1/ 🚨 Pleased to share that our latest manuscript is out now in @EUplatinum!

Baseline and on-treatment #ctDNA biomarkers in men with advanced #ProstateCancer treated with #LuPSMA.

bit.ly/4nzJRyV

Thanks to @LouiseKostos Heidi Fettke @PeterMacCC

Out now in @TheLancetOncol: biomarker data from TALAPRO-2 (Enza+/Tala) in mCR #ProstateCancer

Key data:
1. 81% concordance b/w ctDNA & tissue
2. Baseline ctDNA- & CTC0 strongly prognostic
3. Conversion of ctDNA & CTC at wk 9 strongly prognostic.

Link 👉 rb.gy/347dc4

New TALAPRO-2 Data Highlight the Prognostic Value of ctDNA and CTCs in Prostate Cancer - Arun Azad

@AzadOncology

oncodaily.com/science/arun-a…

@AzadOncology @TheLancetOncol @Yipilimumab @neerajaiims @DrAndreFay @urotoday @EdmondMKwan @PeterMacCC @GUOncologyNow @myESMO @PCF_Science Great work Arun, Neeraj and all involved. You’ll have to explain it to me! Perhaps at the Ashes

Proud of you all

Congratulations @AzadOncology @neerajaiims et al. for a very elegant biomarker work on this practice changing trial! @TheLancetOncol @OncoAlert

1/ 🚨 Pleased to share that our latest manuscript is out now in @EUplatinum!

Baseline and on-treatment #ctDNA biomarkers in men with advanced #ProstateCancer treated with #LuPSMA.

bit.ly/4nzJRyV

Thanks to @LouiseKostos Heidi Fettke @PeterMacCC

Brilliant translational work from @AzadOncology @Yipilimumab @neerajaiims from #TALAPRO2 in @TheLancetOncol! A must read …

Voting for @PGrivasMDPhD - a generous, gregarious and outstanding GU Med Onc who would be a fantastic part of @ASCO Nominating Committee.

Vote #1 @montypal - Monty exemplifies the best of @ASCO: mentorship, collegiality, collaboration and putting patients first.

Out now in @TheLancetOncol: biomarker data from TALAPRO-2 (Enza+/Tala) in mCR #ProstateCancer

Key data:
1. 81% concordance b/w ctDNA & tissue
2. Baseline ctDNA- & CTC0 strongly prognostic
3. Conversion of ctDNA & CTC at wk 9 strongly prognostic.

Link 👉 rb.gy/347dc4

🚨 FDA Approved Talazoparib Plus Enzalutamide for HRR-Mutated Metastatic Castration-Sensitive Prostate Cancer

On October 26, 2026, the FDA approved talazoparib plus enzalutamide for adults with HRR gene-mutated metastatic androgen pathway modulation-naïve or -sensitive prostate s from the Phase III TALAPRO-3 trial.

Key findings:
▫️ Median rPFS: Not reached with talazoparib plus enzalutamide vs 45.8 months with placebo plus enzalutamide (HR 0.48; 95% CI 0.36–0.65; p<0.0001).
▫️ Overall survival: Data remained immature.
▫️ ESMO 2026: Arun A. Azad presented a separate TALAPRO-3 biomarker analysis (2219RO). Among patients ctDNA-positive at baseline, conversion to ctDNA-negative at Week 5 occurred in 82.1% vs 68.2% of evaluable patients, respectively. Early ctDNA changes were associated with rPFS.

Takeaway: This approval expands treatment options for patients with HRR-mutated metastatic prostate cancer in the androgen pathway modulation-naïve or -sensitive setting, supported by a statistically significant rPFS benefit. Further follow-up is needed to establish the effect on overall survival.

