Podcasts about psma pet

SummaryThis Uromigos podcast delves into the evolution and significance of the Prostate Cancer Working Group criteria, highlighting the iterative process of developing guidelines that reflect the latest scientific evidence and clinical practices. The speakers discuss the new PCWG4 including new nomenclature, the role of imaging technologies like PSMA PET, and the importance of biomarkers and patient-reported outcomes in enhancing patient care and treatment efficacy. They emphasize the collaborative nature of the working groups and the ongoing need for adaptation in response to emerging data and technologies.

Host Dr. Davide Soldato and guests Dr. David Einstein and Dr. Ravi Madan discuss JCO article, "National Cancer Institute's Working Group on Biochemically Recurrent Prostate Cancer: Clinical Trial Design Considerations," underscoring the need for a consensus on clinical trial designs implementing novel endpoints in this population, the importance of PSA doubling time as a prognostic factor and with an emphasis on treatment de-escalation to limit toxicity and improve patient outcomes. TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, medical oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO authors Dr. David Einstein and Dr. Ravi Madan. Dr. Einstein is a medical oncologist specializing in genitourinary malignancy working at Beth Israel Deaconess Medical Center, part of the DFCI Cancer Center, and an assistant professor at Harvard Medical School. Dr. Madan is a senior clinician at the National Cancer Institute (NCI), where he focuses on conducting clinical research in prostate cancer, particularly in the field of immunotherapy. Today, we will be discussing the article titled, "National Cancer Institute's Working Group on Biochemically Recurrent Prostate Cancer: Clinical Trial Design Considerations." So, thank you for speaking with us, Dr. Einstein and Dr. Madan. David Einstein: Thanks for having us. This is a great pleasure. Ravi Madan: Appreciate being here. Davide Soldato: So, I just want to start from a very wide angle. And the main question is why did you feel that there was the need to convey a consensus and a working group to talk about this specific topic: biochemically recurrent prostate cancer? What has been the change in current clinical practice and in the trial design that we are seeing nowadays? And so, why was it necessary to convey such a consensus and provide considerations on novel clinical trials? David Einstein: Yeah, so I think it's very interesting, this disease state of biochemically recurrent prostate cancer. It's very different from other disease states in prostate cancer, and we felt that there was a real need to define those differences in clinical trials. Years ago, metastatic castration-resistant prostate cancer was the primary disease state that was explored, and over time, a lot of things shifted earlier to metastatic disease defined on a CAT scan and bone scan to an earlier disease state of metastatic castration-sensitive prostate cancer. And the clinical trial principles from late-stage could be applied to MCSPC as well. However, BCR is very different because the patients are very different. And for those reasons, there are unique considerations, especially in terms of toxicity and treatment intensity, that should be applied to biochemically recurrent prostate cancer as opposed to just using the principles that are used in other disease states. And for that reason, we thought it was very important to delineate some of these considerations in this paper with a group of experts. Davide Soldato: Thanks so much. So, one of the main changes that have been applied in recent years in clinical practice when looking at biochemically recurrent prostate cancer is the use of molecular imaging and particularly of PSMA PET. So, first of all, just a quick question: was the topic of the consensus related on which threshold of PSA to use to order a PET scan to evaluate this kind of patient? David Einstein: Yeah, thanks for that question. It's a super important one. The brief answer is that no, we did not address questions about exactly when clinicians would decide to order scans. We were more concerned with the results of those scans in how you define different disease states. But I think as a broader question, I think a lot of folks feel that finding things on a scan equates that with what we used to find on conventional scans. And fundamentally, we actually sought to redefine that disease space as something that's not equivalent to metastatic disease, and rather coined the term "PSMA-positive BCR" to indicate that traditional BCR prognostic criteria and factors still apply, and that these patients have a distinct natural history from those with more advanced metastatic disease. Ravi Madan: And if I may just add that the National Cancer Institute is running a trial where we're prospectively monitoring PSMA-positive BCR patients. And that data is clearly showing that, much like what we knew about BCR a decade ago, PSMA findings in BCR patients do not change the fact that overall, BCR is an indolent disease state. And the findings, which are usually comprised of five- to seven-millimeter lymph nodes, do not endanger patients or require immediate therapy. And so, while PSMA is a tool that we can be using in this disease state, it doesn't really change the principal approach to how we should manage these patients. And as Dr. Einstein alluded to, there is a drive to create a false equivalency between PSMA-positive BCR and metastatic castration-sensitive prostate cancer, but that is not supported by the data we're accumulating or any of the clinical data as it exists. Davide Soldato: One thing that it's very important and you mentioned in your answer to my question was actually the role of PET scan and conventional imaging, so CAT scan and bone scan that we have used for years to stage patients with metastatic prostate cancer. And you mentioned that there is a distinction among patients who have a positive PET scan and a BCR, and patients who have a positive conventional imaging. And yet, we know that sometimes the findings of the PET scan are not always so clear to interpret. So, I just wanted to understand if the consensus reached an agreement as to when to use conventional imaging to potentially resolve some findings that we have on PET scan among thess patients with BCR? David Einstein: Yeah, I think there's a number of questions actually buried within that question. One of which is: does PSMA PET result in false positives? And the answer has definitely been yes. There's a known issue with false-positive rib lesions. And so, first and foremost, we need to be very careful in calling what truly is suspicious disease and what might actually not be cancer or might be something that is totally separate. So I think that's the first part of the answer to that question. The second is to what extent do we need to use paired PET and conventional imaging to define this disease state? In other words, do you have to have positive findings on one and negative findings on the other in order to enter this definition? The challenge there, as we discussed, is that logistically, oftentimes it's hard to get patients to do multiple sets of scans to actually create that definition. Sometimes it's difficult to get insurers