Podcasts about psma pet

university strategy board risk utah treatments gdpr tumors high risk prostate uc san diego genetic testing seibert stratification treatment strategies active surveillance psma pet neeraj agarwal

Play Episode Listen Later Sep 9, 2025 66:15

Could ongoing trials redefine the management of oligometastatic and advanced prostate cancer? In this installment of BackTable Tumor Board, leading prostate cancer experts Dr. Neeraj Agarwal, a medical oncologist from the University of Utah, and Dr. Tyler Seibert, a radiation oncologist from UC San Diego, join host Dr. Parth Modi to share their insights on the latest clinical trials and persistent challenges in managing prostate cancer.---This podcast is supported by:Ferring Pharmaceuticals https://ad.doubleclick.net/ddm/trackclk/N2165306.5658203BACKTABLE/B33008413.420220578;dc_trk_aid=612466359;dc_trk_cid=234162109;dc_lat=;dc_rdid=;tag_for_child_directed_treatment=;tfua=;gdpr=${GDPR};gdpr_consent=${GDPR_CONSENT_755};gpp=${GPP_STRING_755};gpp_sid=${GPP_SID};ltd=;dc_tdv=1---SYNPOSISThe multidisciplinary discussion addresses clinical decision-making in active surveillance versus early intervention, the role of PSMA PET imaging in detection and treatment planning, and evolving strategies for metastatic and castration-resistant disease. They also evaluate the therapeutic potential of alpha emitters and radioligand therapies, consider the evidence behind treatment intensification and de-intensification, and explore how these approaches can be individualized to optimize patient outcomes.---TIMESTAMPS0:00 - Introduction1:48 - Active Surveillance in Low-Risk Prostate Cancer7:08 - Molecular Testing and Risk Stratification8:28 - Radiation Therapy Approaches20:16 - PSA Recurrence and PSMA PET Scans32:40 - The Role of ADT37:15 - PSMA PET Scans40:58 - Genetic Testing in High-Risk and Metastatic Prostate Cancer46:54 - Treatment Intensification vs. De-Intensification Trials55:59 - Castration-Resistant Prostate Cancer

