Can treatment intensification improve outcomes in high-risk prostate cancer, or does the benefit depend on who we treat?

ascopubs.org/doi/pdf/10.120…

ENZARAD (ANZUP 1303): Phase 3 Trial of Enzalutamide With Androgen Deprivation Therapy and Radiation Therapy in High-Risk Localized or te Cancer

The phase 3 ENZARAD trial evaluated adding enzalutamide to ADT and definitive radiotherapy ☢️ in 802 patients with high-risk localized or locally advanced #ProstateCancer .
➡️At eight years, metastasis-free survival was 74% versus 72%, showing no statistically significant overall benefit.
➡️However, patients receiving pelvic nodal radiotherapy demonstrated a notable benefit (HR 0.47). Grade 3–5 adverse events were identical at 46%, highlighting important questions about patient selection and treatment intensification.

@ChrisSweens1, @DocJarad, @RayMcDermott1, @MartinStockler, @Prof_IanD, @DrPaulNguyen

@OncoAlert 🚨 #LPCCC27
@Silke_Gillessen
@AOmlin
@ProfKHerrmann
@weoncologists

44 out of 134 ‼️ That’s how often the world’s top prostate cancer experts agreed. The disagreements may matter even more.

sciencedirect.com/science/articl…

Management of Patients with High-risk Localised, Locally Advanced, and Biochemically Recurrent Prostate Cancer: Report from the Cancer Consensus Conference

@Silke_Gillessen & @Aomlin
@Prof_Nick_James, @LVM_Walz, @AOmlin, @AttardLab, @bjartell, @LoebStacy, @Tilki_De, @piet_ost, @Nicola_Fossati, @AnthonyMJoshua, @VedangMurthy, @neerajaiims, @Achard_Verane, @PBlanchardMD, @lisahorvath73, @BarbaraJereczek, @fontev1, @ChrisSweens1, @AarmstrongDuke, @CharlesRyanMD, @ProfKHerrmann, @KarimFizazi, @NealShore, @himishabeltran, @HeatherChengMD, @DrRanaMcKay, @AliciaMorgansMD, @declangmurphy, @DrSpratticus, @EvanYuMD, @NehaVapiwalaMD @drjefstathiou @BertrandTOMBAL

#APCCC26 brought together 144 international🌐 #ProstateCancer experts to tackle questions where high-level evidence is limited. Using a modified Delphi process, 133 panellists voted on 134 questions covering high-risk localised, locally advanced and biochemically recurrent disease, including PSA persistence, PSA recurrence and treatment side effects.
✅️ Consensus (≥75% agreement) was reached on 44 questions (32.8%), with strong consensus (≥90%) on seven.
👉 Areas without consensus highlight key priorities for future trials.

Fantastic paper led by from
@APCCC_Lugano group about high-risk localized prostate cancer management in @EUplatinum

kwnsfk27.r.eu-west-1.awstrack.me/L0/https:%2F%2…

dailynews.ascopubs.org/do/parp-inhibi… @DukeGUCancer @DukeCancerCntr

Great to see this data presented by @BGarmezy. Excited for this new potential treatment for men with #prostatecancer and to be part of the efforts at @DukeCancer. Appreciate your hard work and leadership @OncHahn!

#ESMO26 @AarmstrongDuke @OncoAlert @myESMO @oncodaily @OncoDailyGU @urotoday

New #PROpel insights in #mCRPC: #olaparib + #abiraterone improved rPFS vs abiraterone alone in patients without #BRCA mutations, with no new safety signals, supporting further refinement of biomarker-driven treatment selection.
#ProstateCancer
doi.org/10.1016/j.euo.…

Could SPEN become the missing biomarker for predicting resistance to ARPI therapy in metastatic prostate cancer? 🔬

aacrjournals.org/clincancerres/…

SPEN Inactivation Drives Resistance to Androgen Receptor Pathway Inhibitors in Metastatic Prostate Cancer

A new study identifies SPEN tial biomarker 🎯 of androgen receptor pathway inhibitor (ARPI) resistance in metastatic prostate cancer.
➡️ Preclinical and real-world data show that SPEN loss promotes proliferation, stem-like activity, and pro-oncogenic translation.
➡️In 6,828 patients, SPEN mutations were associated with substantially shorter treatment duration on ARPIs, while low SPEN protein expression also predicted reduced benefit. Prospective validation could help personalize treatment selection.

@Sonali_bioc , @SteveBlinka, @RyonGraf

@OncoAlert 🚨 #LPCCC27
@Silke_Gillessen
@AOmlin
@ProfKHerrmann
@weoncologists

The world’s leading prostate cancer researchers came to Carlsbad to share their work, and patients and caregivers came with the questions that matter most.

For 33 years, PCF has brought science and lived experience together to move research forward.

#PCFRetreat26

Clearly there is some efficacy in non BRCA mCRPC patients in PROPEL! sciencedirect.com/science/articl…. Come to #ESMO2026 to see who! @MehraNiven @AstraZeneca @DukeGUCancer

Yet another positive diet, exercise, lifestyle trial....for men on ADT at high-risk of toxicity.