to pay for such scans. And finally, it's hard to sometimes blind radiologists to the results of one scan in reading the other. So, we did have some deliberations about to what extent you could use some of the CAT scan portion of a PSMA PET in order to at least partially define that. We also talked about using bone scans to confirm any bone findings seen on PET. But I think another important part of this is not just the baseline imaging, but also what's going to be done serially on a study in order to define responses and progression. And that's sort of a whole separate conversation about to what extent you can interpret changes in serial PET. Ravi Madan: And just to pick up on the key factor here, I think that the PSMA PET in BCR is pretty good at defining lymph node disease, and that's actually predominantly 80 to 90 percent of the disease seen on these findings. It might be pretty good at also defining other soft tissue findings. The real issues come to bone findings. And one thing the group did not feel was appropriate was to just define only PSMA-positive bone findings confirmed on a CT bone window. There's not really great data on that, but the working group felt that, when in the rare situation, because it is relatively rare, a PSMA-positive finding is in a bone, a bone scan should be done. And it's worth noting that Phu Tran, who is a co-author and a co-leader of this working group, his group has already defined that underlying genomics of conventionally based lesions, such as bone scan, are more aggressive than findings on next-gen imaging, such as PSMA. So, there is also a genomic underlying rationale for defining the difference between what is seen on a PET scan in a bone and what is seen on a bone scan. Davide Soldato: Coming back to this issue of PET PSMA sometimes identifying very small lesions where we don't see any kind of correlates on conventional imaging or where we see only very little alteration on the bone scan or in the CT scan, was there any role that was imagined, for example, for MRI to distinguish this type of findings on the PET scan? Ravi Madan: So, I think that, again, what can be identified on a PSMA frequently cannot be seen on conventional imaging. We didn't feel that it was a requirement to get an MRI or a CT to necessarily confirm the PSMA findings. I think that generally, we have to realize that in this disease state, that questionable lesions are going to be seen on any imaging, including PSMA. We've actually probably put way too much faith in PSMA findings thus far, as Dr. Einstein alluded to with some of the false positives we're seeing. So, I think that these false positives are going to have to be baked into trials. And in terms of clinical practice, it highlights the need to again, not overreact to everything we see and not necessarily need to biopsy everything and put patients' health in jeopardy to delineate a disease that's indolent anyway. Davide Soldato: Thanks so much. That was very clear. So, basically, the main driver was really also the data showing that if we have a BCR, so a patient with a biochemically recurrent disease that is positive on the conventional imaging, this is usually associated with a different aggressiveness of the disease. But coming back to a comment that you made before, Dr. Madan, you said that even if we talk about PSMA-positive BCR, we are still talking about BCR and the same criteria should apply. So, what we have used for years in this space to actually try to stratify the prognosis of patients is the PSA doubling time, so how quickly the PSA rises over time. So, coming back to that comment, was the consensus on the PSA doubling time basically retained as what we were using before, so defining patients with a doubling time less than 12 months, 10 months, 9 months, as patients with a higher risk of progressing in terms of developing metastatic disease? Ravi Madan: Yes, so that's a very important point. And the working group defined high-risk BCR as a PSA doubling time less than six months. And this really comes from Johns Hopkins historical data, which shows that if your doubling time is three months or less, there's about a 67 percent chance of metastasis at five years. If it's between three and six months, it's 50 percent. And if it's over six months, if it's between six and nine months, it's roughly only 27 percent. There are trials that are accruing with eligibility criteria that they may describe as high-risk that are beyond six months, but the data as really it's been defined in the literature highlights that truly high-risk BCR is less than six months. And the working group had a consensus on that opinion, and that was our recommendation. David Einstein: And I think an important follow-on to that is that's regardless of PET findings, right? And so, we present a couple of case studies of patients with positive PET findings who have a long doubling time, in whom the disease is in fact indolent, as you would have expected from a traditional BCR prognostic standpoint. Obviously, there are patients in whom they have fast doubling times, and even if they do not have PET findings, that doesn't make them not high-risk. Ravi Madan: And just to follow up that point, I will let you know a little bit of a free preview that my colleague Melissa Abel from the NCI will be presenting PSMA findings in the context of PSA doubling time at ASCO GU if that data is accepted. Davide Soldato: Looking forward for those data because I think that they're going to clarify a lot of the findings that we have in this specific population. And coming back to one of the points that we made before, so PET PSMA has a very high ability to discriminate also a very low burden of disease, which we currently refer to as oligometastatic biochemically recurrent prostate cancer, which is not entirely defined as an entity. But what we are seeing both in some clinical trials, which use mainly conventional imaging, but also what we're starting to see in clinical practice, is that frequently we use the metastasis-directed therapy to treat these patients. So, just a little bit of a comment on the use of this type of strategy in clinical practice and if the panel thought of including this as, for example, a stratification criteria or mandated in the design of novel clinical trials in the field of BCR? David Einstein: Yeah, I think that's an incredibly important point. You know, fundamentally, there's a lot of heterogeneity in practice where some folks are using local salvage approaches, some are using systemic therapies, in some cases surveillance may be reasonable, or some combination of these different strategies. We certainly have phase two data from multiple trials suggesting that met-directed therapy may help buy patients time off of treatment until subsequent treatments are started. And that in and of itself may be an important goal that we can come back to in discussing novel endpoints. I think what our panel acknowledged was that, in some sense, the clinical practice has gotten even farther ahead than where the data are, and this is being offered pretty routinely to patients in practice. And so, what became clear was that we, in developing clinical trials, cannot forbid investigators from doing something that would be within their usual standard of care, even if it might not be supported by the most robust