LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 7

Video Transcription

Video Summary

Session seven at a prostate cancer meeting focuses on the evolution of treating metastatic castration-sensitive prostate cancer (mCSPC) from androgen deprivation therapy (ADT) alone to intensified regimens. Dr. Crawford reviews the historical path from orchiectomy and estrogens to LHRH agonists and antiandrogens, emphasizing that modern “doublet” (ADT plus an androgen receptor pathway inhibitor or docetaxel) and “triplet” approaches improve survival and that ADT monotherapy is now generally inappropriate. He frames “quadruple therapy” as comprehensive management of treatment toxicities (cardiovascular risk, bone health, diet/exercise), not simply adding another anticancer drug.<br /><br />Dr. Belusic provides an ADT update, stressing that side effects stem from testosterone deprivation: metabolic syndrome, sarcopenic obesity, cognitive decline, falls, and cardiovascular events—yet real-world screening is often inadequate. He notes newer oral ADT options with faster testosterone suppression and recovery. He summarizes survival gains: doublets reduce mortality ~34–40% vs ADT alone; triplets add further benefit. He highlights the AMPLITUDE trial: niraparib + abiraterone + ADT improved radiographic PFS in HRR-mutated mCSPC, with strongest benefit in BRCA mutations, leading to FDA approval for BRCA-positive patients; key toxicities include anemia and hypertension.<br /><br />Dr. Sollinger previews emerging biomarker-driven intensification: CAPItello-281 (capivasertib for PTEN loss), adding lutetium-PSMA to ADT+ARPI in PSMA-positive disease, and ongoing PARP/ARPI combinations—reinforcing the need for early germline and somatic testing, especially to avoid missing BRCA “super responders.”<br /><br />Later talks cover theranostics implementation (PSMA radioligand therapy, logistics for community centers) and metastasis-directed therapy (SBRT) for oligometastatic recurrence to delay ADT, with trials (STOMP, ORIOLE) showing improved progression metrics. A panel debates when to restart systemic therapy in biochemical recurrence with negative imaging, balancing early intensification against quality-of-life and toxicity.

Keywords

metastatic castration-sensitive prostate cancer (mCSPC)

androgen deprivation therapy (ADT)

treatment intensification (doublet and triplet therapy)

androgen receptor pathway inhibitors (ARPI)

docetaxel chemotherapy

quadruple therapy toxicity management

cardiovascular and metabolic side effects of ADT

oral ADT agents testosterone suppression and recovery

AMPLITUDE trial niraparib abiraterone ADT

BRCA and HRR mutation testing PARP inhibitors

PSMA theranostics lutetium-177 PSMA radioligand therapy

oligometastatic recurrence metastasis-directed therapy SBRT (STOMP ORIOLE)