@US_FDA @oncodaily @AzadOncology @neerajaiims @quimmateo @nealshore

oncodaily.com/genitourinary-…

#FDA #ProstateCancer #TALAPRO3 #ESMO26

LuPSMA Retreatment and Other Subsequent Therapies After Progression on LuPSMA in #mCRPC. Presented by @SpainLavinia @PeterMacCC. #ESMO26 written coverage by @RKSayyid @UAUrology &gt; bit.ly/4zamylY #ProstateCancer @myESMO

LuCAB: Phase I/II Trial of Cabazitaxel + 177Lu-PSMA in mCRPC. Presented by @LouiseKostos @PeterMacCC. #ESMO26 written coverage by @RKSayyid &gt; bit.ly/4zULptV #ProstateCancer #mCRPC #ClinicalTrials @myESMO

Huge congratulations @neerajaiims &amp; entire TALAPRO-3 team on the FDA approval of talazoparib-enza ! 🎉👏
A major milestone for precision medicine in mHSPC! @AzadOncology @quimmateo @PCFnews @OncoAlert @montypal @DrChoueiri @PGrivasMDPhD @Uromigos @ChrisSweens1

Just happened today👏🎉👉 @FDA approved Talazoparib + enzalutamide for pts with HRRm positive mAPMS/mHSPC #prostatecancer FDA Link👉 l1nq.com/ltlq6jk 👉 @NEJM paper tinyurl.com/vkvra8cd 👇 @ASCO @OncoAlert @urotoday @PCF_Science @DanaFarber_GU

PROs with Talazoparib + Enzalutamide vs PBO + Enzalutamide in #mCSPC with HRR Gene Alterations: Phase 3 TALAPRO-3. Presented by @AzadOncology @PeterMacCC. #ESMO26 written coverage by @zklaassen_md &gt; bit.ly/3UavnNC #ProstateCancer #PrecisionOncology @myESMO

LuCAB at #ESMO26 - Combination Lu-177 PSMA-617 + cabazitaxel in mCRPC, accepted in @TheLancetOncol

Adding taxane chemotherapy to LuPSMA may overcome heterogeneous PSMA expression and act as a radiosensitiser.

35 pts, post-docetaxel + ARPI:
🧪 No DLTs: cabazitaxel 20 mg/m2 + AEs 24%, no G4/5
📈 RP2D (n=26): PSA50 73%, rPFS 10.9 mo, OS 16.5 mo

Impressive outcomes in an unfavourable cohort (29% M1c).

Randomised trials needed: chemo + LuPSMA together or in sequence?

🙏 Led by @LouiseKostos & @AzadOncology with @ButeauJames , Grace Kong, @pj_physics, @DrBenTran, @MHaskali, @declangmurphy @PeterMacCC and @drlouiseemmett @StVincentsSyd

Above all, thank you to the patients and families who took part.

Funded by @PCFnews through @pros_tic , with PSMA-617 supplied by @Novartis plus additional support.

@myESMO

Himalayas-1: Rinzimetostat, an Allosteric PRC2 Inhibitor, + Daro: 🌎 Ph 3 RC in mCRPC Previously Treated with Abiraterone @urotoday #ESMO26 @quimmateo

📌n=600
📌1:1 to rinzimetostat + Daro vs physician’s choice of ARPI or docetaxel
📌Prim EP: rPFS
📌Sec EP: OS

ctDNA Tumor Fraction as a Prognostic Biomarker in #TALAPRO3: Talazoparib + Enzalutamide in HRR-mutated #mCSPC. Presented by @AzadOncology @PeterMacCC. #ESMO26 written coverage by @zklaassen_md &gt; bit.ly/4zTljYw #ProstateCancer #PrecisionOncology @myESMO

PROs in mCSPC and HRR gene alts receiving Tala + Enza vs PBO + Enza: TALAPRO-3 @AzadOncology @urotoday #ESMO26

📌No diff in change: GHS/QoL, physical functioning, fatigue
📌⏫ change from BL for appetite loss for Tala + Enza
📌No diff in TT definitive deterioration in GHS/QoL, urinary symptoms, pain

🚨⭐🔵 #ESMO26 | Optimising Radioligand Therapy in Advanced Prostate Cancer
🎤 Presented by @AzadOncology 🇦🇺
@OncoAlert

🔬 Beyond ¹⁷⁷Lu-PSMA: combinations, alpha emitters and the emerging promise of Auger electrons.
An excellent overview of how radioligand therapy (RLT) is 1️⃣ EVOLUTION: RADIOLIGANDS + DUAL IMMUNOTHERAPY

Phase II EVOLUTION (ANZUP2001):
¹⁷⁷Lu-PSMA-617 + nivolumab/ipilimumab vs ¹⁷⁷Lu-PSMA-617 alone.