Emerging Treatment Paradigms in Genitourinary Cancers

ASCO eLearning Weekly Podcasts

Play Episode Listen Later Sep 8, 2025 24:10

Dr. Pedro Barata and Dr. Rana McKay discuss the integration of innovative advances in molecular imaging and therapeutics to personalize treatment for patients with renal cell and urothelial carcinomas. TRANSCRIPT Dr. Pedro Barata: Hello, I'm Dr. Pedro Barata, your guest host of By the Book, a podcast series featuring insightful conversations between authors and editors of the ASCO Educational Book. I'm a medical oncologist at University Hospitals Seidman Cancer Center and an associate professor of medicine at Case Western Reserve University in Cleveland, Ohio. I'm also an associate editor of the ASCO Educational Book. Now, we all know the field of genitourinary cancers (GU) is evolving quite rapidly, and we have new innovations in molecular imaging as well as targeted therapeutics. Today's episode will be exploring novel approaches that are transforming the management of renal cell and urothelial carcinomas and also their potential to offer a more personalized treatment to patients. For that, joining for today's discussion is Dr. Rana McKay, a GU medical oncologist and professor at University of California San Diego. Dr. McKay will discuss her recently published article titled, “Emerging Paradigms in Genitourinary Cancers: Integrating Molecular Imaging, Hypoxia-Inducible Factor-Targeted Therapies, and Antibody-Drug Conjugates in Renal Cell and Urothelial Carcinomas.” Our full disclosures are available in the transcript of this episode. And with that, Rana McKay, great to have you on the podcast today. Dr. Rana McKay: Oh, thank you so much, Dr. Barata. It's really wonderful to be here with you. So, thanks for hosting. Dr. Pedro Barata: No, thanks for taking the time, and I'm looking forward to this conversation. And by the way, let me start by saying congrats on a great article in the Educational Book. Really super helpful paper. I'm recommending it to a lot of the residents and fellows at my own institution. I would like to first ask you to kind of give our listeners some context of how novel approaches in the molecular imaging as well as targeted therapeutics are actually changing the way we're managing patients with GU, but specifically with renal cell carcinoma and urothelial carcinoma. So, what are the areas you would call out as like being big areas for innovation in this context, and why are they important? Dr. Rana McKay: Very good question. And I think this is really what this article highlights. It highlights where are we going from an imaging diagnostics standpoint? Where are we going from a therapeutic standpoint? And I think if we have to step back, from the standpoint of diagnostics, we've seen PET imaging really transform diagnostics in prostate cancer with the advent of PSMA PET imaging, and now PSMA PET imaging is used as a biomarker for selection for theranostics therapy. And so, we're starting to see that enter into the RCC landscape, enter into the urothelial cancer landscape to a lesser extent. And I think it's going to potentially be transformative as these tools get more refined. I think when we think about therapeutics, what's been transformative most recently in the renal cell carcinoma landscape has been the advent of HIF2α inhibition to improve outcomes for patients. And we have seen the approval of belzutifan most recently that has reshaped the landscape. And now there's other HIF2α inhibitors that are being developed that are going to be further important as they get refined. And lastly, I think when we think about urothelial carcinoma, the greatest transformation to treatment in that context has been the displacement of cisplatin and platinum-based chemotherapy as a frontline standard with the combination of enfortumab vedotin plus pembrolizumab. And we've seen antibody-drug conjugates really reshape treatment and tremendously improve outcomes for patients. So, I think those are the three key areas of interest. Dr. Pedro Barata: So with that, let's focus first on the imaging and then we'll get to the therapeutic area. So, we know there's been a paradigm shift, really, when prostate-specific targets emerged as tracers for PET scanning. And so, we now commonly use prostate-specific membrane antigen, or PSMA-based PET scanning, and really transform how we manage prostate cancer. Now, it appears that we're kind of seeing a similar wave in renal cell carcinoma with the new radiotracer against the target carbonic anhydrase IX. What can you tell us about this? And is this going to be available to us anytime soon? And how do you think that might potentially change the way we're managing patients with RCC today? Dr. Rana McKay: First, I'll step back and say that in the context of PSMA PET imaging, we have actually been able to better understand RCC as well. So, we know that PSMA is expressed in the neovasculature of tumors, and it can actually be used to detect renal cell carcinoma tumors. It has a detection rate of about 84% when used for detection. And so, you know, I don't think it's just restricted to carbonic anhydrase IX, but we will talk about that. So, PSMA expressed in the neovasculature has a detection rate of around 84%, particularly if we're looking at clear cell RCC. CAlX is overexpressed in clear cell RCC, and it's actually used in diagnosing renal cell carcinoma when we think of CAlX IHC for diagnosing clear cell RCC. And now there are CAlX PET tracers. The first foray was with the ZIRCON study that was actually an interestingly designed study because it was designed to detect the likelihood of PET imaging to identify clear cell RCC. So, it was actually used in the early diagnostics setting when somebody presents with a renal mass to discriminate that renal mass from a clear cell versus a non-clear cell, and it was a positive study. But when I think about the potential application for these agents, you know, I think about the entire landscape of renal cell carcinoma. This is a disease that we do treat with metastasis-directed therapy. We have certainly seen patients who've undergone metastasectomy have long, durable remissions from such an approach. And I think if we can detect very early onset oligometastatic disease where a metastasis-directed therapy or SABR could be introduced - obviously tested in a trial to demonstrate its efficacy - I think it could potentially be transformative. Dr. Pedro Barata: Wonderful. It's a great summary, and I should highlight you are involved in some of those ongoing studies testing the performance of this specific PET scanning for RCC against conventional imaging, right? And to remind the listeners, thus far, for the most part, we don't really do FDG-PET for RCC. There are some specific cases we do, but in general, they're not a standard scanning. But maybe that will change in the future. Maybe RCC will have their own PSMA-PET. And to your point, there's also emerging data about the role of PSMA-PET scanning in RCC as well, as you very elegantly summarized. Wonderful. So, let me shift gears a little bit because you did, in your introduction, you did highlight a novel MOA that we have in renal cell carcinoma, approved for use, initially for VHL disease, and after that for sporadic clear cell renal cell carcinoma. We're talking about hypoxia-inducible factor 2-alpha inhibitors, or HIF2α inhibitors, such as belzutifan. But there's also others coming up. So, as a way to kind of summarize that, what can you tell us about this breakthrough in terms of therapeutic class, this MOA that got to our toolbox of options for patients with advanced RCC? Tell us a little bit what is being utilized currently in the management of advanced RCC. And where do you see the future going, as far as, is it moving early on? Is it getting monotherapy versus combinations? Maybe other therapies? What are your thoughts about that? What can you tell us about it? Dr. Rana McKay: Belzutifan is a first-in-class HIF2α inhibitor that really established clinical validation for HIF2α as a therapeutic target. When we think about the activity of this agent, the pivotal LITESPARK-005 trial really led to the approval of belzutifan in patients who were really heavily pretreated. It was patients who had received prior IO therapy, patients who had received prior VEGF-targeted therapy. And in the context of this study, we saw a median PFS of 5.6 months, and there did seem to be a tail on the curve when you looked at the 12-month PFS rate with belzutifan. It was 33.7% compared to 17.6% with everolimus. And then when we look at the response rate, it was higher with belzutifan on the order of 22-23%, and very low with everolimus, as we've previously seen. I think one of the Achilles heels of this regimen is the primary PD rate, which was 34% when used in later line. There are multiple studies that are testing belzutifan in combination across the treatment landscape. So, we have LITESPARK-011, which is looking at the combination of belzutifan plus lenvatinib in the second-line setting. We've got the MK-012 [LITESPARK-012] study, which is looking at belzutifan in various combinations in the frontline setting. So there is a combination with IO plus belzutifan. And so this is also being looked at in that context. And then we also have the LITESPARK-022 study, which is looking at pembrolizumab with belzutifan in the adjuvant setting. So there's a series of studies that will be exploring belzutifan really across the treatment landscape. Many of these studies in combination. Additionally, there are other HIF2α inhibitors that are being developed. We have casdatifan, which is another very potent HIF2α inhibitor. You know, I think pharmacologically, these are different agents. There's a different half-life, different dosing. What is going to be the recommended phase 3 dose for both agents, the EPO suppression levels, the degree of EPO suppression, and sustainability of EPO suppression is very different. So, I think we've seen data from casdatifan from the ARC-20 trial from monotherapy with a respectable response rate, over 30%, primary PD rate hovering just around 10%. And then we've also seen data of the combination of casdatifan with cabozantinib as well that were recently presented this year. And that agent is also being tested across the spectrum of RCC. It's being looked at in combination with cabozantinib in the PEAK-1 study, and actually just at the KCRS (Kidney Cancer Research Summit), we saw the unveiling of the eVOLVE-RCC trial, which is going to be looking at a volrustomig, which is a PD-1/CTLA-4 inhibitor plus casdatifan compared to nivo-ipi in the frontline setting. So, we're going to see some competition in this space of the HIF2α inhibitors. I think when we think of mechanism of action in that these are very potent, not a lot of off-target activity, and they target a driver mutation in the disease. And that driver mutation happens very early in the pathogenesis. These are going to be positioned much earlier in the treatment landscape. Dr. Pedro Barata: All these studies, as you're saying, look really promising. And when we talk about them, you mentioned a lot of combinations. And to me, when I think of these agents, it makes a lot of sense to combine because there's not a lot of overlapping toxicities, if you will. But perhaps for some of our listeners, who have not used HIF2α inhibitors in practice yet, and they might be thinking about that, what can you tell us about the safety profile? How do you present it to your patients, and how do you handle things like hypoxia or anemia? How do you walk through the safety profile and tolerability profile of those agents like belzutifan? Dr. Rana McKay: I think these drugs are very different than your traditional TKIs, and they don't cause the classic symptoms that are associated with traditional TKIs that many of us are very familiar with like the rash, hand-foot syndrome, hypertension, diarrhea. And honestly, these are very nuanced symptoms that patients really struggle with the chronicity of being on a chronic daily TKI. The three key side effects that I warn patients about with HIF2α inhibitors are: (1) fatigue; (2) anemia; and (3) hypoxia and dysregulation in the ability to sense oxygen levels. And so, many of these side effects - actually, all of them - are very dose-dependent. They can be very well-managed. So, we can start off with the anemia. I think it's critically important before you even start somebody on belzutifan that you are optimizing their hemoglobin and bone marrow function. Make sure they don't have an underlying iron deficiency anemia. Make sure they don't have B12 or folate deficiency. Check for these parameters. Many patients who have kidney cancer may have some hematuria, other things where there could be some low-level blood loss. So, make sure that those are resolved or you're at least addressing them and supplementing people appropriately. I monitor anemia very closely every 3 to 4 weeks, at least, when people start on these medications. And I do initiate EPO, erythropoietin, should the anemia start to worsen. And I typically use a threshold of around 10g/dL for implementing utilization of an EPO agent, and that's been done very safely in the context of the early studies and phase 3 studies as well. Now, with regards to the hypoxia, I think it's also important to make sure that you're selecting the appropriate individual for this treatment. People who have underlying COPD, or even those individuals who have just a very high burden of disease in their lung, lymphangitic spread, pleural effusions, maybe they're already on oxygen - that's not an ideal candidate for belzutifan. Something that very easily can be done in the clinic before you think about initiating somebody on this treatment, and has certainly been integrated into some of the trials, is just a 6-minute walk test. You know, have the patient walk around the clinic with one of the MAs, one of the nurses, put the O2 sat on [measuring oxygen saturation], make sure they're doing okay. But these side effects, like I said, are very dose-dependent. Typically, if a patient requires, if the symptoms are severe, the therapy can be discontinued and dose reduced. The standing dose is 120 mg daily, and there's two dose reductions to 80 mg and 40 mg should somebody warrant that dose modification. Dr. Pedro Barata: This is relatively new, right? Like, it was not that we're used to checking oxygen levels, right? In general, we're treating these patients, so I certainly think there's a learning curve there, and some of the points that you highlight are truly critical. And I do share many of those as well in our practice. Since I have you, I want to make sure we touch base on antibody-drug conjugates as well. It's also been a hot area, a lot of developments there. When I think of urothelial carcinoma and renal cell carcinoma, I see it a little bit different. I think perhaps in urothelial carcinoma, antibody-drug conjugates, or ADCs, are somewhat established already. You already mentioned enfortumab vedotin. I might ask you to expand a little bit on that. And then in renal cell carcinoma, we have some ADCs as well that you include in your chapter, and that I would like you to tell us what's coming from that perspective. So, tell us a little bit about how do you see ADCs in general for GU tumors, particularly UC and RCC? Tell us a little bit about the complexity or perhaps the challenges you still see. At the same time, tell us about the successes. Dr. Rana McKay: Stepping back, let's just talk about like the principles and design of ADCs. So, most ADCs have three components. There's a monoclonal antibody that typically targets a cell surface antigen, which is conjugated by a linker, which is the second component, to a payload drug. And typically, that payload drug has been chemotherapy, whether it be topoisomerase or whether it be MMAE or other chemotherapeutic. We can start in the RCC space. There's been multiple antibody-drug conjugates that have been tested. There's antibody-drug conjugates to CD70, which is expressed on clear cell RCC. There's been antibody-drug conjugates to ENPP3, which is also expressed on RCC. There's antibody-drug conjugates to CDH6. And they have different payloads, like I said, whether it be topoisomerase I or other microtubule inhibitors. Now, when we think about kidney cancer, we don't treat this disease with chemotherapy. This disease is treated with immunotherapy. It is treated with treatments that target the VEGF pathway and historically has not been sensitive to chemo. So, I think even though the targets have been very exciting, we've seen very underwhelming data regarding activity, and in some context, seen increased toxicity with the ADCs. So, I think we need to tread lightly in the context of the integration and the testing of ADCs in RCC. We just came back from the KCRS meeting, and there was some very intriguing data about a c-Kit ADC that's being developed for chromophobe RCC, which is, you know, a huge unmet need, these variant tumors that really lack appropriate therapeutics. But I just caution us to tread lightly around how can we optimize the payload to make sure that the tumor that we're treating is actually sensitive to the agent that's targeting the cell kill. So, that's a little bit on the ADCs in RCC. I still think we have a long way to go and still in early testing. Now, ADCs for UC are now the standard of care. I think the prototypical agent, enfortumab vedotin, is a nectin-4-directed ADC that's conjugated to an MMAE payload and was the first ADC approved for advanced urothelial, received accelerated approval following the EV-201 trial, which was basically a multicenter, single-arm study that was investigating EV in cisplatin-ineligible patients with advanced urothelial carcinoma, and then ultimately confirmed in the EV-301 study as well. And so, that study ended up demonstrating the support superiority of EV from an overall survival standpoint, even PFS standpoint. Building on that backbone is the EV-302 study, which tested EV in combination with pembrolizumab versus platinum-based chemotherapy in the frontline setting. And that was a pivotal, landmark study that, like I said, has displaced platinum therapy as a frontline treatment for people with advanced urothelial carcinoma. And when we think about that study and the median overall survival and just how far we've come in urothelial cancer, the median OS with EV-pembro from that trial was 31 and a half months. I mean, that's just incredible. The control arm survival was 16 and a half months. The hazard ratio for OS, 0.47. I mean this is why when this data was presented, it was literally a standing ovation that lasted for several minutes because we just haven't seen data that have looked that good. And there are other antibody-drug conjugates that are being tested. We've all been involved in the saga with sacituzumab govitecan, which is a trophoblast cell surface antigen 2 (Trop-2) targeted ADC with a topoisomerase I payload. It was the second ADC to receive approval, but then that approval was subsequently withdrawn when the confirmatory phase 3 was negative, the TROPiCS-04 trial. So, approval was granted based off of the TROPHY-U-01, single-arm, phase 2 study, demonstrating a response rate of around 28% and a PFS of, you know, about 5 and a half months. But then failure to show any benefit from an OS standpoint. And I think there's a lot of controversy in the field around whether this agent still has a role in advanced urothelial carcinoma. And I think particularly for individuals who do not have molecular targets, like they're not HER2-amplified or have HER2-positivity or FGFR or other things like that. Dr. Pedro Barata: Fantastic summary, Rana. You were talking about the EV, and it came to mind that it might not be over, right, for the number of ADCs we use in clinical practice in the near future. I mean, we've seen very promising data for ADC against the HER2, right, and over-expression. It also can create some challenges, right, in the clinics because we're asking to test for HER2 expression. It's almost like, it's not exactly the same to do it in breast cancer, but it looks one more time that we're a little bit behind the breast cancer field in a lot of angles. And also has vedotin as a payload. Of course, I'm referring to disitamab vedotin, and there's very elegant data described by you in your review chapter as well. And it's going to be very interesting to see how we sequence the different ADCs, to your point as well. So, before we wrap it up, I just want to give you the opportunity to tell us if there's any area that we have not touched, any take-home points you'd like to bring up for our listeners before we call it a day. Dr. Rana McKay: Thank you so much. I have to say, you know, I was so excited at ASCO this year looking at the GU program. It was fantastic to see the progress being made, novel therapeutics that really there's a tremendous excitement about, not just in RCC and in UC, but also in prostate cancer, thinking about the integration of therapies, not just for people with refractory disease that, even though our goal is to improve survival, our likelihood of cure is low, but also thinking about how do we integrate these therapies early in the treatment landscape to enhance cure rates for patients, which is just really spectacular. We're seeing many of these agents move into the perioperative setting or in combination with radiation for localized disease. And then the special symposium on biomarkers, I mean, we've really come a long, long way. And I think that we're going to continue to evolve over the next several years. I'm super excited about where the field is going in the treatment of genitourinary malignancies. Dr. Pedro Barata: Oh, absolutely true. And I would say within the Annual Meeting, we have outstanding Educational Sessions. And just a reminder to the listeners that actually that's where the different teams or topics for the Educational Book chapters come from, from actually the educational sessions from ASCO. And your fantastic chapter is an example of that, right, focusing on advanced GU tumors. So, thank you so much, Rana, for taking the time, sharing your insights with us today on the podcast. It was a fantastic conversation as always. Dr. Rana McKay: My pleasure. Thanks so much for having me, Dr. Barata. Dr. Pedro Barata: Of course. And thank you to our listeners for your time today. You will find the link to the article discussed today in the transcript of this episode. I also encourage you to check out the 2025 ASCO Educational Book. You'll find an incredible wealth of information there. It's free, available online, and you'll find, hopefully, super, super important information on the key science and issues that are shaping modern oncology, as we've heard from Dr. McKay and many other outstanding authors. So, thank you, everyone, and I hope to see you soon. 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. Follow today's speakers:       Dr. Pedro Barata @PBarataMD Dr. Rana McKay @DrRanaMcKay Follow ASCO on social media:       @ASCO on X (formerly Twitter)       ASCO on Bluesky      ASCO on Facebook       ASCO on LinkedIn       Disclosures:     Dr. Pedro Barata: Stock and Other Ownership Interests: Luminate Medical Honoraria: UroToday Consulting or Advisory Role: Bayer, BMS, Pfizer, EMD Serono, Eisai, Caris Life Sciences, AstraZeneca, Exelixis, AVEO, Merck, Ipson, Astellas Medivation, Novartis, Dendreon Speakers' Bureau: AstraZeneca, Merck, Caris Life Sciences, Bayer, Pfizer/Astellas Research Funding (Inst.): Exelixis, Blue Earth, AVEO, Pfizer, Merck Dr. Rana McKay: Consulting or Advisory Role: Janssen, Novartis, Tempus, Pfizer, Astellas Medivation, Dendreon, Bayer, Sanofi, Vividion, Calithera, Caris Life Sciences, Sorrento Therapeutics, AVEO, Seattle Genetics, Telix, Eli Lilly, Blue Earth Diagnostics, Ambrx, Sumitomo Pharma Oncology, Esiai, NeoMorph, Arcus Biosciences, Daiichi Sankyo, Exelixis, Bristol Myers Squibb, Merck, Astrazeneca, Myovant Research Funding (Inst.): Bayer, Tempus, AstraZeneca, Exelixis, Bristol Myers Squibb, Oncternal Therapeutics, Artera

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Is It Really Cancer? Rethinking Prostate Diagnosis and the Gleason Score

Intellectual Medicine with Dr. Petteruti

Play Episode Listen Later Aug 26, 2025 18:19

A cancer label can change the course of a man's life, but too often that label is built on shaky ground. The Gleason score and routine biopsies remain standard, yet these methods can mislead patients into unnecessary treatments that compromise both health and quality of life.In this episode, Dr. Stephen Petteruti challenges outdated diagnostic tools and exposes the risks behind relying on them. He explains how advanced imaging technologies like prostate MRI and PSMA PET scans, paired with precise biomarker strategies, are reshaping the future of prostate care.The goal isn't just early detection, it's accurate understanding. If proactive healthcare and clear answers matter to you, watch the full episode of Is It Really Cancer? Rethinking Prostate Diagnosis and the Gleason ScoreEnjoy the podcast? Subscribe and leave a 5-star review on your favorite platforms.Dr. Stephen Petteruti is a leading Functional Medicine Physician dedicated to enhancing vitality by addressing health at a cellular level. Combining the best of conventional medicine with advancements in cellular biology, he offers a patient-centered approach through his practice, Intellectual Medicine 120. A seasoned speaker and educator, he has lectured at prestigious conferences like A4M and ACAM, sharing his expertise on anti-aging. His innovative methods include concierge medicine and non-invasive anti-aging treatments, empowering patients to live longer, healthier lives.Website: www.intellectualmedicine.com Website: https://www.theprostateprotocol.com/ YouTube: https://www.youtube.com/@intellectualmedicine LinkedIn: https://www.linkedin.com/in/drstephenpetteruti/ Instagram: instagram.com/intellectualmedine Consultation: https://www.theprostateprotocol.com/book-a-consultation Store: https://www.theprostateprotocol.com/store Community: https://www.theprostateprotocol.com/products/communities/v2/fightcancerlikeaman/home Disclaimer: The content presented in this video reflects the opinions and clinical experience of Dr. Stephen Petteruti and is intended for informational and educational purposes only. It is not medical advice and should not be used as a substitute for professional diagnosis, treatment, or guidance from your personal healthcare provider. Always consult your physician or qualified healthcare professional before making any changes to your health regimen or treatment plan.Produced by https://www.BroadcastYourAuthority.com