data. But at minimum, it definitely should be used as a stratification factor, or in some trial designs, you can do met-directed therapy after a primary endpoint is assessed. And that offers a compromise between testing, say, the effect of a systemic therapy but also not excluding patients and investigators from doing what they would have done had they not been on a study. Ravi Madan: And I would just like to follow up your phrasing in the question of "oligometastatic prostate cancer." We have a figure in the paper and it highlights the fact that, unfortunately, that term in prostate cancer is imaging agnostic. And we've already discussed in this podcast, as well as in the paper, that imaging used to define a metastatic lesion, whether it's PSMA or conventional imaging, carries with it a different clinical weight and a different prognosis. So, we feel in the working group, that the correct term for this disease state of PSMA-positive BCR is just that: PSMA-positive BCR. We also have to realize that when we talk about oligometastatic disease, while it's imaging agnostic, it seems to be numerically based, whether it's five or three or 10 depending on the trial. But PSMA-positive BCR does not have a limit in terms of the number of lesions. And so again, we just feel that there is an important need to delineate what we're seeing in this disease state, which again is PSMA-positive BCR, and that should be differentiated frankly from oligometastatic disease defined on other imaging platforms. David Einstein: Right, and that also makes clear that patients can have polyfocal disease on PET that still is not what we would consider metastatic, but goes beyond the traditional definition of oligometastatic. So, in other words, just because someone has PET-detected disease only, that does not automatically equate with oligometastatic. Davide Soldato: Thanks so much. So, you were speaking a little bit, Dr. Einstein, about the different types of treatment that we can propose or not propose to this patient because you mentioned, for example, that in clinical practice MDT, so metastasis-directed therapy, is becoming more and more used. For these patients, we can potentially use systemic treatments, which include androgen deprivation therapy, which can be given continuously or in an intermittent fashion. And recently, we can also use novel systemic therapies, for example, enzalutamide, to treat this type of patient. So, given that the point of the consensus was really to provide consideration for novel clinical trials in this space, what was the opinion on the panel regarding the control arm? So, if we're looking at a novel therapy in the BCR space, does the control arm need to include a therapy or not? And if so, which therapy? David Einstein: Yeah, this is a super important question and one that's subject to a lot of discussion, especially in light of recent data from EMBARK. What we came to a consensus around was the fact that neither MDT nor systemic therapy should be required as a control arm on BCR trials. And we can talk about a number of reasons for that. There's also the pragmatics of what investigators might actually accrue patients to and what they would consider their standard of care, and that's important to factor in, too. I think that one of the major goals of our working group was outlining what kinds of trials we would like to see in the future and where the limitations of the current data stand. For example, EMBARK proposes a strategy of a single treatment discontinuation and resumption at a predefined threshold indefinitely. That's probably not how most people are practicing. Most folks are probably using some version of intermittent therapy as they would have before this trial, but we actually don't have any data supporting that. Moreover, we don't have data comparing different intermittent strategies to one another. We don't know what the right thresholds are, we don't know how much time we buy patients off treatment, and we don't know to what extent MDT modifies that. And so, those are all really important questions to be asking in future versions of these trials. I'd say my second point would be that a lot of drug development is happening with novel therapies that are not hormonal, trying to bring them into this space. And when you think about trying to compare one of those types of therapies to a hormonal therapy on short-term endpoints, the hormonal therapy is always going to win. Hormonal therapy is almost universally effective, it will bring down PSAs, and it will prolong, quote-unquote, "progression." The downside of that is that hormonal therapy doesn't actually modify the disease, it suppresses it, and it tends to have fairly transient effects once you remove it. And so, part of our goal was in trying to figure out some novel endpoints that would allow these novel types of therapies to be examined head-to-head against a more traditional type of hormonal therapy and have some measurement of some of the more long-term impacts. Davide Soldato: So, jumping right into the endpoints, because this is a very relevant and I think very well-constructed part of the paper that you published. Because in the past we have used some of these endpoints, for example, metastasis-free survival, as potentially a proxy for long-term outcomes. But is this the right endpoint to be using right now, especially considering that frequently this outcome is measured using conventional imaging, but we are including in these trials patients who are actually negative on conventional imaging but have a positive PSMA when they enter this type of trial? David Einstein: Yeah, there's a number of challenges with those types of endpoints. One of which is, as you say, we're changing the goalposts a little bit on how we're calling progression. We still don't exactly understand what progression on PET means, and so that's something that is challenging. That said, we're also cognizant of the fact that many times investigators are likely to get PET scans in the setting of rising PSA, and that's going to affect any endpoint that relies purely on conventional imaging. So, there's some tension there between these two different sets of goalposts. One thing that we emphasize is that not only are there some challenges in defining those, but also there're challenges in what matters to a patient. So, if a progression event occurs in the form of a single lesion on a PET scan or even a conventional image, that might be relevant for a clinical trial but might be less relevant for a patient. In other words, that's something that, in the real world, an investigator might use serial rounds of metastasis-directed therapy or intermittent therapy to treat in a way that doesn't have any clinical consequences for the patient necessarily. In other words, they're asymptomatic, it's not the equivalent of a metastatic castration-resistant disease progressing. And so, we also need to be cognizant of the fact that if we choose a single endpoint like PFS, that there's going to be many different versions of progression, some of which probably matter clinically more than others, and some of which are more salvageable by local therapies than others. Ravi Madan: So I think the working group really thoughtfully looked at the different options and underscored perhaps strengths and weaknesses, and I think that's presented