“Given known tox of ADT-based strategies in #ProstateCancer, overtreatment of #BCR could… bring more near-term harms than benefits…individualized approaches…which factors in PSA in the context of PSADT… while excluding presumptive use of PSMA data…”
shorturl.at/MB0JN
“enzalutamide &ADT present a…consideration for at-risk #BCR pts (likely PSA DT<6 mos min PSA of 1 ng/ml & few competing mortality risks) but…these characteristics represent a minority of pts...Most pts w/BCR can be monitored for yrs w/out therapy regardless of next-gen imaging”
shorturl.at/MB0JN
#EMBARK in #BCR #ProstateCancer: a Journey for Some but NOT Most
By Dr. Melissa Abel et al.
“EMBARK was a biomarker-selected study enrolling pts @ the greatest risk…based on PSADT…required a PSADT≤ 9 mos…data suggests the true benefits are in pts w/PSADT≤ 6mos”
shorturl.at/MB0JN
“enzalutamide &ADT present a…consideration for at-risk #BCR pts (likely PSA DT<6 mos min PSA of 1 ng/ml & few competing mortality risks) but…these characteristics represent a minority of pts...Most pts w/BCR can be monitored for yrs w/out therapy regardless of next-gen imaging”
shorturl.at/MB0JN
April 10,2026
ALL GOOD THINGS…🥹
Thx🙏🏽 to the patients & so many amazing people @thenci & beyond in my 21+yrs
Many good Friends on the Journey
Dr. Melissa Abel continues the research:#PSMA+ #BCR & #cytokines #ProstateCancer #immunotherapy
The future @ NCI is bright☀️
Some thoughts on the management of #BCR #ProstateCancer #EMBARK
Coming 🔜 in The Oncologist w/Dr. Melissa Abel & Dr. Fatima Karzai
“EMBARK In Biochemically Recurrent Prostate Cancer: A Journey for Some but not Most”
Appreciate the⚠️caution voiced by #PCWG4 @ascocancer.bsky.social
#PSMA imaging in #ProstateCancer is not🚫ready for prime time to determine treatment failure (distinct from imaging PD) in clinical practice
PSMA may harm pts if it leads to stopping a tx too quickly
Lots of zeal in #oncology for new tech to detect recurrence (eg ctDNA, molecular imaging)
Sobering however to recall that it remains unclear if early detection improves outcomes @nejm
This presumption remains unclear in #ProstateCancer w/#PSMA & #PSA
x.com/dr_ravimadan...
Result never in doubt in #mCSPC #ProstateCancer given design
Questions should focus on short & long term toxicity. Also is sequencing (w/deferred tox) in any way inferior❓
Talazoparib/Enzalutamide Shows Improved Radiographic PFS
www.targetedonc.com/view/talazop...
A rationale for #SBRT to #Oligomets in #PSMA+BCR is “delay #ADT”
But this presupposes #PSMA+#BCR requires ADT/ARPI…
What if that’s not the case & most PSMA+BCR #ProstateCancer was indolent?
Thats what a study @theNCI shows @asco #Gu26
shorturl.at/IyBBT
Recently had a discussion on “#mentorship”
Many mentors confuse it w/ hyperdelegation
1st clue picking a “mentor”
Did they ever ask what YOU want to do❓
Too many “mentors” presume you want to be them-Do you❓
Choose your path w/someone who asks you the right
Thank you. Agree, PSMA and PSA are just phenotypic markers that are demonstrably dispensable as mPC evolves under environmental and treatment selective pressure.
Thank you. Could you expand? PSA response vs PSMA response - is one better?
Still in the Dark…
#PCWG4 launched #GU26 w/aspirational reliance on #PSMA imaging for drug development
But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging
#PSMAdark
@ascocancer.bsky.social
@melissaabel20 et al
rdcu.be/eKNQe
The #NCI past meets the present #GU26 @ascocancer.bsky.social
Dr. Melissa Abel discusses emerging #PSMA tumor volume data with Dr. Harpreet Singh
The emerging data is from a follow-up trial based on a trial Dr. Singh worked on during her time at the NCi
More data on PSA
Almost none on PSMA
So I would not used PSMA “response” since all that really is telling us about fundamentally is #PSMA expression.