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8.4.2025 - De-Squamate

Winning the War on Cancer (Video)

Play Episode Listen Later Aug 4, 2025 10:26

Check out this week's QuadCast as we highlight de-escalated therapy for cutaneous SCC based on pembro response, a comparison of fluciclovine vs. PSMA PET scan in biochemically recurrent prostate cancer, an important change to HPV+ oropharyngeal staging, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

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Metastatic Hormone-Sensitive Prostate Cancer

Play Episode Listen Later Jul 21, 2025 9:27

Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]

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Metastatic Hormone-Sensitive Prostate Cancer

Health and Medicine (Video)

Play Episode Listen Later Jul 21, 2025 9:27

Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]

therapy cancer treatments survival hormones diagnosis sensitive fitzgerald imaging prostate cancer prostate adt metastatic medicine show id psma cancer and oncology kelly fitzgerald psma pet

Metastatic Hormone-Sensitive Prostate Cancer

University of California Audio Podcasts (Audio)

Play Episode Listen Later Jul 21, 2025 9:27

Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]

therapy cancer treatments survival hormones diagnosis sensitive fitzgerald imaging prostate cancer prostate adt metastatic medicine show id psma cancer and oncology kelly fitzgerald psma pet

Metastatic Hormone-Sensitive Prostate Cancer

Health and Medicine (Audio)

Play Episode Listen Later Jul 21, 2025 9:27

Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]

therapy cancer treatments survival hormones diagnosis sensitive fitzgerald imaging prostate cancer prostate adt metastatic medicine show id psma cancer and oncology kelly fitzgerald psma pet

Metastatic Hormone-Sensitive Prostate Cancer

Winning the War on Cancer (Audio)

Play Episode Listen Later Jul 21, 2025 9:27

Dr. Kelly Fitzgerald explains current standards of care for metastatic hormone-sensitive prostate cancer, focusing on treatment strategies shaped by both clinical trial data and emerging imaging technologies. She defines key terms such as poly- and oligometastatic disease and outlines how newer imaging methods like PSMA PET scans are reshaping diagnosis. She describes the shift from traditional androgen deprivation therapy (ADT) to intensified ADT, where additional agents—such as chemotherapy or novel hormone therapies—are shown to improve survival. Fitzgerald also reviews ongoing questions around triplet therapy and the potential benefits of local treatments like radiation. She highlights the importance of patient-specific factors and the evolving definitions that influence treatment decisions in this complex disease landscape. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40809]

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Prostate Cancer: PSMA PET and Functional Imaging

Winning the War on Cancer (Video)

Play Episode Listen Later Jul 7, 2025 9:41

Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]

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Prostate Cancer: PSMA PET and Functional Imaging

Health and Medicine (Video)

Play Episode Listen Later Jul 7, 2025 9:41

Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]

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Prostate Cancer: PSMA PET and Functional Imaging

University of California Audio Podcasts (Audio)

Play Episode Listen Later Jul 7, 2025 9:41

Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]

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Prostate Cancer: PSMA PET and Functional Imaging

Health and Medicine (Audio)

Play Episode Listen Later Jul 7, 2025 9:41

Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]

therapy cancer fda diagnosis ongoing functional mri radiation imaging prostate cancer prostate staging tracer medicine show id psma cancer and oncology psma pet

Prostate Cancer: PSMA PET and Functional Imaging

Winning the War on Cancer (Audio)

Play Episode Listen Later Jul 7, 2025 9:41

Dr. Thomas Hope presents PSMA PET imaging as a transformative advancement in prostate cancer care. This technology uses a radioactive tracer to precisely detect cancer spread by targeting PSMA, a protein found on prostate cancer cells. It outperforms traditional bone and CT scans in sensitivity and accuracy, allowing for better staging and treatment planning. PSMA PET improves radiation therapy outcomes by revealing cancer in areas previously undetected. While multiple tracers exist, all FDA-approved options show similar performance, and accessibility is the key factor. Hope also discusses current challenges, including false positives and rare cases of PSMA-negative tumors. Ongoing research explores replacing biopsy or MRI with PSMA PET in select patients. Today, PSMA PET is considered the standard imaging method in nearly all stages of prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40806]

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Prostate Cancer Alert: What to Ask Your Doctor When Your PSA Is High

Intellectual Medicine with Dr. Petteruti

Play Episode Listen Later Jul 1, 2025 17:33

Does a high PSA automatically mean you need a biopsy? Think again.In this eye-opening episode, Dr. Stephen Petteruti challenges outdated prostate care protocols and reveals the critical questions every man should ask before making any big decisions.Learn how cutting-edge tools like MRIs and biomarker tracking can often replace invasive biopsies, offering a safer, smarter way to monitor your health. Plus, Dr. Stephen dives into the financial conflicts of interest that might be influencing your care and introduces powerful tests like the calcium score and PSMA PET scan to help you see the bigger picture of your long-term health.Listen now and walk into your next doctor's visit armed with the right questions. Prostate Cancer Alert: What to Ask Your Doctor When Your PSA Is High.Enjoy the podcast? Subscribe and leave a 5-star review!Dr. Stephen Petteruti is a leading Functional Medicine Physician dedicated to enhancing vitality by addressing health at a cellular level. Combining the best of conventional medicine with advancements in cellular biology, he offers a patient-centered approach through his practice, Intellectual Medicine 120. A seasoned speaker and educator, he has lectured at prestigious conferences like A4M and ACAM, sharing his expertise on anti-aging. His innovative methods include concierge medicine and non-invasive anti-aging treatments, empowering patients to live longer, healthier lives.Website: www.intellectualmedicine.com Website: https://www.theprostateprotocol.com/ YouTube: https://www.youtube.com/@intellectualmedicine LinkedIn: https://www.linkedin.com/in/drstephenpetteruti/ Instagram: instagram.com/intellectualmedine Consultation: https://www.theprostateprotocol.com/book-a-consultation Store: https://www.theprostateprotocol.com/store Community: https://www.theprostateprotocol.com/products/communities/v2/fightcancerlikeaman/home Disclaimer: The content presented in this video reflects the opinions and clinical experience of Dr. Stephen Petteruti and is intended for informational and educational purposes only. It is not medical advice and should not be used as a substitute for professional diagnosis, treatment, or guidance from your personal healthcare provider. Always consult your physician or qualified healthcare professional before making any changes to your health regimen or treatment plan.Produced by https://www.BroadcastYourAuthority.com#ProstateCancer #Biopsy #MensHealth

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Dr. M. Miszczyk and Prof. W. Fendler on the PSMA-PET revolution

EAU Podcasts

Play Episode Listen Later Jun 21, 2025 16:50

In "Episode 7" of the series on "Present and future of diagnostics in prostate cancer", Dr. Marcin Miszczyk (PL) and Prof. Wolfgang Fendler (DE) discuss the role of PSMA-PET imaging in modern prostate cancer management.They examine how this advanced imaging modality compares to conventional techniques, and whether its improved sensitivity and specificity are enough to shift treatment paradigms. Drawing on key trials like proPSMA, ORIOLE, STORM, and RADIOSA, the episode highlights both the clinical value and the unresolved questions surrounding PSMA-PET, particularly regarding overdiagnosis, stage migration, and missed lesions.Dr. Miszczyk and Prof. Fendler consider its potential in dose escalation, personalised therapy, and integration with MRI for better staging. They also reflect on upcoming changes in clinical guidelines, especially for high-risk patients, and share a hopeful outlook on the impact of PSMA-PET in shaping more precise and effective prostate cancer care.For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.

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Precision Matters: Focal Therapy for Prostate Cancer with Dr. Preston Sprenkle

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Play Episode Listen Later Jun 14, 2025 51:12

In this powerful episode of the Dr. Geo Prostate Podcast, Dr. Geo sits down with Dr. Preston Sprenkle, leading urologic oncologist at Yale School of Medicine, to explore the emerging role of focal therapy in prostate cancer care. A pioneer in MRI-ultrasound fusion biopsy using the Artemis Device, Dr. Sprenkle shares how focal treatments can offer cancer control while preserving quality of life.Whether you're on active surveillance or facing a Gleason 7 or 8 diagnosis, this episode helps you better understand:When focal therapy is appropriate—and when it's notKey differences between cryoablation, IRE (NanoKnife), and Tulsa Pro How patient goals (erectile function, continence, cancer control) shape treatmentWhat recent research shows about focal therapy success ratesHow to approach higher-risk prostate cancer (Gleason 8–10) with focal therapyWhat to know about PSMA PET scans, genomic tests, and repeat biopsiesThe real risks of skipping follow-up on active surveillanceYou'll also hear candid reflections on the evolution of holistic and integrative urology, and why building trust with your urologist matters more than ever.

Episode 54: Discussing PSMA PET scanning in prostate cancer with Dr Amar Challapalli

Simply Oncology

Play Episode Listen Later Jun 9, 2025 36:11

Send us a textJoin us for this weeks episode where we discuss the role of PSMA PET scanning in prostate cancer with Dr Amar Challapalli.PSMA PET scanning in prostate cancer has been a game changer in both diagnosis and treatment.We explore its role in the post-prostatectomy space.We look at how PSMA Lutetium offers a new treatment option in prostate cancer.

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AUA2025: Embracing Multi-Disciplinary Care for Advanced Prostate Cancer: A Case-Based Update 2025

AUAUniversity

Play Episode Listen Later May 21, 2025 105:46

AUA2025: Embracing Multi-Disciplinary Care for Advanced Prostate Cancer: A Case-Based Update 2025 CME Available: https://auau.auanet.org/node/42997 At the conclusion of this activity, participants will be able to: 1. Initial Management of Metastatic Prostate Cancer: Evaluate and treat a patient with new diagnosed M1 prostate cancer with androgen deprivation therapy (ADT) plus be skilled to offer novel oral antiandrogens. Furthermore, to recognize high-volume new M1 prostate cancer so as to be able to partner with GU medical oncologist for docetaxel chemotherapy in a multidisciplinary team. 2. Non-Metastatic Castrate Resistant Prostate Cancer (M0 CRPC): The learner will be skilled to diagnose M0 CRPC and be able to educate patients about using either enzalutamide or apalutamide or darolutamide added to traditional ADT as a way to improve their patent's overall and radiographic progression-free survival. Furthermore, the skilled learner will be able to understand the differences between these three oral agents and to educate patients about side-effects and toxicities. Finally, understand the pros and cons of PSMA PET scan imaging in further staging in this disease Non-metastatic Castrate-Resistant Prostate Cancer (M0 CRPC): Diagnose M0 CRPC and be able to educate patients about using novel oral antiandrogens added to traditional ADT as a way to improve their patent's overall and radiographic progression-free survival. Furthermore, the skilled learner will be able to understand the differences between these novel oral agents and to educate patients about side effects and toxicities. Finally, understand the pros and cons of PSMA PET scan imaging in further staging in this disease state. 3. Metastatic Castrate-Resistant Prostate Cancer (M1 CRPC): Describe and have a working knowledge of the latest phase III RCT results for new therapies in M1 CRPC and be able to educate their patients on treatment options and participate in a multidisciplinary team caring for men with this disease state of far-advanced prostate cancer. 4. Describe that advanced prostate cancer is a complex group of disease states with an ever-changing therapeutic landscape and for providers and teams to embrace the multi-disciplinary nature of care for our patients. 5. Identify the molecular and molecular genetic underpinnings of advanced prostate cancer and recognize the future will be based on a more personalized therapy landscape including PARP inhibition, immune checkpoint agents, and novel AR targeted agents emerging in 2025 and beyond.

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Dr. Baliga's Internal Medicine Podcasts

Play Episode Listen Later May 19, 2025 3:41

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156. Back to Basics - Prostate Cancer - Biochemical Recurrence and Oligometastatic Disease Control

Oncology for the Inquisitive Mind

Play Episode Listen Later May 17, 2025 24:26

As we "EMBARK" on our next Prostate Cancer adventure via the "SOLAR" system to "SATURN," Michael and Josh explore the idea of biochemical recurrence in prostate cancer and the role of radiotherapy in tumour-directed therapy for de novo versus recurrent PSMA PET–defined oligo-M1 prostate cancer. Both excellent studies raise the question of newer technologies and how we apply this information to trials that already exist.Studies discussed in the episode:EMBARKSOLAR/SATURNFor more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice.Oncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have access to the episode at the same time you do and have no editorial control over the content. Hosted on Acast. See acast.com/privacy for more information.