as you mentioned in the paper. But I think it's also going to depend on the modality, the approach of the therapeutic intervention. In some cases if it's hormone-based, then maybe PSA is providing some early metrics, maybe metastasis-free survival is more relevant in a continuous therapy, but intermittent therapies might have a different approach. There's emerging immunotherapy strategies, radiopharmaceutical strategies, they might have some more novel strategies as well. I think we have to be open-minded here, but we also have to be very clear: we do not know what progression is on a PSMA scan. Just new lesions may not carry the clinical significance that we think, and we may not know what threshold that ultimately becomes clinically relevant is. So, I do think that there was some caution issued by the working group about using PSMA as an endpoint because we still do not have the data to understand what that modality is telling us. Again, I'm optimistic that the National Cancer Institute's prospective data set that we've been collecting, which has over 130 patients now, will provide some insights in the months and years ahead. Davide Soldato: So, just to ask the question very abruptly, what would you feel like the best endpoint for this type of trials is? I understand that is a little bit related to the type of treatments that we're going to use, whether it's intermittent, whether it's continuous, but do we have something that can encapsulate all of the discussion that we have up until this point? David Einstein: Yeah, so that's a perfect segue to the idea of novel endpoints, which we feel are very important to develop in these novel disease spaces. So, one thing that we discussed was an endpoint called treatment-free survival, which conceptually you can think of as exactly what it sounds like, but statistically you actually have to do some work to get there. And so essentially, you imagine a series of Kaplan-Meier curves overlaid: one about overall survival, one time to next therapy, one time on initial therapy. You can actually then take the area under those curves or between those curves and essentially sum it up using restricted mean survival time analysis. And that can give you a guide about the longitudinal experience of a patient: time spent on treatment versus off treatment; time spent with toxicity versus without toxicity. And importantly, each one of those time-to-event metrics can be adjusted depending on exactly what the protocol is and what is allowed or not allowed and what's prespecified as far as initiation of subsequent therapies. So, we felt that this was a really important endpoint to develop in this disease space because it can really capture that longitudinal aspect. It can really reward treatments that are effective in getting durable responses and getting patients off of therapy, because unfortunately, PFS-based endpoints generally reward more or longer systemic therapy versus shorter or no systemic therapy, and that's sort of an artificial bias in the way those endpoints are constructed. So, I think that there are challenges of course in implementing any new endpoint, and some of the things that are really critical are collecting data about toxicity and about subsequent therapies beyond what a typical trial might collect. But I think in this kind of disease space, that longitudinal aspect is critical because these are really patients who are going to be going through multiple rounds of therapy, going to be going on and off treatments, they're going to be using combinations of local and systemic therapies. And so, any one single endpoint is going to be limited, but I think that really highlights the limitations of using PFS-based endpoints in this space. Ravi Madan: I also think that in the concept of treatment-free survival lies one of the more powerful and, honestly, I was surprised by this, that it was so universally accepted, recommendations from the committee. And that was that the general approach to trials in this space should be a de-escalation of the EMBARK strategy as it's laid out with relatively continuous therapy with one pause. And so, I think again, buried in all of this highlights the need for novel endpoints like treatment-free survival. We get to the fact that these are patients who are not at near-term clinical risk from symptoms of their disease, so de-escalating therapies does not put them at risk. And if you look at, for example, lower-volume metastatic castration-sensitive prostate cancer, it's become realized that we need to de-escalate, and there are now trials being done to look at that. Historically, we know that BCR is an indolent disease process for the vast majority of patients who are not at near-term risk from clinical deterioration. So, therefore, we shouldn't wait a decade into abundant BCR trials to de-escalate. The de-escalation strategy should be from the outset. And that was something the committee really actually universally agreed on. David Einstein: And that de-escalation can really take multiple forms. That could be different strategies for intermittent therapy, different start-stop strategies. It could also mean actually intensifying in the short-term with the goal long-term de-intensification, kind of analogous to kidney cancer where we might use dual checkpoint inhibitors up front with some higher upfront toxicity but with the hope of actually long-term benefit and actually being able to come off treatment and stay in remission. Those kinds of trade-offs are the types of things that are challenging to talk about. There's not a one-size-fits-all answer for every patient. And so, that's why some of these endpoints like treatment-free survival would be really helpful in actually quantifying those trade-offs and allowing each patient to make decisions that are concordant with their own wishes. Davide Soldato: Thanks so much. That was very clear, especially on the part of de-escalation, because, as you were mentioning, I think that we are globally talking about a situation, a clinical situation, where the prognosis can be very good and patients can stay off treatment for a very long period of time without compromising long-term outcomes. And I think that well-constructed de-escalation trials, as you were mentioning and as the consensus endorsed, are really needed in this space also to limit toxicity. This brings us to the end of this episode. So, I would like to thank again Dr. Einstein and Dr. Madan for joining us today. David Einstein: We really appreciate the time and the thought, and I think that even starting these types of discussions is critical. Even just recognizing that this is a unique space is the beginning of the conversation. Ravi Madan: Yeah, and I want to thank JCO for giving us this forum and the opportunity to publish these results and all the expert prostate cancer investigators who were part of this committee. We produced some good thoughts for the future. Davide Soldato: We appreciate you sharing more on your JCO article titled, "National Cancer Institute's Working Group on Biochemically Recurrent Prostate Cancer: Clinical Trial Design Considerations." If you enjoy our show, please leave us a rating and review and be sure to come back for another 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 opinion of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

