❓ADT+/-ARPI? How long?
❓PFS vs Eugonadal PFS?
❓how many mets? Where?
🔑❓what imaging 🩻❓
#PSMA mets🚫🟰CT/Bone scan mets
shorturl.at/n3JwU
Std of Care? Or just something we can do?
❓ADT+/-ARPI? How long?
❓PFS vs Eugonadal PFS?
❓how many mets? Where?
🔑❓what imaging 🩻❓
#PSMA mets🚫🟰CT/Bone scan mets
shorturl.at/n3JwU
Std of Care? Or just something we can do?
But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging
This likely impacts the desire to use PSMA in restating (still unclear how to do that) & drug development #PSMAdark
#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social
rdcu.be/eKNQe
But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging
This likely impacts the desire to use PSMA in restating (still unclear how to do that) & drug development #PSMAdark
That is how @theNCI #BCR Working Group unanimously agreed to define pts w/PSMA findings & neg CT/bone scan after definitive tx
Retains all that is known about #BCR while drawing a distinction vs. mCSPC
More than semantics for #ProstateCancer pts & clinicians
@ascocancer.bsky.social
That is how @theNCI #BCR Working Group unanimously agreed to define pts w/PSMA findings & neg CT/bone scan after definitive tx
Retains all that is known about #BCR while drawing a distinction vs. mCSPC
More than semantics for #ProstateCancer pts & clinicians
@ascocancer.bsky.social
2 subgroups w/LACK of clear benefit are⬆️CV risk(competing mortality-logical)
But why would pts under⬇️65 not🚫 have clear benefit?
This is a subgp where competing mortality shouldn’t be an issue & Tx should help ⁉️🧐
2 subgroups w/LACK of clear benefit are⬆️CV risk(competing mortality-logical)
But why would pts under⬇️65 not🚫 have clear benefit?
This is a subgp where competing mortality shouldn’t be an issue & Tx should help ⁉️🧐
#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social
rdcu.be/eKNQe
#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social
rdcu.be/eKNQe
Here is data published last year which demonstrates that #ProstateCancer specific death is rare among unselected #BCR pts.
EMBARK Tx is for high risk pts (eg PSA DT<6mos)
tinyurl.com/y69hb5ue
Here is data published last year which demonstrates that #ProstateCancer specific death is rare among unselected #BCR pts.
EMBARK Tx is for high risk pts (eg PSA DT<6mos)
tinyurl.com/y69hb5ue
How does #PSMA imaging factor in? See poster #2393P presented by @HelenMoonMD Saturday
+PSMA findings in BCR pts shouldn’t be the reason to treat as rPD is rare @1yr
How does #PSMA imaging factor in? See poster #2393P presented by @HelenMoonMD Saturday
+PSMA findings in BCR pts shouldn’t be the reason to treat as rPD is rare @1yr
#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social
rdcu.be/eKNQe
#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social
rdcu.be/eKNQe
73 yo male PSA=17 PSADT=11.6mos
PSMA=5+ nodes in pelvis RP & torso
(All~5mm). Neg CT and bone scan
No🚫Treatment
1 yr later
PSA=40 PSADT=13.1 mos
PSMA stable across 2 scans over 12 mos
#PSMA+ #BCR #ProstateCancer is an indolent process-OK to monitor these pts
73 yo male PSA=17 PSADT=11.6mos
PSMA=5+ nodes in pelvis RP & torso
(All~5mm). Neg CT and bone scan
No🚫Treatment
1 yr later
PSA=40 PSADT=13.1 mos
PSMA stable across 2 scans over 12 mos
#PSMA+ #BCR #ProstateCancer is an indolent process-OK to monitor these pts
Serosal lesions are better seen on #PSMA vs CT/MRI in #ProstateCancer but likely have an indolent course even with no 🚫therapy (even on the liver!)
Dr. Melissa Abel at el @natrevurol.nature.com
rdcu.be/eBwPs
Serosal lesions are better seen on #PSMA vs CT/MRI in #ProstateCancer but likely have an indolent course even with no 🚫therapy (even on the liver!)
Dr. Melissa Abel at el @natrevurol.nature.com
rdcu.be/eBwPs
Sadly a year later this remains true & the frequency of this is 📈
@ascocancer.bsky.social @ascopost.bsky.social
ascopubs.org/doi/pdf/10.1...
Sadly a year later this remains true & the frequency of this is 📈
@ascocancer.bsky.social @ascopost.bsky.social
ascopubs.org/doi/pdf/10.1...
1. The control arm of a randomised trial should be best standard of care.
2. A PFS benefit against an inactive comparator is not a major advance, if progressive disease is required for eligibility.