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AUA2025: Integration of Biomarkers, MRI and PSMA PET Imaging Into the Management of Prostate Cancer

AUAUniversity

Play Episode Listen Later May 7, 2025 102:38

AUA2025: Integration of Biomarkers, MRI and PSMA PET Imaging Into the Management of Prostate Cancer CME Available: https://auau.auanet.org/node/43069 At the conclusion of this CME activity, participants will be able to: 1. Evaluate recent advances in biomarkers and molecular imaging technologies and their role in improving the accuracy of prostate cancer staging, and treatment monitoring. 2. Identify the clinical scenario in which PSMA PET/CT is most helpful to identify the localization and extent of locoregional or systemic metastatic disease. 3. Identify the pitfalls of false-positive and false-negative PSMA PET/CT findings. 4. Apply the findings of PSMA PET/CT for the best individual therapeutic approach. 5. Identify patients with radiorecurrent organ-confined prostate cancer. ACKNOWLEDGEMENTS Support provided by independent educational grants from: Blue Earth Diagnostics, Inc. Lantheus Medical Imaging Novartis Pharmaceuticals Corporation

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154. Back to Basics - Non Metastatic and Metastatic Prostate Cancer - The Journey Continues

Oncology for the Inquisitive Mind

Play Episode Listen Later May 3, 2025 22:09

Prostate Cancer has a multitude of presentations, but when metastatic, it usually spreads directly to the lymph nodes or the bones. This episode focuses on the contentious definition of "M0 Castrate Resistant Prostate Cancer (CRPC)", also known as Nonmetastatic CRPC. Does this definition exist, and what role will PSMA PET have in this cohort of patients? The second trial, TITAN looks at apalutamide, another ARPI/ARSI and how it compares to it's cousins who are fighting for the top spot in the prostate cancer world.Studies discussed in the episode:ARAMISTITANFor more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of AlisiaBeats: https://pixabay.com/users/alisiabeats-39461785/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice.Oncology for the Inquisitive Mind is recorded with the support of education grants from our foundation partners Pfizer, Gilead Pharmaceuticals and Merck Pharmaceuticals. Our partners have access to the episode at the same time you do and have no editorial control over the content. Hosted on Acast. See acast.com/privacy for more information.

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Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer Guideline Update

ASCO Guidelines Podcast Series

Play Episode Listen Later May 2, 2025 22:48

Dr. Rohan Garje shares the updated recommendations for the ASCO guideline on systemic therapy for patients with metastatic castration-resistant prostate cancer. He discusses the systemic therapy options for patients based on prior therapy received in the castration-sensitive and non-metastatic castration-resistant settings. He emphasizes personalizing treatment choices for each individual, considering patient-specific symptoms and signs, treatment-related toxicities, potential drug interactions, cost, and access. He also reviews recommendations on response assessment. The conversation wraps up with a discussion of potential future updates to this guideline, as the guideline transitions into a “living guideline” on mCRPC. Read the full guideline update, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update”. Transcript This guideline, clinical tools, and resources are available at www.asco.org/genitourinary-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology. Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Rohan Garje from Miami Cancer Institute Baptist Health South Florida, lead author on, “Systemic Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer: ASCO Guideline Update.” Thank you for being here today, Dr. Garje. Dr. Rohan Garje: Absolutely. Thank you so much for having me, Brittany. Brittany Harvey: And then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Garje, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to start on the content of this guideline, first, could you provide us an overview of the purpose of this guideline update? Dr. Rohan Garje: Sure. So ASCO has guidelines for prostate cancer and the specific guideline which we have updated for metastatic castrate-resistant prostate cancer was originally published in 2014. It's almost a decade. It's been a long time due for an update. Over the last decade, we have seen a lot of advances in the treatment of prostate cancer, specifically with regards to genomic testing, newer imaging modalities, and also the treatment landscape. Now we have newer options based on genomic targets such as PARP inhibitors, we have radiopharmaceuticals, a newer variant of chemotherapy, and also some specific indications for immunotherapy which were not addressed previously. Because all these advances have been new, it was really important for us to make an update. In 2022, we did make a rapid update with lutetium-177, but these additional changes which we have seen made it an appropriate time frame for us to proceed with a newer guideline. Brittany Harvey: Absolutely. It's great to hear about all these advances in the field to provide new options. So I'd like to next review the key recommendations from this guideline. So let's start with the overarching principles of practice that the panel outlined. What are these key principles? Dr. Rohan Garje: As a group, all the panel members came up with some ground rules: What are necessary for all our patients who are being treated for metastatic CRPC? First, the founding aspect was a definition for what is metastatic CRPC. So we defined metastatic CRPC as castrate level of testosterone with evidence of either new or progressive metastatic disease on radiological assessments or patients who have two consecutive rising PSAs in the setting of existing metastatic disease. We also emphasized on the need for germline and somatic testing for patients with metastatic prostate cancer at an earliest available opportunity because it is critical to select appropriate treatment and also right treatment for patients at the right time. And we actually have a concurrent guideline which addresses what genes to be tested and the timing. The other principles are patients should continue to receive androgen deprivation therapy or undergo surgical castration to maintain castrate level of testosterone. Now the key aspect with these guidelines is personalizing treatment choices. As you can see the evolution of treatment options for prostate cancer, the drugs that were initially developed and approved for prostate cancer were primarily in castrate-resistant settings, but now most of these drugs are being utilized in castrate-sensitive. So, when these patients develop castration resistance, the challenges are there are no appropriate particular drug-specific guidelines they meet. So, it's very important for the clinicians to be aware of what treatments have been received so far prior to castration resistance so that they can tailor the treatment to patient specific situations. In addition, prior to choosing a therapy, it is important for the physicians to consider patient specific symptoms or signs, treatment-related toxicities, potential drug interactions, cost, and also access to the drugs. There may be multiple treatment options available for the patients, but for a patient specific scenario, there may be a drug that may be more promising than the others. So, it is important to tailor the drug choices based on patients' unique circumstances. The panel also recommends to early integrate palliative and supportive care teams for symptom management and also discuss goals of care with the patient as each patient may have unique needs and it's important for physicians to address those concerns upfront in the care. The panel also suggests patients to receive RANK ligand inhibitors such as denosumab or bisphosphonates such as zoledronic acid to maintain the bone strength to prevent skeletal-related events. Finally, I would like to also emphasize this point about the lack of randomized clinical trial data for optimal sequencing of therapies for patients with metastatic CRPC. As I previously alluded, we have taken into account all ongoing clinical trials, prior published data, and came up with a format of preferred drugs based on prior treatments and, I think, by following these several clinical principles which I just mentioned, we can optimally choose and utilize best treatments for patients with metastatic CRPC. Brittany Harvey: Absolutely. These principles that you just outlined are important for optimal patient care, and then I want to touch on one of those things. You talked importantly about the treatments received so far. So in the next set of recommendations, the role of systemic therapy was stratified by the prior therapy received in the castration-sensitive and non-metastatic castration-resistant setting. So starting with what does the panel recommend for patients who are previously treated with androgen deprivation therapy alone in these previous settings and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: There are multiple treatment options based on prior treatment received. So for patients who received only ADT for their castration-sensitive disease, the panel strongly urges to get HRR testing to check for homologous recombinant repair related changes, specifically for BRCA1 and BRCA2 mutations, because we have three studies which have really shown significant clinical benefit for patients who have BRCA1 and BRCA2 mutations with drugs such as the combination of talazoparib and enzalutamide or olaparib with abiraterone or niraparib with abiraterone. Unless we test for those mutations, we'll not be able to give these agents upfront for the patients. In the HRR testing, if patients have HRR alterations but they are in genes which are non-BRCA, the guideline panel recommends to utilize talazoparib and enzalutamide based combination therapies. Now, if they don't have HRR alterations then there are multiple treatment choices available. It could either include androgen receptor pathway inhibitors such as abiraterone with prednisone. We could also consider docetaxel chemotherapy. The alternate choices for androgen receptor pathways include enzalutamide or the newer agents such as apalutamide and docetaxel. So, as you can see there are multiple options available, but the panel definitely emphasizes to test for HRR testing because this gives patients access to more precision therapies at this point. There may be various scenarios where a unique drug may be available for a specific patient situation. For example, patients who have very limited disease burden and may have one or two metastatic lesions, after a multidisciplinary discussion, targeted local therapies such as radiation or potentially surgery could also be offered. In select patients who have very indolent disease where they are castrate-resistant based on slow rising PSA, low-volume disease or asymptomatic disease can consider sipuleucel-T. And in patients who have bone-only metastatic disease, we could also consider radium-223, which is primarily now utilized for patients who have symptomatic bone disease. Brittany Harvey: Great. I appreciate you reviewing all those options and talking about how important it is to tailor treatment to the individual patient. So then the next category of patients, what is recommended for those who have been previously treated with ADT and an androgen receptor pathway inhibitor and whose disease has now progressed to metastatic castration-resistant prostate cancer? Dr. Rohan Garje: So for patients who received ADT along with an androgen receptor pathway inhibitor, which we consider would be a most common cohort because most patients now in castration-sensitive setting are receiving androgen receptor pathway inhibitor. It was different in the past where five or six years back ADT alone was the most common treatment, but fortunately, with enough awareness and education, treatment choices have improved. Patients are now receiving ADT and ARPI as the most common choice of drug. Once again, at this point the panel emphasizes to consider HRR testing in there is enough data for us to suggest that patients who have alterations in the HRR pathway definitely will benefit with the PARP inhibitor. You know the multiple options, but specifically we speak about olaparib. And then if they are HRR-negative, we prefer patients receive agents such as docetaxel or if they are intolerant to docetaxel, consider cabazitaxel chemotherapy, options such as radium-223, and if they have a specific scenario such as MSI-high or mismatch repair deficiency, pembrolizumab could also be considered. The panel also discussed about the role of a second ARPI agent. For example, if patients progressed on one androgen receptor pathway inhibitor, the second androgen receptor pathway inhibitor may not be effective and the panel suggests to utilize alternate options before considering androgen receptor pathway inhibitor. There may be specific scenarios where a second ARPI may be meaningful, specifically, if alternate choices are not feasible for the concern of side effects or toxicities or lack of access, then a potential ARPI could be considered after progression on ARPI, but the panel definitely encourages to utilize alternate options first. Brittany Harvey: Great. Thank you for outlining those options as well for those patients. So then the next category, what is recommended for patients who have been previously treated with ADT and docetaxel? Dr. Rohan Garje: For patients who received ADT and docetaxel and were never treated with androgen receptor pathway inhibitors, the panel again emphasizes on HRR testing. If they have BRCA1 and 2 mutations, the combination therapies of talazoparib with enzalutamide, olaparib with abiraterone, or niraparib with abiraterone are all good choices. If they don't have BRCA mutations but they have other HRR mutations, the panel suggests to potentially utilize talazoparib with enzalutamide. And if they do not have any HRR alterations, the options could include androgen receptor pathway inhibitors such as abiraterone or enzalutamide. I want to emphasize that these are preferred options, but not the only options. As you can see, there are multiple options available for a particular clinical situation - so the ability of the physicians to access particular combinations, the familiarity of those drugs or the patient's unique situation where they have other medications which can potentially interact with a choice of agents. So I think based on access, based on cost and patients' concurrent illness with potential drug interactions can make one particular combination of therapy better over the other options. Brittany Harvey: Absolutely. That's key to keep in mind that access, contraindications, and cost all play a role here. So then the next set of recommendations. What are the key recommendations for patients who have previously been treated with ADT, an androgen receptor pathway inhibitor, and docetaxel who now have mCRPC? Dr. Rohan Garje: Yes. In this group, the options remain, again, broad. We utilize PSMA imaging here specifically and if they are positive on PSMA imaging, lutetium-177 is a good option. If they do not have PSMA-positive disease on PSMA imaging but if they have HRR alterations, olaparib could be utilized. And if they are negative on PSA imaging, they don't have HRR alterations, then alternate options could include cabazitaxel, radium-223. And if they have MSI-high or deficiency in mismatch repair, pembrolizumab could be utilized in this setting. Brittany Harvey: Thank you for outlining those options as well. So then next the panel addressed treatment options for de novo or treatment emergent small cell neuroendocrine carcinoma of the prostate. What are those key recommendations? Dr. Rohan Garje: Yes. This is a very high unmet need group because there are limited clinical trials, especially prospective clinical trials addressing treatment options for this group. Most of our current guidelines are always an extrapolation from lung small cell cancer based guidelines, but the panel recommends to utilize cisplatin or carboplatin along with etoposide as a preferred choice for this group. Also, an alternate option of carboplatin along with cabazitaxel could be considered for this cohort. The panel also encourages participation in clinical trials. There are numerous trials ongoing now in smaller phase studies and I think it's important for patients to consider these trials as well, because this will give them access to newer agents with potential biological targets. In addition to these agents in specific scenarios or potentially case by case basis, because we don't have prospective data, so we have made it as a select case by case basis to consider adding immunotherapy along with platinum-based chemotherapy followed by maintenance immunotherapy, which is currently a standard of care in small cell lung cancer. But the data is so limited in prostate cancer, so the panel suggested that it has to be a case by case basis only. The alternate options also include lurbinectedin, topotecan, tarlatamab upon progression on platinum-based chemotherapy. Brittany Harvey: Yes. It's important to have these recommendations in these unique situations where there is really a lack of data. So then the final set of recommendations I'd like to cover, what does the panel recommend for how clinicians should assess for response while patients are on systemic therapy and what scans are recommended for this response assessment? Dr. Rohan Garje: Yes. Again, this is another strong emphasis of the panel for global assessment of the patients. Traditionally, patients and physicians per se are heavily reliant on PSA as an accurate marker for response. This is in fact true in earlier phases of prostate cancer either in castrate-sensitive setting or localized prostate cancer setting. But as patients evolve into castrate-resistant, we don't want to heavily rely on PSA alone as a marker of response. The panel suggests to incorporate clinical response, radiological response, and also include PSA as a component, but not just rely primarily on PSA. So the panel also suggests that patients should get a bone scan and a CT scan every three to six months while on treatment to assess for appropriate response or for progression. And now one key important aspect, we are all aware about the evolving role of PSMA-based imaging with several of these new agents that are currently available. We do acknowledge these scans definitely have an important role in the care for patients with metastatic prostate cancer. Currently, the utility is primarily to select patients for lutetium-based therapy and also in situations where the traditional scans such as technitium 99 bone scan or CT scan are equivocal, then a PSMA-based imaging can be helpful. Now we are also aware that there are newer studies coming up, prospective data coming up for the role of PSMA-based imaging for response assessment. We are hoping to update the guidelines if we get access to newer data, but currently we have not recommended the utility of PSMA-based imaging for response assessments. Brittany Harvey: Understood. And I appreciate you describing where there is data here and where there's a lack of data to currently recommend. And we'll look forward to future updates of this guideline. Coming back to – at the start you mentioned how much has changed since the last guideline update. So Dr. Garje, in your view, what is the importance of this update and how will it impact both clinicians and patients with metastatic castration-resistant prostate cancer? Dr. Rohan Garje: The updated guidelines are designed to have a significant impact on clinical practice and also patient outcomes by providing clinicians with a comprehensive evidence-based framework for managing patients with metastatic CRPC. And also, by using these guidelines can make informed decisions, can select therapies tailored to patients' unique genomic status, clinical situation, where they are in the course of the cancer based on what they received previously. Also utilizing these guidelines, we can potentially improve patient outcomes, improve survival, and importantly have efficient use of healthcare resources. Brittany Harvey: Absolutely. We're always looking for ways to improve patient outcomes and survival. I want to wrap us up by talking a little bit about the outstanding questions in this field. So earlier you had mentioned about prospective data to come about PSMA PET scans, but what other outstanding questions are there for patients with metastatic castration-resistant prostate cancer? And what evidence is the panel looking forward to for future updates? Dr. Rohan Garje: We do have now rapidly evolving data specifically about the utility of the radiopharmaceutical lutetium-177 prior to chemotherapy. We are hoping that with newer data we can make some changes to the guideline based on that. We are also looking at newer drugs that are coming up in the pipeline, for example, androgen receptor degraders. We are looking at data that might potentially help based on bispecific T-cell engagers and newer radiopharmaceuticals. So I think in the next few years, we will definitely update all the guidelines again. But this time we are trying to do it more proactively. We are following a newer model. We are calling it as ‘living guidelines' where we are actually utilizing week by week updates where we look at the literature and see if there is any potential practice impacting change or publication that comes up. And we are trying to incorporate those changes as soon as they are available. That way patients and practicing physicians can get the latest information available through the guidelines as well. Brittany Harvey: That's great to hear. Yes, we'll await this data that you mentioned to continuously update this guideline and continue to improve patient outcomes for the future. So Dr. Garje, I want to thank you so much for your time to update this guideline. It was certainly a large amount of recommendations, and thank you for your time today, too. Dr. Rohan Garje: Thank you so much for having me here. And it's always nice talking to you. Brittany Harvey: And finally, thank you to our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/genitourinary-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. 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.