Prostate MRI is changing how clinicians decide when a biopsy is needed and how sampling is targeted to better detect clinically significant prostate cancer. In this episode of Better Edge, Hiten Patel, MD, discusses MRI‑informed risk stratification, including the use of an MRI‑based risk calculator, and how MRI‑targeted biopsy can reduce missed high‑grade disease. The episode also highlights how PSA density informs decision‑making after a negative MRI and how to manage discordant targeted and systematic biopsy results. Dr. Patel reviews lesion characteristics, like size and suspicion score, in the context of follow‑up and treatment intensity, along with emerging tools like PSMA PET and AI that may further refine detection and biopsy targeting.

Is the biopsy needle more dangerous than the cancer itself? In this episode, Dr. Geo sits down with Dr. Mark Emberton, Dean of Medical Sciences at UCL and a global leader in urologic oncology. We dive deep into the "See and Treat" revolution—a massive shift in prostate cancer care that moves away from "blind" invasive biopsies toward precision imaging like MRI and PSMA PET scans.Dr. Emberton explains why many prostate cancers found through traditional methods are "biological non-events" that never needed treatment, and how younger men (ages 40-50) can better navigate their diagnosis. We also discuss the future of focal therapy, the role of AI in radiology, and the groundbreaking "Transform" study that aims to change prostate screening forever.WHAT YOU'LL LEARN IN THIS EPISODE:✅ Why a normal MRI (PI-RADS 1-2) might mean you can skip the biopsy entirely.✅ The difference between "visible" tumors on imaging vs. microscopic disease.✅ How PSA density acts as the crucial "tie-breaker" for indeterminate results.✅ The future of "See and Treat": Targeting lesions while avoiding surgery side effects.✅ Why tumor location (Anterior vs. Posterior) changes your treatment options.✅ How AI and new magnets are making MRI screening cheaper and faster.

