Ravi Madan
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ravimadan.bsky.social
Ravi Madan
@ravimadan.bsky.social
Clinical researcher focused on #ProstateCancer, early recurrence (#BCR/PSMA+ BCR) & #immunotherapy. Views are my own & do not represent the National Cancer Institute #Medsky
Lots of ❓s in defining benefits of “#oligomet” or “#MDT” therapy in #ProstateCancer

❓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?
November 11, 2025 at 12:55 PM
We don’t need to fear the Dark in #ProstateCancer

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
As #ESMO25 brings new data on #PSMA it may be time to consider what happens when you target a surface antigen in cancer. How will that impact diagnostic sensitivity of that target?

#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social

rdcu.be/eKNQe
November 5, 2025 at 3:29 PM
#PSMA+BCR

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
October 28, 2025 at 3:05 PM
#EMBARK #BCR📈 #ProstateCancer I have a forrest plot ?

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 ⁉️🧐
October 23, 2025 at 12:27 PM
Reposted by Ravi Madan
As #ESMO25 brings new data on #PSMA it may be time to consider what happens when you target a surface antigen in cancer. How will that impact diagnostic sensitivity of that target?

#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social

rdcu.be/eKNQe
October 14, 2025 at 2:11 PM
#EMBARK #ESMO25 creates the need to risk stratify pts

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
October 19, 2025 at 1:29 PM
Lots @ #ESMO25 re: #BCR #ProstateCancer but over-treatment of this indolent disease remains an important issue

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
October 18, 2025 at 9:43 AM
As #ESMO25 brings new data on #PSMA it may be time to consider what happens when you target a surface antigen in cancer. How will that impact diagnostic sensitivity of that target?

#PSMAdark
#ProstateCancer #theranostics
Dr Abel et al
@natrevurol.nature.com @ascocancer.bsky.social

rdcu.be/eKNQe
October 14, 2025 at 2:11 PM
From The NCI #PSMA files

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
homer simpson is holding a hammer next to a sign that says caution
ALT: homer simpson is holding a hammer next to a sign that says caution
media.tenor.com
September 26, 2025 at 2:58 PM
Important to distinguish #serosal findings on #PSMA 🩻vs. #parenchymal

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
Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course
Nature Reviews Urology - Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+...
rdcu.be
August 21, 2025 at 12:02 PM
Restaging w/ #PSMA Imaging in #mCRPC #ProstateCancer: When Seeing More Is Detrimental to Care

Sadly a year later this remains true & the frequency of this is 📈

@ascocancer.bsky.social @ascopost.bsky.social

ascopubs.org/doi/pdf/10.1...
August 4, 2025 at 8:05 PM
Reposted by Ravi Madan
We have known for more than 20 years that chemotherapy has clinically significant efficacy in metastatic #ProstateCancer #pcsm, including improved overall survival. It has not stopped working just because new agents are available or are being tested.
July 26, 2025 at 11:49 PM
Reposted by Ravi Madan
Two opinions that to my surprise are either unpopular or not widely held:
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.
July 26, 2025 at 10:40 PM
Reposted by Ravi Madan
Pleasure to highlight your work with #UroToday @ravimadan.bsky.social - as we all consider how best to treat PSMA avid disease.
July 19, 2025 at 11:17 PM
Do #PSMA+ findings in #BCR #ProstateCancer require immediate treatment?

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 PET in Biochemical Recurrence: When to Treat vs When to Wait - Ravi Madan
Tian Zhang interviews Ravi Madan about a prospective study monitoring PSMA PET-positive biochemically recurrent prostate cancer patients. The trial enrolls patients with PSA > 0.5 and negative convent...
www.urotoday.com
July 18, 2025 at 1:14 PM
Great discussions #ProstateCancer posters #ASCO25 @ascocancer.bsky.social

#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...
June 4, 2025 at 9:13 AM
Most expected #Arches 5 yr follow up data to be pro-forma #ASCO25
@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?
June 4, 2025 at 2:59 AM
It remains disappointing that (unlike the Lu-PSMA trials) the #PARP inhibitor trials do not include cross over and thus continue to leave the key question of sequence unanswered. This limits understanding of clinical optimization
#AMPLITUDE #ASCO25 @ascocancer.bsky.social
June 4, 2025 at 2:57 AM
How to discern important new data @ ASCO?

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
May 29, 2025 at 1:21 PM
Around this time of year we see the “How should #oncology #fellows navigate the ASCO mtg?” advice.

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
May 29, 2025 at 3:17 AM
Rorschach Test for #ProstateCancer in 2025

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...
May 22, 2025 at 2:20 PM
Case from the #NCI #PSMA files

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
May 15, 2025 at 1:13 PM
Reposted by Ravi Madan
Do these clinical trial failures demonstrate a failure of traditional pre-clinical models to reflect the human disease?

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
March 17, 2025 at 1:48 PM
Dr. Susan Slovin from MSK asks some key questions regarding #ProstateCancer #Immunotherapy

@ascocancer.bsky.social

ascopubs.org/doi/10.1200/...
Immune Checkpoint Combos in Metastatic Castration-Resistant Prostate Cancer: Where Are We Going, What Are We Doing, and Why?
ascopubs.org
March 17, 2025 at 1:21 PM