#ProstateCancer @ascocancer.bsky.social #GU26
“Dry Mouth” remains a frequent toxicity w/#PSMA therapies #GU26; easy to discount which is why worth reviewing below
There are no Grads 4/5 and grade 3 is TPN. Grade 2 is also no picnic for pts
We need a better grading system & more data on reversibility
#ProstateCancer
@ascocancer.bsky.social
Dr. Fred Saad presents #Trillium 225Ac-PSMA in #mCRPC phase 1 study
Substantial amount of dry mouth observed including 30% grade 2.
@ascocancer.bsky.social
#GU26
Dr. Fred Saad presents #Trillium 225Ac-PSMA in #mCRPC phase 1 study
Substantial amount of dry mouth observed including 30% grade 2.
@asco #GU26
Still in the Dark…
#PCWG4 launched @ascocancer.bsky.social #GU26 w/aspirational reliance on #PSMA imaging for drug development
But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging
#PSMAdark
@melissaabel20 et al
rdcu.be/eKNQe
Drs. Melissa Abel & Alexandra Sokolova chair the #GU26 chair this evening Rapid Abstract Presentations in #ProstateCancer
@ascocancer.bsky.social
Poster A14
#GU26
@ascocancer.bsky.social
One key bit of data missing in the context of #PSMA+ #BCR #ProstateCancer management in the wake of the #EMBARK data is how does #PSA Doubling Time interface w/ #PSMA Pet findings.
Dr. Melissa Abel from #NCI will share this data today
PosterA4 #GU26
@ascocancer.bsky.social
#BCR #ProstateCancer study @thenci
🩻PSMA➡️ 3 mos Enza💊➡️PSMA🩻
PSA control=days below baseline=clinical benefit🔵
PSA⬇️88-100%🟠
#PSMA Tumor Volume🟢
🚨PSMA-TV⬇️s/p Enza does NOT predict benefit
These data in PSMA responders raise❓for adaptive designs
Oh I like this…
#GU26
You’ve just beautifully summarised the vast majority of “🚨BREAKING NEWS! 🚨” papers and social media posts that come out of so many major meetings these days. We definitely need to do better.
#GU26
🔜 #GU26 @ascocancer.bsky.social
How to approach a vast meeting w/so much data?
Look beyond data that repackages known truths but do NOT really advance understanding
Common examples:
1. Less cancer is better than more cancer
2. Responders do better
3. More treatments vs. less improves PFS
🔜 #GU26 @ascocancer.bsky.social
#ProstateCancer liver mets are lethal Finding at risk pts may be valuable
“Using this unique approach we have identified a candidate gene signature for detection of LM in advanced PCa using platforms such as EV-based liquid biopsy. Further studies are underway…”
🔜 #GU26 @ascocancer.bsky.social
“These findings… highlight the need for larger… studies to validate the prognostic value of PSMA-guided disease stratification & ensure its generalizability across diverse populations.”
Agree!! Need more #PSMA data less presumption in #ProstateCancer
🔜 #GU26 @ascocancer.bsky.social
Provocative early data
“#Microplastics were found in tissue samples from 9/10 pts w/ #prostatecancer…w/greater concentration in tumor tissue compared to benign tissue. Additional research is in progress to study the link between MNPs w/prostate carcinogenesis.”
🔜 #GU26 @ascocancer.bsky.social
“Detection of nodal and distant metastases below the Phoenix threshold challenges the current reliance on biochemical criteria to trigger imaging.”
Contemporary ❓But does early #PSMA+ #BCR #ProstateCancer require tx? Probably not based on data from the NCI @ #GU26