Is the biopsy needle more dangerous than the cancer itself? In this episode, Dr. Geo sits down with Dr. Mark Emberton, Dean of Medical Sciences at UCL and a global leader in urologic oncology. We dive deep into the "See and Treat" revolution—a massive shift in prostate cancer care that moves away from "blind" invasive biopsies toward precision imaging like MRI and PSMA PET scans.Dr. Emberton explains why many prostate cancers found through traditional methods are "biological non-events" that never needed treatment, and how younger men (ages 40-50) can better navigate their diagnosis. We also discuss the future of focal therapy, the role of AI in radiology, and the groundbreaking "Transform" study that aims to change prostate screening forever.WHAT YOU'LL LEARN IN THIS EPISODE:✅ Why a normal MRI (PI-RADS 1-2) might mean you can skip the biopsy entirely.✅ The difference between "visible" tumors on imaging vs. microscopic disease.✅ How PSA density acts as the crucial "tie-breaker" for indeterminate results.✅ The future of "See and Treat": Targeting lesions while avoiding surgery side effects.✅ Why tumor location (Anterior vs. Posterior) changes your treatment options.✅ How AI and new magnets are making MRI screening cheaper and faster.

In this episode, UROONCO PCa Associate Editor Assoc. Prof. Pawel Rajwa (PL) interviews medical oncologist Prof. Silke Gillessen Sommer (CH) about the present and future directions of metastatic prostate cancer treatment.They discuss the greatest survival gains in metastatic prostate cancer over the past decade, triplet therapy in mHSPC and patient selection, the role of PSMA-PET imaging and sequencing of systemic therapies in metastatic prostate cancer, biomarker-driven treatment selection, and finally where the future of metastatic prostate cancer treatment is heading.Here are the links to the articles and event which were mentioned in this podcast: EORTC GUCG 2238 De-escalate trialCAPItello-281 phase III studyAPCCC (Advanced Prostate Cancer Consensus Conference)For more updates on prostate cancer, please visit our educational platform UROONCO PCa.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.

I have neuropathy in both my feet and lower legs.  Are there any natural supplements I can take for it?I purchased two containers of Flavamix. What is the ingredient Lucuma and why is it in their cocoa powder?What are your thoughts on the PSMA PET scan for detecting prostate cancer?What supplements do you recommend for prostate health?What are your thoughts on taking famotidine 2 to 3 times a day for GERD?  Can you discuss the different creatine products?

In this podcast, experts Scott T. Tagawa, MD, MS, FASCO, FACP; Himisha Beltran, MD; and Neeta Pandit-Taskar, MD, MBA, discuss the latest evidence on PSMA PET and RLT, including combination strategies, selection, sequencing, toxicity monitoring, and operations, with careful attention to access and equity.

