer, Inc.

Featuring slide presentations and related discussion from Prof Simon Chowdhury and Drs Tanya B Dorff and Matthew R Smith, including the following topics: Management of Nonmetastatic Castration-Resistant Prostate Cancer (nmCRPC) — Matthew R Smith, MD, PhD (0:00) Therapeutic Options for Patients with Metastatic Hormone-Sensitive Prostate Cancer (mHSPC), and Real-World Experiences — Simon Chowdhury, MD, PhD (32:00) Implications of Differential Toxicity for Treatment Selection in mHSPC and nmCRPC — Tanya B Dorff, MD (1:04:36) CME information and select publications