✅ PSA-PFS at 12 months: 33% vs 17%
✅ rPFS at 12 months: 47% vs 23%
📈 Median rPFS: 12.0 vs 8.5 months

⚠️ However:
• Grade 3–4 AEs: 75% vs 29%
• Treatment-related myocarditis: 7% in the combination arm
• Trial recruitment stopped early.
⭐ An important reminder: biological synergy must translate into meaningful benefit without unacceptable toxicity.

💊 2️⃣ Lu-PSMA COMBINATIONS: ENCOURAGING SIGNALS
📊 PSA50 | Median rPFS | Median OS
🔹 VISION (¹⁷⁷Lu-PSMA-617 + protocol-permitted standard care): 46% | 8.7 mo | 15.3 mo

🔹 PRINCE (+ pembrolizumab, n=37): 76% | 11.2 mo | 20.8 mo
🔹 LuPARP (+ olaparib, n=29): 69% | 12.8 mo | 33.5 mo
🔹 AlphaBet (+ radium-223, n=33): 55% | 10.0 mo | 13.5 mo
🔹 LuCAB (+ cabazitaxel, n=26): 73% | 10.9 mo | 16.5 mo

⚠️ These are cross-trial descriptive comparisons, not evidence that any combination is superior to VISION. Patient selection, prior therapies and trial designs differ.

☢️ 3️⃣ ALPHA EMITTERS: A NEW LEVEL OF PRECISION

Unlike beta particles, alpha particles have shorter tissue penetration and high linear energy transfer, potentially improving tumor-cell killing.
🔬 PAnTHa: ²²⁵Ac-PSMA-Trillium
Phase I dose escalation | N=50

✅ PSA50: 58% overall
✅ PSA50: 83% at 125 kBq/kg
✅ PSA90: 58% at the expansion dose
✅ ORR: 46%
✅ Disease control: 83%
⚠️ Xerostomia: 76%
⚠️ Grade ≥3 treatment-emergent AEs: 38%
✅ No dose-limiting toxicities observed.
These preliminary results support further investigation, not routine clinical adoption.

⚛️ 4️⃣ AUGER ELECTRONS: TARGETING MICROSCOPIC DISEASE
An exciting emerging concept.
Auger electrons deposit energy over extremely short distances, potentially targeting microscopic tumor deposits and individual cells.

🔬 Terbium-161 (¹⁶¹Tb) emits beta particles and Auger/conversion electrons.
Could this improve radioligand effectiveness against micrometastatic disease?
The biological rationale is compelling, but clinical benefit remains to be demonstrated.

⭐ MY POINT OF VIEW | CLINICAL PEARL
The future of radioligand therapy will not be defined by the strongest radiation emitter, but by the right radiation strategy for the right patient.
Three essential questions remain:

🔹 Which combinations truly improve survival?
🔹 Can we intensify antitumor activity without unacceptable toxicity?
🔹 How should PSMA expression, tumor heterogeneity and disease burden guide isotope selection?
💡 Precision radioligand therapy means more than targeting PSMA: it means optimizing the payload, the partner, the timing and the patient.
From beta to alpha and Auger emitters, we are entering an exciting new era in #ProstateCancer.

@urologysummit @gbanna74 @ravikanesvaran @Uromigos @LosUromigos

@neerajaiims @Silke_Gillessen @EfstathiouEleni @AOmlin @declangmurphy @montypal @DrScottTagawa @ChrisSweens1 @brian_rini

@ecancer @UrologyTimes @urotoday @wearemedsir @OpenMedicineHQ

#GUOncology #mCRPC #PSMA #RadioligandTherapy #NuclearMedicine #PrecisionOncology