In this podcast, the Brian, Tm and David Einstein discuss the EMBARK study and its implications for patients with biochemically relapsed prostate cancer. They explore the criteria for high-risk patients, the role of PSMA PET imaging, and the findings related to metastasis-free survival and overall survival. The conversation also delves into treatment strategies, adverse events, and patient perspectives on treatment decisions, ultimately highlighting the need for future research in this evolving field.

In de podcastserie proefschriften spreekt AIOS interne geneeskunde dr. Tessa Steenbruggen met promovendi. In deze aflevering spreekt zij met Fleur Kleiburg over haar proefschrift, getiteld: ‘Clinical value of PSMA-targeted PET/CT imaging in prostate and non-prostate cancers.' Fleur bespreekt de toegevoegde waarde van de PSMA PET/CT bij gemetastaseerd hormoongevoelige en castratieresistente prostaatkanker. Daarnaast vertelt ze hoe de PSMA PET/CT mogelijk ingezet kan worden bij niet-prostaatkankers. Fleur zal op 20 januari 2026 haar proefschrift verdedigen aan de Universiteit van Leiden bij promotoren prof. dr. Lioe-Fee de Geus-Oei, prof. dr. Srirang Manohar, en copromotoren dr. Linda Heijmen en dr. Tom van der Hulle. Referenties Inspiratietip: Die ene patiënt – Ellen de Visser PSMA PET/CT scan bij mCRPC: PSMA PET/CT for treatment response evaluation at predefined time points is superior to PSA response for predicting survival in metastatic castration-resistant prostate cancer patients PSMA PET/CT scan bij sarcoom/weke delen tumoren: PSMA expression and PSMA PET/CT imaging in metastatic soft tissue sarcoma patients, results of a prospective study

Today's guest is someone exceptionally qualified to bring clarity and insight to the world of urological cancer. In this episode of Y Is It So, Professor Nathan Lawrentschuk explains where the prostate is, how it works, and why PSA testing matters. He outlines the latest advances in prostate screening, MRI and PSMA PET imaging, active surveillance, focal therapy, robotic surgery.  Professor Lawrentschuk emphasises informed conversations with your GP, knowing your family history, and the benefits of early detection to improve outcomes while minimising unnecessary treatment and side effects.

Can high-precision radiation change how we treat metastatic prostate cancer? In this episode, I'm joined by Ronald C. Chen, MD, MPH—radiation oncologist, national guideline author (AUA/ASCO), and clinical-trial leader with 170+ publications—to unpack stereotactic body radiation therapy (SBRT) for disease that has spread to lymph nodes, bones, and beyond. We get practical about who benefits, where SBRT shines, and how to balance treatment intensity with quality of life.SBRT offers highly focused, short-course radiation that can control limited (“oligo-”) metastatic prostate cancer and delay systemic therapy for many men. Dr. Chen explains when to treat individual nodes/bone lesions versus comprehensive nodal fields, how anatomy determines dose/fraction choices (often 3–5 treatments), and why modern SBRT sometimes reduces the need for concurrent hormone therapy. We cover salvage options after prior radiation (brachytherapy seeds, HIFU, cryo, repeat SBRT, or salvage prostatectomy), the role and limits of PSMA PET, fracture risk and bone health (DEXA), and the evolving data—including the large NRG-GU013 trial—for higher-risk disease. Throughout, we emphasize shared decision-making, realistic expectations, and considering clinical trials when data are evolving.00:00 – Can SBRT change metastatic prostate cancer care? Meet Dr. Ron Chen.01:00 – Disclaimer: Views are Dr. Geo's and guests'—independent of NYU Langone.07:00 – Recurrence scenarios: prostate-only, nodal, or bone/other; why catching early matters.12:00 – Five salvage options after prostate radiation: seeds (brachytherapy), HIFU, cryo, SBRT (focal or whole-gland), or salvage prostatectomy.19:00 – Nodal relapse: treat all pelvic nodes + ADT ± abiraterone vs. SBRT to a few nodes only—how patient priorities drive the plan.26:30 – Oligometastasis: SBRT alone can control disease for many men ~2+ years on average, delaying hormones.30:00 – Fractions: why 3–5 treatments is typical and how adjacent bowel/organ anatomy sets the pace.31:00 – SBRT in 2 fractions for select primary cases looks promising; high-risk SBRT under study (NRG-GU013).37:00 – Bone mets: SBRT preferred; understanding fracture risk (tumor size, dose, shrinkage).40:00 – DEXA before ADT; spine SBRT can spare the spinal cord with modern planning.48:00 – Clavicle/hilar nodes: SBRT near lung/heart/esophagus—safe with careful dose constraints.56:00 – Why clinical trials matter for “how long on hormones?” and other open questions.57:00 – Soft-tissue mets (liver/brain): SBRT can help, often alongside systemic therapy.59:00 – Parting advice: early detection, close follow-up, and hopeful trajectory of care.___________________________________