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Episode 21: Prostate Cancer Imaging: When, Why and How? with Dr. Frédéric Pouliot

The View on GU | with Lalani and Wallis

Play Episode Listen Later Apr 24, 2025 30:32

In this informative episode, Dr. Aly-Khan Lalani and Dr. Christopher Wallis are joined by Dr. Frédéric Pouilot, a urologist-oncologist and researcher in molecular imaging at the CHU de Québec-Université Laval Research Center. Together, they unpack the evolving role of PSMA PET in prostate cancer and how advanced imaging tools are reshaping treatment decisions. The conversation also looks ahead, to the future of dynamic imaging, and its potential to revolutionize personalized cancer care.The View on GU with Lalani & Wallis integrates key clinical data from major conferences and high impact publications, sharing meaningful take home messages for practising clinicians in the field of genitourinary (GU) cancers. Learn more about The View on GU: theviewongu.caThis podcast has been made possible through unrestricted financial support by Novartis, Bayer, Astellas, Tolmar, J&J, Merck, Pfizer, Eisai and AbbVie.

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Revolution in Radiation Therapy for Prostate Cancer with Dr. Jonathan Lischalk

Play Episode Listen Later Apr 17, 2025 47:24

In this episode of the Dr. Geo Prostate Podcast, we welcome Dr. Jonathan Lischalk, Director of Genitourinary Cancers at MedStar Georgetown University Hospital and former Medical Director at NYU's NYCyberKnife Center. Dr. Lischalk breaks down the evolution of radiation oncology and how cutting-edge imaging and targeted SBRT (Stereotactic Body Radiation Therapy) are reshaping prostate cancer treatment.We explore how imaging advances like MRI and PSMA PET scans are enabling unprecedented precision, the future of genetic-based personalization in prostate cancer therapy, and why fewer, more focused radiation sessions might soon become the new standard. From understanding the biology of radiation dosing to upcoming trials eliminating ADT in select patients, this is a must-listen for anyone looking to stay informed on the forefront of cancer care.

PSMA PET Scans work for Prostate Cancer with Dr. Alberto Vargas

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Play Episode Listen Later Apr 8, 2025 44:52

In this episode of the Dr. Geo Prostate Podcast, Dr. Geo welcomes Dr. Alberto Vargas, Vice Chair of Oncologic Imaging at NYU Langone Health and expert in prostate cancer imaging.They dive deep into the evolving world of diagnostic tools—MRI, PET, CT, and PSMA scans—and how these technologies help detect, monitor, and guide treatment for prostate cancer. Dr. Vargas explains the difference between imaging modalities, when to use them, and how PSMA PET scans are changing the game in identifying recurrent and metastatic disease earlier than ever before.Key topics covered:MRI vs. PET vs. CT: what each scan shows and when it matters mostThe rise of PSMA PET for finding prostate cancer at extremely low PSA levelsWhy not all PET scans are the same, and how tracers like FDG, Axumin, and PSMA workThe potential future of prostate cancer diagnosis: fewer biopsies, more imagingLimitations, false positives, and how imaging results are interpretedThe role of imaging in both first-time diagnosis and recurrenceWhether you're a patient, caregiver, or clinician, this episode offers valuable insight into how imaging helps guide smart, proactive decisions in prostate cancer care.----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations Dr. Geo's Supplement...

PSMA PET Scans work for Prostate Cancer with Dr. Alberto Vargas

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Play Episode Listen Later Apr 7, 2025 0:55

In this episode of the Dr. Geo Prostate Podcast, Dr. Geo welcomes Dr. Alberto Vargas, Vice Chair of Oncologic Imaging at NYU Langone Health and expert in prostate cancer imaging.They dive deep into the evolving world of diagnostic tools—MRI, PET, CT, and PSMA scans—and how these technologies help detect, monitor, and guide treatment for prostate cancer. Dr. Vargas explains the difference between imaging modalities, when to use them, and how PSMA PET scans are changing the game in identifying recurrent and metastatic disease earlier than ever before.Key topics covered:MRI vs. PET vs. CT: what each scan shows and when it matters mostThe rise of PSMA PET for finding prostate cancer at extremely low PSA levelsWhy not all PET scans are the same, and how tracers like FDG, Axumin, and PSMA workThe potential future of prostate cancer diagnosis: fewer biopsies, more imagingLimitations, false positives, and how imaging results are interpretedThe role of imaging in both first-time diagnosis and recurrenceWhether you're a patient, caregiver, or clinician, this episode offers valuable insight into how imaging helps guide smart, proactive decisions in prostate cancer care.----------------Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that maintain the body in a fasting state.Special Offer: Thank you for listening, you can purchase the ProLon kit for just $148 by using this link.We'd also like to thank our partner AG1 by Athletic Greens. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This special blend of ingredients supports your gut health, nervous system, immune system, energy, recovery, focus, and aging. All the essentials in one scoop. Enjoy AG1 by Athletic Greens.----------------Thanks for listening to this week's episode. Subscribe to The Dr. Geo YouTube Channel to get more content like this and learn how you can live better with age.You can also listen to this episode and future episodes of the Dr. Geo Podcast by clicking HERE.----------------Follow Dr. Geo on social media. Facebook, Instagram Click here to become a member of Dr. Geo's Health Community.Improve your urological health with Dr. Geo's formulated supplement lines:XY Wellness for Prostate cancer lifestyle and nutrition: Mr. Happy Nutraceutical Supplements for prostate health and male optimal living.You can also check out Dr. Geo's online dispensary for other supplement recommendations

3.31.2025 - Calculus problem

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Play Episode Listen Later Mar 31, 2025 8:07

Check out this week's QuadCast where we highlight the link between dental hygiene and oral mucositis risk, the optimal timing of post-treatment PSMA PET scans, the impressive impact of immunotherapy in MSI-high colorectal cancer, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

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GU Cast in Shanghai | Prostate Cancer in China in 2025

GU Cast

Play Episode Listen Later Mar 19, 2025 32:31

Declan Murphy is in the GU Cast studio in Shanghai with GU Cast China Editor, Prof Yao Zhu. We sit down with Prof Hao Zeng (West China Hospital) and Dr Ye Yan to discuss their experiences and perspectives on advancements in diagnostics like MRI and PSMA PET, the increasing use of Chinese-developed robotic surgery platforms, and the ongoing debate surrounding pelvic lymph node dissection. They also address the application of systemic therapies for metastatic disease, considering the unique characteristics of the Chinese patient population and the potential for dose adjustments. Today's pod also highlights the growing importance of precision oncology, including genomic testing for mutations to guide treatment decisions, while acknowledging the challenges and future directions in this area.This is a Themed Podcast supported by our Gold Partner, Bayer China. Even better on our YouTube channel https://youtu.be/xlOuS4swcuc

When prostate cancer returns a nuclear medicine scan can help, Elizabeth Tracey reports

Health Newsfeed – Johns Hopkins Medicine Podcasts

Play Episode Listen Later Jan 26, 2025 1:05

Prostate specific membrane antigen or PSMA PET scanning is very accurate at detecting and visualizing prostate cancer throughout the body. Now a study using this type of scan on men whose disease recurred shows its efficacy in this case also. … When prostate cancer returns a nuclear medicine scan can help, Elizabeth Tracey reports Read More »