The STAMINA RCT - thelancet.com/journals/lanon…

Working Group 4 introduces updated terminology for advanced #ProstateCancer. @AarmstrongDuke @DukeCancer sits down with @neerajaiims @huntsmancancer to discuss the Prostate Cancer Working Group 4 consensus criteria and updated disease nomenclature. Dr. Armstrong explains that the ive and castration-resistant have been replaced by androgen pathway modulator naive, sensitive, and resistant, applicable to any treatment, not just ADT. #WatchNow > bit.ly/4fud78e

Thrilled to share our ARCHES external validation of NADIR, now in Cancer!
In 558 men with mAPMS on enzalutamide, NADIR showed AUC 0.80 w/ strong calibration for predicting PSA ≤0.2 by 6 months.
acsjournals.onlinelibrary.wiley.com/doi/10.1002/cn…
@neerajaiims @DrRanaMcKay @AarmstrongDuke @DrSpratticus

Great morning kicking off our @DukeGUCancer #GUrus Community Education Event with a great turnout of patients, colleagues, and industry partners. Looking forward to joining the #ProstateCancer Lunch & Learn with @AarmstrongDuke, @hannahdzmd, Dr. Jeff Gahan, and Dr. Paul Koffer for ion on the recent updates in the field.

@DukeHealth @DukeCancer @Daniel_J_George @MSuperdock @MRHarrisonMD @MattLabsMD

Just published! Smoking is associated with lethal prostate cancer and several genetic alterations. See nature.com/articles/s4139… @DukeGUCancer @DukeCancer Chris Choi, Matt Labriola and our PROMISE team!

🚨 New PEACE-3 data: adding radium-223 to enzalutamide in mCRPC didn't just deepen biomarker responses — it got them faster.

Article 📰
sciencedirect.com/science/articl…

Alkaline Phosphatase and Prostate-specific Antigen Response in Metastatic Castration-resistant Prostate Cancer de Alone or in Combination with Radium-223: Ad Hoc Analysis of the PEACE-3 Consortium Trial

This exploratory analysis of the 🕊️ PEACE-3 trial found that adding radium-223 to enzalutamide in patients with metastatic castration-resistant #ProstateCancer and bone metastases produced faster and more frequent biomarker responses than enzalutamide 💊 alone. The combination improved alkaline phosphatase responses and normalization and significantly 📈 increased deep PSA responses.

@SoaresAndrey , @Silke_Gillessen , @achoud72 , @y_loriot , @RayMcDermott1 , @ThRoumeguere , @DaugaardGedske , @Bea_Fournier , @BertrandTOMBAL

@OncoAlert 🚨 #LPCCC27
@Silke_Gillessen
@AOmlin
@ProfKHerrmann
@weoncologists

The 5-year follow-up from KY-564 now published in @Annals_Oncology --the first ever adjuvant trial in Kidney cancer continues to show a survival benefit now with OS at 5+years and in key subgroups!

annalsofoncology.org/article/S0923-…

@HaasNaomi @tompowles1 @OncoAlert @OncBrothers @DanaFarber_GU @DanaFarber @harvardmed @AUC3_Official

Working Group 4 introduces updated terminology for advanced #ProstateCancer. @AarmstrongDuke @DukeCancer sits down with @neerajaiims @huntsmancancer to discuss the Prostate Cancer Working Group 4 consensus criteria and updated disease nomenclature. Dr. Armstrong explains that the ive and castration-resistant have been replaced by androgen pathway modulator naive, sensitive, and resistant, applicable to any treatment, not just ADT. #WatchNow > bit.ly/4fud78e

PSMAddition trial of upfront lutetium-177-PSMA-617 in metastatic hormone-sensitive #ProstateCancer. @AarmstrongDuke @DukeCancer joins @sartor_oliver @EJHospital to discuss where PSMA-targeted radioligand therapy fits before castration resistance. Dr. Armstrong argues the six-dose me disease. #WatchNow > bit.ly/4bUH80a

🚨 Are we missing prostate cancer in the peri-rectal lymph nodes?

practicalradonc.org/article/S1879-…

Peri-rectal Nodal Clinical Target Volume (CTV) Delineation in Patients with Prostate Cancer

PSMA PET is reshaping how clinicians understand pelvic nodal spread in #ProstateCancer , ri-rectal lymph node involvement that traditional radiation ☢️ fields may miss.

➡️ This review proposes incorporating the mesorectum into peri-rectal CTVs for selected patients, with tailored rectal coverage, dose, and image guidance. ✅ The approach emphasizes comprehensive elective nodal treatment over metastasis-directed therapy when cure remains possible, while balancing gastrointestinal toxicity and treatment reproducibility.

@RonaldChenMD
@BrianJDavisMDPh

@OncoAlert 🚨 #LPCCC27
@Silke_Gillessen
@AOmlin
@ProfKHerrmann
@weoncologists

Eight years later 📅 , the question is no longer whether enzalutamide works in mHSPC—it’s how much long-term survival benefit we should expect from early disease control.

Article 📰
annalsofoncology.org/article/S0923-…

Eight-year outcomes of testosterone suppression plus enzalutamide or a ogen for metastatic, hormone-sensitive prostate cancer (ENZAMET; ANZUP 1304)

With 8.1 years of follow-up in mHSPC, enzalutamide 💊 plus testosterone suppression continued to improve survival versus first-generation NSAA therapy. Eight-year OS was 50% 🆚 40%, with fewer prostate cancer deaths and markedly better clinical PFS (43% vs 20%). One-third of patients remained on enzalutamide at 8 years, mostly at full dose. PSA ≤0.2 ng/mL at 7 months identified patients with particularly favorable long-term outcomes, supporting durable disease control. #ProstateCancer

@mfrydenberg
@crashimminent
@docpook
@scserendipity1
@ChrisSweens1
@RonanAndrewMcL1
@RayMcDermott1
@nklawrence1
@Prof_IanD

@OncoAlert 🚨 #LPCCC27
@Silke_Gillessen
@AOmlin
@ProfKHerrmann
@weoncologists