In the US overnight Wall St closed lower as investors pulled back from the recent AI run on comments made by Fed Chair Jerome Powell around equity prices being highly valued at present. The S&P500 closed 0.55% lower in afternoon trade, while the Nasdaq saw the biggest fall of 0.95%, and the Dow Jones is closed 0.19% lower so far on Tuesday.In Europe overnight it was a different story with markets closing in the green following the record strength on Wall St on Monday. The STOXX 600 rose 0.4%, Germany's DAX added 0.36%, the French CAC climbed 0.54% and, in the UK, the FTSE100 ended the day flat.Across the Asia region on Tuesday, markets closed mostly higher buoyed by a tech rally in the region after Nvidia announced a partnership with OpenAI. Taiwan's Taiex index rose 1.42% to a record high, while South Korea's Kospi index climbed 0.51%, Hong Kong's Hang Seng fell 0.99% and India's Nifty 50 ended the day down 0.13%.The local market started the new trading week with an extension of last week's rally as investor optimism has been boosted by strength on Wall St and the gold price soaring to new records which has boosted gold stocks to new heights. On Tuesday, the ASX200 posted a 0.4% gain at the closing bell as financial and materials stocks led the day's winning sectors.Myer (ASX:MYR) plunged over 30% on Tuesday after the department store giant released its FY25 results including a slight sales increase, but investors were more focused on responding to the 13.8% decline in EBIT while NPAT fell 30% YoY to $36.8m. The company also reported gross margins for Myer DS down 65bps due to a mix change toward concessions and promotional activity, and reported a statutory net loss of $211.2m primarily due to the acquisition of Premier Investments' apparel brands in January.Telix Pharmaceuticals (ASX:TLX) rallied a further 6% yesterday after announcing that the US Centres for Medicare & Medicaid Services has granted Transitional Pass-Through (TPT) payment status for Telix's Gozellix drug candidate which is the company's next-generation PSMA-PET imaging agent for prostate cancer.What to watch today:On the commodities front this morning, oil is trading 1.97% higher at US$63.50/barrel, gold is up 0.84% at US$3778/ounce and iron ore is flat at US$105.49/tonne.Ahead of Tuesday's trading session, the SPI futures are anticipating the ASX will open the day down 0.35% tracking Wall Street's slide overnight.Trading ideas:Bell Potter has maintained its hold rating on Technology One (ASX:TNE) and lifted its target price from $35.75 per share to $38.22 per share, ahead of its annual showcase event where the company's new products and developments will be highlighted.And Trading Central have identified a bullish signal in Navigator Global Investments (ASX:NGI), indicating that the stock may rise from the close of $1.20 to the range of $2.43 to $2.51 over a period of 21 days, according to the standard principles of technical analysis.

About 1 in 8 men will face a prostate cancer diagnosis. Early-stage prostate cancer often has no symptoms—so how should men approach screening and advocacy? What disparities do Black men experience that would negatively impact their outcomes? And what can we do about it? We spoke with Otis Brawley, MD, professor of oncology at Johns Hopkins, about the types of prostate cancer, key symptoms, when and how often to screen, and why access to equal treatment is essential for equal outcomes for Black men. He also explains metastatic castration-resistant prostate cancer and why advanced imaging like PSMA PET scans matters. Survivor David Diaz Sr., executive director of The Reluctant Brotherhood, also shares his story of diagnosis, treatment, and the power of support groups for men navigating prostate cancer. See omnystudio.com/listener for privacy information.

Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]

Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]

Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]

Experts present new tools for managing PSA-recurrent prostate cancer. Dr. Steven Seyedin describes how PET/CT imaging enhances detection by reducing false positives and improving staging accuracy. Dr. Thomas Hope highlights PSMA PET imaging, now the standard approach, which identifies cancer more precisely by targeting tumor-specific proteins. Dr. Julian Hong discusses stereotactic body radiation therapy (SBRT) for patients with limited metastases, showing that it offers effective, low-toxicity treatment while preserving quality of life. Series: "Prostate Cancer Patient Conference" [Health and Medicine] [Show ID: 40867]

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

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    

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 

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

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]

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]

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]

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]

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]

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]

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]

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]

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

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.

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.

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.

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.

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

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.

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.

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.

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.

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...

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

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

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

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 »

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/

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!

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

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/