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120: DigPath Digest #21 | AI's Role in Prostate & Breast Cancer Diagnosis and Collaborative Annotation Tools

Digital Pathology Podcast

Play Episode Listen Later Jan 26, 2025 46:03 Transcription Available

Send us a textWelcome to the 21st edition of DigiPath Digest! In this episode, together with Dr. Aleksandra Zuraw you will review the latest digital pathology abstracts and gain insights into emerging trends in the field. Discover the promising results of the PSMA PET study for prostate cancer imaging, explore the collaborative open-source platform HistioColAI for enhancing histology image annotation, and learn about AI's role in improving breast cancer detection. Dive into topics such as the role of AI in renal histology classification, the innovative TrueCam framework for trustworthy AI in pathology, and the latest advancements in digital tools like QuPath for nephropathology. Stay tuned to elevate your digital pathology game with cutting-edge research and practical applications.00:00 Introduction to DigiPath Digest #2101:22 PSMA PET in Prostate Cancer06:49 HistoColAI: Collaborative Digital Histology12:34 AI in Mammogram Analysis17:21 Blood-Brain Barrier Organoids for Drug Testing22:02 Trustworthy AI in Lung Cancer Diagnosis30:09 QuPath for Nephropathology35:30 AI Predicts Endocrine Response in Breast Cancer40:04 Comprehensive Classification of Renal Histologic Types45:02 Conclusion and Viewer EngagementLinks and Resources:Subscribe to Digital Pathology Podcast on YouTubeFree E-book "Pathology 101"YouTube (unedited) version of this episodeTry Perplexity with my referral linkMy new page built with PerplexityHistoColAI Github PagePublications Discussed Today:

Ep. 210 Personalizing ADT Across the Prostate Cancer Spectrum with Dr. Rana McKay

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Play Episode Listen Later Jan 21, 2025 34:33

What is the role of androgen deprivation therapy (ADT) in prostate cancer treatment? In this episode of the BackTable Urology Podcast, Dr. Rana McKay, a medical oncologist from UC San Diego, joins host Dr. Aditya Bagrodia to discuss the administration of ADT and other management strategies for prostate cancer. --- This podcast is supported by: Photocure https://www.photocure.com/ --- SYNPOSIS The doctors offer a historical perspective into the evolution of ADT over time and discuss the variety of different ADT treatment options available. They compare management strategies for localized and metastatic prostate cancer and discuss how to align therapy with patient goals, focusing on the side effects. The conversation also explores the impact of prostate-specific membrane antigen (PSMA) PET imaging on management and the future directions of hormonal therapies in urologic oncology. --- TIMESTAMPS 00:00 - Introduction 05:25 - ADT Options 10:36 - Choosing an Agent and Managing Side Effects 26:42 - Continuous Versus Intermittent Therapy 30:30 - Closing Remarks --- RESOURCES Photocure https://www.photocure.com/

Advancing Prostate Cancer Care with Dr. William Oh: Precision Medicine, Diagnostics and Advocacy (Part 2)

Precision Medicine Podcast

Play Episode Listen Later Dec 30, 2024 32:41

In this two-part episode of the Precision Medicine Podcast, host Karan Cushman continues her deep dive into prostate cancer care with expert guest Dr. William Oh, a leading genitourinary oncologist, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Building on part one (episode 63), they explore the transformative role of precision medicine, advanced diagnostics, and targeted therapies—emphasizing the urgent need for greater awareness, understanding, and advocacy as prostate cancer continues to rise steadily. Karan opens the conversation by emphasizing the growing complexity of prostate cancer diagnostics and treatment. Dr. Oh discusses the wide array of diagnostic tools, from PSA tests and MRIs to the cutting-edge PSMA PET scan, which has revolutionized staging and treatment planning by providing detailed insights into cancer spread. He highlights how these tools are helping oncologists tailor treatment plans with unprecedented precision. The discussion shifts to molecular diagnostics, a burgeoning field that provides critical information about the aggressiveness of cancer. Dr. Oh explains how molecular tests, such as genomic profiling, are enabling personalized treatment decisions for prostate cancer patients, particularly those on the fence about options like surgery, radiation, or active surveillance. Karan and Dr. Oh also address disparities in access to these advanced diagnostics, underlining the need for wider implementation. Karan steers the conversation toward advancements in targeted therapies. Dr. Oh outlines breakthroughs in precision treatments, including PARP inhibitors for patients with BRCA mutations and the innovative LU-177-PSMA therapy, a “smart bomb” approach that targets cancer cells with remarkable specificity. He also explores the promise of immunotherapy, though he acknowledges its limited applicability for prostate cancer due to the disease's low mutational burden. The role of artificial intelligence in precision oncology is another key topic. Dr. Oh and Karan discuss how AI and machine learning are helping clinicians process complex data, from imaging to genomic profiles, to guide more informed treatment decisions. Dr. Oh envisions AI as an essential tool for streamlining oncology workflows while preserving the human connection between doctors and patients. Karan highlights the importance of effective communication in prostate cancer care, referencing a recent editorial co-authored by Dr. Oh. Together, they explore the need for more patient-centered terminology, such as replacing the term “castration-resistant prostate cancer” with “androgen deprivation-resistant prostate cancer,” to foster better understanding and improve patient experience. The episode concludes with a forward-looking discussion on clinical trials, the integration of new technologies like liquid biopsies, and the ongoing efforts to expand insurance coverage for biomarker testing. Dr. Oh emphasizes the critical role of collaboration, awareness, and education in advancing precision medicine and ensuring that patients benefit from the latest innovations. With Karan's thoughtful questions and Dr. Oh's expertise, this episode offers a comprehensive and accessible exploration of how precision medicine is reshaping the future of prostate cancer care. We hope you'll tune in to the series and share this important episode with others!

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Ep. 206 Biochemical Recurrence: Insights from AUA/ASTRO/SUO Guidelines with Dr. Todd Morgan

Play Episode Listen Later Dec 17, 2024 51:33

Have you checked out the AUA/ASTRO/SUO's recently released guidelines for salvage therapy in prostate cancer biochemical recurrence? In this episode of the BackTable Urology Podcast, guest Dr. Todd Morgan from the University of Michigan and host Dr. Aditya Bagrodia continue with part two of our series on prostate cancer biochemical recurrence management. --- This podcast is supported by: Veracyte https://www.veracyte.com/decipher --- SYNPOSIS The doctors focus on the difficulty in declaring a patient 'cured' and the implications of biochemical recurrence after treatment. Dr. Morgan highlights the importance of PSA in the postoperative setting and explores the role of the Decipher Prostate Genomic Classifier in personalizing treatment. He talks through the latest AUA/ASTRO/SUO consensus on biochemical recurrence guidelines, including the significance of early salvage therapy and the integration of advanced imaging techniques like PSMA PET scans. Further, Dr. Morgan emphasizes the role for multidisciplinary evaluation, patient counseling, and future directions of research to refine treatment options. This discussion underscores the transition from adjuvant to early salvage radiation as a standard practice and considers emerging biomarker strategies to inform treatment decisions. --- TIMESTAMPS 00:00 - Introduction 03:41 - Consensus Biochemical Recurrence Guidelines 08:56 - Evolution of Post-Prostatectomy Biochemical Recurrence Management 13:24 - Patient Counseling and Risk of Recurrence 17:42 - PSMA PET Scans 20:44 - Postoperative PSA Monitoring 28:35 - The Role of Radiation 31:56 - Hormone Therapy 39:00 - Salvage Lymphadenectomy 46:30 - Future Directions and Concluding Thoughts --- RESOURCES Veracyte https://www.veracyte.com/ Salvage Therapy for Prostate Cancer: AUA/ASTRO/SUO Guideline (2024) https://www.auanet.org/guidelines-and-quality/guidelines/salvage-therapy-for-prostate-cancer

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Ep. 200 Managing Biochemical Recurrence After Prostate Radiation with Dr. Amar Kishan

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Play Episode Listen Later Nov 19, 2024 36:32

Biochemical recurrence of prostate cancer can be difficult to diagnose and treat. In this episode of BackTable Urology, where Dr. Aditya Bagrodia hosts Dr. Amar Kishan, a genitourinary radiation oncologist at UCLA, to discuss the complexities of biochemical recurrence and local failure after radiation therapy for prostate cancer. --- This podcast is supported by: Veracyte https://www.veracyte.com/decipher --- SYNPOSIS First, they evaluate alternatives to androgen deprivation therapy (ADT), the benefits and risks associated with ADT, and the role of genetic classifier tests. They also detail the goals of prostate-specific antigen (PSA) monitoring, PSA trends post-radiation, and advancements in PSMA PET scans. Then, the conversation highlights modern treatment options like targeted radiation, low dose rate brachytherapy, salvage radical prostatectomy, and focal therapy. Finally, the doctors emphasize personalized and multidisciplinary treatment plans as they hope to improve long-term outcomes for patients with prostate cancer. --- TIMESTAMPS 00:00 - Introduction 04:31 - PSA Levels Post-Radiation 13:21 - Local Recurrence and PSMA PET 21:29 - Explaining Radiation Effects to Patients 22:41 - Managing PSA Bounce 26:05 - Imaging and Biopsy Techniques 28:55 - Treatment Options for Local Recurrence 30:16 - Re-Irradiation and Focal Therapy 33:13 - Concluding Thoughts --- RESOURCES Veracyte https://www.veracyte.com/