1. The control arm of a randomised trial should be best standard of care.
2. A PFS benefit against an inactive comparator is not a major advance, if progressive disease is required for eligibility.
NO based on emerging data @theNCI
Appreciate @tiansterzhangmd.bsky.social & #Urotoday for the opportunity to discuss
Ongoing trial of PSMA scans in BCR is still enrolling shorturl.at/36nGQ
www.urotoday.com/categories-m...
NO based on emerging data @theNCI
Appreciate @tiansterzhangmd.bsky.social & #Urotoday for the opportunity to discuss
Ongoing trial of PSMA scans in BCR is still enrolling shorturl.at/36nGQ
www.urotoday.com/categories-m...
NO based on emerging data @theNCI
Appreciate @tiansterzhangmd.bsky.social & #Urotoday for the opportunity to discuss
Ongoing trial of PSMA scans in BCR is still enrolling shorturl.at/36nGQ
www.urotoday.com/categories-m...
#PSMA+ #BCR is indolent & pts do NOT require urgent therapy in most cases
We should be ⚠️ cautious about over-treatment
🔗shorturl.at/NtxdF
Trial continues to accrue @theNCI
www.clinicaltrials.gov/study/NCT055...
#PSMA+ #BCR is indolent & pts do NOT require urgent therapy in most cases
We should be ⚠️ cautious about over-treatment
🔗shorturl.at/NtxdF
Trial continues to accrue @theNCI
www.clinicaltrials.gov/study/NCT055...
@ascocancer.bsky.social
But then this data popped up 👀
Less clear benefit of Enza+ADT in low volume #mCSPC
Should this raise ?s for #mCSPC intensification w/#parp & #LU-psma
Implications for over treating PSMA+ recurrence?
#AMPLITUDE #ASCO25 @ascocancer.bsky.social
#AMPLITUDE #ASCO25 @ascocancer.bsky.social
Look beyond data that repackages known truths but do NOT really advance our understanding
Common examples:
1. Less cancer is better than more cancer
2. Responders do better
3. More treatments vs. less improve PFS
Happy #ASCO25
@ascocancer.bsky.social
Look beyond data that repackages known truths but do NOT really advance our understanding
Common examples:
1. Less cancer is better than more cancer
2. Responders do better
3. More treatments vs. less improve PFS
Happy #ASCO25
@ascocancer.bsky.social
My take:
👉🏽Very Carefully 🤓
Distinguish science from showmanship and make sure the substance of a presentation aligns with the “take home message”
Happy ASCO ☺️
@ascocancer.bsky.social
#ASCO25
My take:
👉🏽Very Carefully 🤓
Distinguish science from showmanship and make sure the substance of a presentation aligns with the “take home message”
Happy ASCO ☺️
@ascocancer.bsky.social
#ASCO25
Treat w/your favorite approach +/- your 2nd favorite approach?
Or acknowledge lack of data supporting long term benefits in this case & defer tx?
@theNCI continues to enroll #BCR pts on #PSMA monitoring trial
www.clinicaltrials.gov/study/NCT055...
Treat w/your favorite approach +/- your 2nd favorite approach?
Or acknowledge lack of data supporting long term benefits in this case & defer tx?
@theNCI continues to enroll #BCR pts on #PSMA monitoring trial
www.clinicaltrials.gov/study/NCT055...
67 yo w/#BCR #ProstateCancer
4 yrs s/p RP (declined salvage)
PSA=1.0
PSA DT=11 mos(“high risk”per European criteria)
PSMA shows only 6 mm obturator node next to ureter (SUVmax=26)
—no treatment
18 months later PSA is 1.1
LN=8mm
No new findings on PSMA
67 yo w/#BCR #ProstateCancer
4 yrs s/p RP (declined salvage)
PSA=1.0
PSA DT=11 mos(“high risk”per European criteria)
PSMA shows only 6 mm obturator node next to ureter (SUVmax=26)
—no treatment
18 months later PSA is 1.1
LN=8mm
No new findings on PSMA
In addition to the complete avoidance of biomarker-driven clinical trials to find the subset of patients that would benefit.? @asharpmedonc.bsky.social @pcf-science.bsky.social
@ascocancer.bsky.social
ascopubs.org/doi/10.1200/...
In addition to the complete avoidance of biomarker-driven clinical trials to find the subset of patients that would benefit.? @asharpmedonc.bsky.social @pcf-science.bsky.social
@ascocancer.bsky.social
ascopubs.org/doi/10.1200/...
@ascocancer.bsky.social
ascopubs.org/doi/10.1200/...