Transcriptomic Profiling of Non-Localized Prostate Cancer

JCO Precision Oncology Conversations

Play Episode Listen Later Oct 16, 2024 27:07

JCO PO author Dr. Amar U. Kishan, Professor, Executive Vice Chair, and Chief of Genitourinary Oncology Service in the Department of Radiation Oncology at the University of California, Los Angeles, shares insights into his JCO PO article, “Transcriptomic Profiling of Primary Prostate Cancers and Nonlocalized Disease on Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography: A Multicenter Retrospective Study.” Host Dr. Rafeh Naqash and Dr. Kishan discuss the relationship between Decipher genomic classifier scores and prostate-specific membrane antigen (PSMA) PET/CT-based metastatic spread. TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO articles. I'm your host, Dr. Rafeh Naqash, Assistant Professor at the OU Health Stephenson Cancer Center at the University of Oklahoma. Today we are joined by Dr. Amar Kishan, Executive Vice Chair of the Department of Radiation Oncology at the David Geffen School of Medicine at UCLA and UCLA Jonsson Comprehensive Cancer Center, and also the corresponding and senior author of the JCO Precision Oncology article entitled, “Transcriptomic Profiling of Primary Prostate Cancers and Non Localized Disease on Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography: A Multicenter Retrospective Study.” Dr. Kishan, welcome to our podcast and thank you for joining us today. Dr. Amar Kishan: Thank you so much for that kind introduction and the invitation to be here today. Dr. Rafeh Naqash: Well, it seems to me that there's a theme that people in the GU space, investigators in the GU space, are very interested in trying to understand risk predictors for prostate cancer. We had somebody, I believe from Huntsman Cancer Center a few months back on a previous podcast, where they were trying to do risk prediction modeling as well. Could you tell us why that's something that the GU community is very interested in? What's the background? Is it because there's no risk prediction approaches currently? And would this somehow influence management in the near future? Dr. Amar Kishan: Yeah, that's a great question. So, I think this goes back to the point that we're in the era of precision medicine now, and many cancers have these molecular stratification scores and all that. Prostate cancer has lagged a little bit behind in that regard, despite the fact that it's such a common cancer that affects so many people across the country and across the world. So, we do have risk stratification schemes for prostate cancer. These are based off clinical and pathologic variables, like the level of PSA, the size of the tumor on digital rectal examination, now, we're incorporating MRI imaging as well, and then what the cancer looks like under the microscope, the Gleason score. And now there have been revisions to the Gleason score, but it's really kind of the architecture, what the biopsy looks like. And this was kind of developed many, many years ago by Donald Gleason, a pathologist at the VA. What we're not necessarily taking into account routinely is kind of the biology of the cancer per se. You know, what are the molecular drivers? How could that influence ultimate outcome? And that's very important because we have these risk groups, low risk, very low risk, favorable intermediate risk, unfavorable intermediate risk, high risk, very high risk. But within each of those groups, based on the clinical kind of pathological characteristics, there's a huge heterogeneity in outpatients too, and our treatments are effective, but they can be morbid. Putting someone on hormone therapy for an extended period of time has a lot of side effects. Dose escalating radiotherapy or doing surgery and then radiation afterwards, these are big things that have a big impact on the patient, and I think we really need better risk stratification tools to understand who needs intensification and who we can de-escalate treatment for. Dr. Rafeh Naqash: I think those are absolutely valid points, perhaps not just for prostate cancer, more so for all cancers that we currently treat, especially in the current day and age, where we have a tendency to add more and more therapies, combination therapies for patients, and as you mentioned, risk stratification to help identify high risk versus low risk, where you can de intensify treatment, is of high value from a patient standpoint as well as from a financial toxicity standpoint. So then, going to this next part of the approach that you used, and from what I understand in this paper, you had the radiological aspect, which is the PSMA PET, which we'll talk about. Then you had the genomic aspect, where you did some genomic risk-based stratification. Then you had the transcriptomic score based on the Decipher score. So, could you go into some of the details, first, for the PSMA PET, when is it used? What is the utilization? What is it based on, the science behind the PSMA PET? And then we can talk about some of the other genomic transcriptomic predictors that you use in this study. Dr. Amar Kishan: Sure. Absolutely. So, a PSMA PET is an advanced molecular imaging tool. PSMA stands for prostate specific membrane antigen. It's a membrane protein that is expressed on the surface of prostate cancer cells. It is expressed elsewhere in the body as well. The utilization of this for imaging has been a revolution in the staging of prostate cancer, both upfront and in the recurrent setting. We basically had fairly recent approval for PSMA PET being used more routinely in upfront staging and recurrent staging in 2022. Essentially, what this is it gives us an ability to detect whether prostate cancer has spread at a time of diagnosis or try to localize the recurrence. Now, no imaging test is perfect, of course, and a PET has a resolution of about 3 mm. There are questions about the sensitivity of the PET. You get it on a patient with high-risk disease, the PET is negative; you do surgery, there are positive lymph nodes. That can happen, but it's far superior to the tools that we have had before. For instance, beforehand, all we would have is a contrast enhanced CT, bone scan, and MRI. And the sensitivity of those is far below that of a PSMA PET. And that has actually been shown in a randomized trial called the ProPSMA trial out of Australia, where they compared conventional upfront imaging versus PSMA upfront imaging with a crossover design, and there was better detection of disease with the PSMA PET. So that's been a revolution in how we stage prostate cancer. But I'm sure many of your listeners and others are aware of the concerns. When you get a new test and you're detecting disease that's extra prostatic, for instance, are you seeing truly significant new disease that we do need to change our management for, or are we just seeing stuff that wasn't there before that actually wouldn't impact anything? And what I mean by that is, let's say you're seeing things that would never have made a difference to the patient, but now you're saying they have metastatic disease. You're changing their entire treatment paradigm, all kinds of things like that. There's implications to this that hasn't been fully fleshed out. But very recently, like we're talking in July of 2024, essentially, there was a Lancet Oncology paper that looked at the long-term prognosis of patients who had extra prostatic disease on PSMA PET, judged by something called a PROMISE score, kind of gives a quantification on the volume of disease, the brightness of disease, and they correlated that with long term outcomes. And that was really the first time that we have long term follow up data that this extra prostatic disease on PSMA PET actually is prognostically important. So, we're getting there. I mean, now that it's approved and, in some sense, the cat is out of the bag, patients are coming in asking for a PSMA PET, etc. I'm sure everyone has experienced that, but I think we now do have good evidence that it actually is prognostically important as well. Dr. Rafeh Naqash: Thank you for that explanation. And again, to put this into context for things that I've seen and that might also help the listeners in other tumors, so, for example, melanoma surveillance tends to be or while on treatment, patients tend to have more PET scans than what you see, maybe in individuals with lung cancer, where you get a baseline PET and then you have follow up CT scan based imaging is that something that you guys have shifted from in the prostate cancer space with the approval for PSMA PET, where follow up imaging, whether patient is on treatment or surveillance imaging, is PSMA PET based? Dr. Amar Kishan: Yeah, that's a good question. I think there's actually less robust data to support it as a means of treatment response. But in terms of evaluating a recurrence, then, yes, that has become kind of a standard tool. It's very complicated because all of the metrics that we have for, say, a treatment failing are based on conventionally detected metastases or something that shows up on a CT or bone scan. So, again, that question arises if someone is on systemic therapy and then you see something on a PSMA PET, are you going to abandon the therapy that you're on? It technically would be earlier than you would otherwise have done that, or what are you going to do? So, that hasn't been fully fleshed out, but it is used in that circumstance. So, I'd say less for treatment monitoring and more for evaluation of suspected recurrence. Dr. Rafeh Naqash: Understood. And I'm guessing, as a futuristic approach, somebody out there may perhaps do a trial using PSMA PET based imaging to decide whether treatment change needs to be made or does not need to be made. Dr. Amar Kishan: Yeah. It is being incorporated into trials as we speak, I think. Dr. Rafeh Naqash: Now, going to the second part of this paper is the Decipher score. Could you explain what the score is, what its components are, how it's calculated? Is it DNA, is it RNA, is it both combined? Is it tissue based; is it blood based? Dr. Amar Kishan: Yeah. So, the Decipher is also an approved test now, was approved in 2018. What it is, essentially, and how it's derived is based on the idea originally that patients might have a recurrence after surgery for prostate cancer. And it's just a PSA recurrence. It's this way. It's literally what we call a biochemical recurrence. That patient might not have any problems, whereas other patients with a recurrence might go on to develop metastatic disease. And we didn't have a good way of determining which patient is which. Get back to that prognostic problem that we have. So, some investigators, they looked at men that had radical prostatectomy from 1987 to 2001 at the Mayo Clinic that had archived tissue. They looked at FFPE, or basically paraffin embedded tissue. They extracted the RNA and then did a microarray analysis and looked at transcriptomic signatures and wanted to see, could this discern the patients who had mets, who had clinically significant recurrences from those that didn't? And out of that exercise came the Decipher Genomic Classifier, which basically is based on 22 genes. These are involved with cell proliferation, etc., but it's an RNA-based, tissue-based assay. So, if you wanted to order a Decipher on somebody, you would need to use a biopsy or prostatectomy specimen to do so. Essentially, that the samples, they would take the highest grade, highest Gleason grade specimen, send it to their lab. Their main lab is in California. The company is called Veracyte. And then they will do this RNA express analysis with a microarray and then return a score. The score is 0 to 1. Basically, 0 is the lowest, one is the highest, and it is a way of prognosticating the risk of metastasis. Originally, when you get a Decipher report, it actually will tell you the 5 and 10-year risks of distant metastasis, and we'll quantify that. Dr. Rafeh Naqash: And you said this is approved or has been approved in 2018. So, is this insurance reimbursable at this point? Dr. Amar Kishan: Most insurances do, not all, and the criteria for getting it can vary, so we can talk about it, but it was initially developed in this post-op setting. On the basis of a significant amount of validation studies, it has been moved to being used in the upfront setting as well. So, if you look at some of the ongoing NRG trials, for instance, they are stratifying patients based off the upfront Decipher score. And this is based off of validation studies that have been conducted looking at past RTOG trials and other trials. That said, sometimes it is not approved by commercial insurances in the upfront setting, because that wasn't where it was initially validated and derived. But honestly, here in 2024, that's very uncommon. It's much more common that it's approved. Dr. Rafeh Naqash: Understood. And in your practice, or the medical oncologist practice at your institution or other institutions, is this something that is commonly used for some sort of treatment decision making that you've seen? Dr. Amar Kishan: Yeah. So, as a radiation oncologist, I do think it's a useful test, because my approach is, if we're talking about adding hormone therapy, for instance, which is oftentimes dominating the conversation, we know that it offers a relative benefit to a lot of patients. We've published on this; others have published on it. Let's say it reduces the chance of metastasis by about 40%. 10-year risk of metastasis has a ratio of 0.6. So, 40% reduction. But if your risk of metastasis is 2%, that benefit is not that much in absolute terms. And we don't historically have a great way of saying, what is your absolute risk of metastasis? And I think Decipher is one tool that does tell us that - it literally gives it on the report. Now, is that a holy grail? Is it 100% accurate? Nothing is 100% accurate. But it does give us some quantification. Then I can go back to the patient and say, yes, you will get a benefit from adding hormone therapy, but you're talking about going from 2% to 1%, and so they can decide if that's worth it to them. Conversely, it could be a situation where they really don't want hormone therapy, but it comes back that their risk of metastasis is 20%, and then there's actually a big absolute benefit. So that's how I use it as a radiation oncologist, and we would use it upfront. Now surgeons, and if I was consulting on a post operative patient, maybe it plays more of a role. And do we need to do post operative radiotherapy on this patient, or do we need to add hormone therapy in the postoperative situation? From the medical oncology perspective, there are emerging data that may be useful in the choice of systemic therapy for metastatic disease, but that is a little bit earlier in the investigational stage, I would say. So, when I'm working with medical oncologists, it's often still in this localized setting, and typically, do we add hormone therapy or not, and that type of thing. Dr. Rafeh Naqash: Understood. And from a reporting standpoint, so the Decipher score, I'm guessing it's some sort of a report that comes back to the ordering physician and you basically see the score, it gives you a potential recurrence free survival percentage or a metastasis percentage of what is your risk for having metastasis in the next five years - is that how they generally do it? Because I've personally never seen one, so I'm just curious. Dr. Amar Kishan: Yeah, essentially, it comes back with a score, a numerical score, again, from 0 to 1, and it will basically give you the five-year risk of distant metastasis. The ten-year risk of distant metastasis. You can request an extended report that provides additional, not as well supported signatures that are out there, like ADT response signature, etc. But those maybe may have been published, but are not clinically validated as much, but the actual Decipher report, which goes to patients too, just has this kind of 5,10-year risk of distant metastasis. They have some estimations on prostate cancer specific mortality as well. Dr. Rafeh Naqash: Sure. Now, the third part of this project, and correct me if I'm wrong, the grid database of the 265 genomic signature score. From what I understood, this is a different component than the Decipher score. Is that a fair statement? Dr. Amar Kishan: Yeah. No, that's exactly correct. And that was an exploratory part of this analysis, to be honest. Basically, I think our main focus in the paper was those advances that we've talked about PSMA and Decipher, those happened concurrently. People started developing PSMA PET, people started developing Decipher. And so, what we wanted to understand was, if you have a patient that has extra prosthetic disease on PSMA PET, are those biologically more aggressive cancers, is their Decipher score going to be higher? What can we learn about the biology of this? And we were the first, to my knowledge, where we actually had a large data set of patients that actually received PSMA PETs and Decipher. And that's kind of the gist of the paper. We have patients in the upfront setting, patients in the post radical prostatectomy setting, and we're essentially showing that there is this correlation. In the upfront setting, the odds of extra prosthetic disease are higher for higher Decipher scores, which is kind of maybe validating that this biology is capturing something that's akin to this ability to spread. And in the post-op setting, because we have time to failure, technically, we can calculate a hazard ratio rather than odds ratio. So, we have a hazard ratio that's significantly associated with an increased risk of spread for patients with higher Decipher. The grid portion, which is the genomic resource information database, was more of an exploratory part where I mentioned the Decipher score is based off this microarray, they're looking at 1.4 million transcripts. Only 22 are part of the Decipher, but you can request the rest of the signature data as well. And so, we wanted to look at other pathways, other signatures that have been published, like looking at DNA repair, neuroendocrine pathway, just to see if we could see any correlations there that's not necessarily as clinically actionable. These are more exploratory. But again, we were trying to just look at whether patients who had non localized disease on their PSMA PET, whether their primary had more aggressive biology. We did see that. So that's kind of loosely speaking things like PTEN loss, androgen receptor, DNA repair, metabolism, neuroendocrine signaling, which are thought to be portenders of aggressive disease. Those pathways were upregulated at the RNA level in patients who had non-localized disease. And that's kind of the take home from that. But I wouldn't say any of that is clinically actionable at this point. It's more kind of defining biology. Dr. Rafeh Naqash: Some of the interesting correlations that you make here, at least in the figures that we see, you're looking at different local occurrences, nodal metastases, M1A and M1B disease. And one thing that I'm a little curious about is the Decipher score seems to be lower in pelvic nodal metastasis, that is, PSMA PET positive versus local recurrence, which has a slightly higher Decipher score. Is that just because of a sample size difference, or is there a biologically different explanation for that? Dr. Amar Kishan: Yeah, that's a good point. I would assume that's probably because of a sample size in this case, and it's a little bit complicated. It wasn't statistically different. And it was 0.76 on average for patients with local recurrence and 0.7 for patients with a pelvic nodal metastasis. Well, what I think is interesting is we can maybe think that in this post-op setting the time to failure could have been long in some of these cases. So, it is conceivable that an isolated nodal recurrence 10 years after the surgery, for instance, is not as aggressive a cancer as a local recurrence in a short time after the surgery. And that's not taken into account when you're just looking at median scores like we are in this fox and whiskers plot. But overall, I think what it's suggesting is that there are patients who have more indolent disease. That's actually pretty widespread there. There are pretty indolent cases that have these nodal metastases. So just because you have a nodal metastasis doesn't mean it's an incredibly aggressive cancer, biologically. Dr. Rafeh Naqash: Now, the exploratory component, as you mentioned, is the grid part where you do look at TP53, which is a cell cycle gene, and higher TP53 associated with worse recurrences, from what I understand. Do you see that just from a cell cycle standpoint? Because from what I, again, see in the paper, there's a couple of other cell cycle related signatures that you're using. Is that just a surrogate for potential Gleason score? Have you guys done any correlations where higher Gleason score is associated with maybe higher cell cycle checkpoint, pathway related alterations and replication stress and DNA damage and perhaps more aggressive cancers? Dr. Amar Kishan: Yeah, that's a great question. We haven't done that in this paper, but it has been published before that there is this correlation loosely between grade and some of these parameters - so repair, metabolism, androgen receptor signaling. However, it's a very great point that you bring up, which is that it's pretty heterogeneous and that's why we need something like this as opposed to Gleason score. So, you can have Gleason 10 cancer. I mean, that would be pretty uncommon. But within the Gleason 9, at least, which we have published on and looked at, there's a heterogeneity. There are some that are biologically not that aggressive. And the converse Gleason 7, you can have some that are actually biologically aggressive. That's why it may be useful to move away from just the pathological architecture and get a little bit more into some of these pathways. Dr. Rafeh Naqash: What's the next step here? I know this perhaps isn't ready for primetime. How would you try to emphasize the message in a way that makes it interesting and clinically applicable for your colleagues in the GU community? Dr. Amar Kishan: Yeah. I think for me, what I would try to emphasize here and what I think is the main takeaway is this is kind of a validation that having extra prostatic disease on PSMA PET is likely suggestive of a more aggressive disease biology. And I think what this stresses to me is the importance of getting a PSMA PET, particularly in patients with high-risk prostate cancer. This isn't always happening. And I think if we see things on a PSMA PET, we really need to consider systemic therapy intensification. And what do I mean by that as a practical point? You have a high-risk prostate cancer patient. You get a PSMA PET, you see an isolated pelvic lymph node. If we believe the results of the study, that's a more aggressive biology likely. Whether we have the Decipher or whether we have genomic signatures, which we may or may not have, maybe that patient should get treated with something like an androgen receptor signaling inhibitor in addition to ADT, more akin to a clinically node positive case. So, intensify the systemic therapy, more aggressive disease. That's how I would incorporate it practically into my practice, that really what we're seeing on the PSMA PET is real. It's a reflection of biology that's aggressive. It's not just some Will Rogers effect where you're upstaging stuff needlessly. I think this is telling us some true biology. So that's kind of what my takeaway would be. I think future areas of investigation would be, honestly, to try to have a better idea of what's going on in these metastases. So, if you could design a study potentially, where your biopsy some of these and actually do sequencing and understand a little bit more of that. And so, we're looking into stuff like that. But my takeaway for like the everyday clinician would be to try to get a PSMA PET, if you can, and to intensify therapy on the basis of that, or at least consider it, discuss it in a multidisciplinary setting. Dr. Rafeh Naqash: And I'm guessing somebody out there, perhaps even you, are thinking or planning on doing a ctDNA MRD based correlation here, since that's up and coming in this space. Dr. Amar Kishan: That is up and coming, I think one of the challenges in prostate cancer is the amount of ctDNA can be low. But yes, you're right, that's certainly things that a lot of us are looking at, too. Dr. Rafeh Naqash: Excellent. Well, thank you for the science discussion, Dr. Kishan, could you tell us a little bit about yourself, your career trajectory, where you started, what you're doing, and perhaps some advice for early career junior investigators, trainees, things that might have worked for you, that could also work for them as they are progressing in their careers. Dr. Amar Kishan: Sure. So, yeah, I'm a radiation oncologist at UCLA. I run the prostate cancer radiation program. Clinically. I'm also heavily involved in our research enterprise, so I kind of oversee the clinical and translational research aspect. That's what I do currently. So, I did my residency in radiation oncology at UCLA. Just on a personal note, my wife is from LA, her parents live in LA. We really wanted to stay in LA, so I was fortunate to be able to join the faculty here. I always liked GU oncology, so that was kind of a natural thing for me to kind of go into this position here and try to build the GU program. I've been very fortunate to have great collaborators. My message to students and trainees is to try to reach outside your department for mentorship as well. It's important to have people inside your department who can mentor you. But as a radiation oncologist, I work so closely with urology, so closely with medical oncology that I'm very fortunate to have individuals in those departments who have a vested interest in me and my success as well. I like working with them. It's important to be a team player. If they need help, you help them. If you need help, you ask for help from them. So, I think that's the single biggest thing that I would say to any trainee is don't be intimidated. Please reach outside of your department. Lots of people are willing to help and provide mentorship, and it's helpful to have that perspective. We are in a very multidisciplinary environment and era of practicing medicine. Dr. Rafeh Naqash: Well, thank you again for those personal insights and especially for submitting your work to JCO PO. And we hope to see more of this work perhaps in the subsequent sessions for JCO PO, and maybe we'll bring you back again. And at that point, the Decipher and the PSMA PET scan will have more data, more implementation in the clinically relevant real-world setting. Dr. Amar Kishan: Thank you very much. And if I could just give one quick shout out. The first author of this work, which I presented, was Dr. John Nikitas, who is a trainee that works with me here at UCLA a PGY5 resident. So, I do want to give credit to him as well. Dr. Rafeh Naqash: And John, if you're listening to this hopefully, it's always great to get a shout out from your mentor. Thank you both again for putting in the work and effort to submit this manuscript. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcasts. 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. Disclosures Dr. Kishan Honoraria Company: Varian Medical Systems, Boston Scientific, Janssen Oncology Consulting or Advisory Role Company: Janssen, Boston Scientific, Lantheus Research Funding Company: Janssen , Point Biopharma

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Advances in Nuclear Medicine for Prostate Cancer Imaging

Radiology Imaging Cancer Podcasts | RSNA

Play Episode Listen Later Sep 5, 2024 37:47

Dr. Daniel Kwon interviews Dr. Peter Choyke, a leading expert in molecular imaging and nuclear medicine, about the recent advancements in the use of PSMA PET imaging for prostate cancer. Check out more articles on this topic Prostate Cancer Special Collection

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AUA2024:How to use PSMA-PET/CT in the Management of Relapsing Prostate Cancer Patients

AUAUniversity

Play Episode Listen Later Aug 21, 2024 101:21

How to use Prostate-Specific Membrane Antigen-Positron Emission Tomography/CT in the Management of Relapsing Prostate Cancer Patients following Local Therapy with Curative Intent CME Available: https://auau.auanet.org/node/41124 At the conclusion of this activity, participants will be able to: 1. Identify the clinical scenario in which PSMA PET/CT is most helpful to identify the localization and extent of locoregional or systemic metastatic disease. 2. Identify the pitfalls of false-positive and false-negative PSMA PET/CT findings. 3. Apply the findings of PSMA PET/CT for the best individual therapeutic approach. 4. Identify patients with radiorecurrent organ-confined prostate cancer. 5. Identify those patients who are candidates for local therapy of oligometastatic disease in relapsing prostate cancer. ACKNOWLEDGEMENTS This educational activity is supported by independent educational grants from: Astellas, Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC, Lantheus Medical Imaging, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer, Inc.

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AI for Improved PET/CT Attenuation Correction in Prostate Cancer Imaging

Oncotarget

Play Episode Listen Later Jul 11, 2024 5:51

Positron Emission Tomography (PET) combined with Computed Tomography (CT) is a powerful imaging modality used in oncology for diagnosis, staging, and treatment monitoring. However, one limitation of PET/CT is the need for accurate attenuation correction (AC) to account for tissue density variations. Traditionally, low-dose CT scans are used for AC, but these contribute to patient radiation exposure. In a new study, researchers Kevin C. Ma, Esther Mena, Liza Lindenberg, Nathan S. Lay, Phillip Eclarinal, Deborah E. Citrin, Peter A. Pinto, Bradford J. Wood, William L. Dahut, James L. Gulley, Ravi A. Madan, Peter L. Choyke, Ismail Baris Turkbey, and Stephanie A. Harmon from the National Cancer Institute proposed an artificial intelligence (AI) tool to generate attenuation-corrected PET (AC-PET) images directly from non-attenuation-corrected PET (NAC-PET) images, reducing the reliance on CT scans. Their research paper was published in Oncotarget's Volume 15 on May 7, 2024, entitled, “Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN.” Full blog - https://www.oncotarget.org/2024/07/11/ai-for-improved-pet-ct-attenuation-correction-in-prostate-cancer-imaging/ Paper DOI - https://doi.org/10.18632/oncotarget.28583 Correspondence to - Stephanie A. Harmon - stephanie.harmon@nih.gov Video short - https://www.youtube.com/watch?v=0mZItCB8AtI Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28583 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, deep learning, PSMA PET, attenuation correction About Oncotarget Oncotarget is an open-access, peer-reviewed journal that has published primarily oncology-focused research papers since 2010. These papers are available to readers (at no cost and free of subscription barriers) in a continuous publishing format at Oncotarget.com. Oncotarget is indexed and archived by PubMed/Medline, PubMed Central, Scopus, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science). To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

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7.1.2024 - CONTINUUM

Winning the War on Cancer (Video)

Play Episode Listen Later Jul 1, 2024 8:58

Check out this week's QuadCast as we highlight the benefit of immunotherapy for nasopharynx cancer, new ASTRO guidelines for HPV+ oropharynx cancer treatment, the benefits of surgery for low grade serous ovarian cancer, the potential of PSMA PET to help with recurrent GBM, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom

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Functional Imaging and Recurring Prostate Cancer

Play Episode Listen Later May 29, 2024 18:58

As part of the 2024 Prostate Cancer Patient Conference, Dr. Thomas Hope presents information on PSMA-PET and discusses imaging in the evaluation of biochemical recurrence in prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 39762]

care medicine cancer patients disease treatments cure male surgery functional imaging oncology recurring prostate cancer prostate ucsf medicine show id cancer and oncology psma pet prostate cancer patient conference

Functional Imaging and Recurring Prostate Cancer

Health and Medicine (Video)

Play Episode Listen Later May 29, 2024 18:58

As part of the 2024 Prostate Cancer Patient Conference, Dr. Thomas Hope presents information on PSMA-PET and discusses imaging in the evaluation of biochemical recurrence in prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 39762]

care medicine cancer patients disease treatments cure male surgery functional imaging oncology recurring prostate cancer prostate ucsf medicine show id cancer and oncology psma pet prostate cancer patient conference

Functional Imaging and Recurring Prostate Cancer

University of California Audio Podcasts (Audio)

Play Episode Listen Later May 29, 2024 18:58

As part of the 2024 Prostate Cancer Patient Conference, Dr. Thomas Hope presents information on PSMA-PET and discusses imaging in the evaluation of biochemical recurrence in prostate cancer. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 39762]

care medicine cancer patients disease treatments cure male surgery functional imaging oncology recurring prostate cancer prostate ucsf medicine show id cancer and oncology psma pet prostate cancer patient conference

2.26.2024 - Change of Plan