LUGPA 2026 Global Prostate Cancer Congress Enduring Program-Session 8

Video Transcription

Video Summary

The transcript captures the closing morning of a Global Prostate Cancer Conference, featuring updates on advanced prostate cancer therapies and practical issues clinicians face.

Dr. Sharif Ghaemi reviews PSMA radioligand therapy (notably lutetium-177), framing it as a diagnostic–treatment–monitoring “theranostics” pathway. He emphasizes the limited tissue penetration of beta/alpha emitters, supporting a favorable safety profile, but argues the field’s next major leap is <strong>adaptive dosing/dosimetry</strong>—moving beyond fixed 200 mCi x 6 cycles to individualized dosing based on delivered tumor and marrow dose. He cites VISION outcomes (modest survival/PFS benefits, PSA responses) and discusses expanding trials into hormone-sensitive and oligometastatic settings, including the LUNAR trial combining Lu-177 with SBRT.

A second speaker reviews <strong>PARP inhibitors</strong> in mCRPC, noting ~23% of metastatic cases harbor DNA repair mutations. Olaparib and rucaparib have distinct FDA indications; combination regimens (PARP + abiraterone or enzalutamide) are now approved, with rationale that AR blockade may enhance DNA-repair vulnerability. TRITON3 supports rucaparib benefit mainly in <strong>BRCA</strong> (not ATM). Early combination data also include PARP plus radioisotopes (e.g., olaparib + radium-223).

Dr. Todd Morgan addresses <strong>repeat somatic testing</strong> at progression. Real-world PROMIS data show repeat testing (mostly ctDNA) yields new actionable findings in ~11%, though results depend on ctDNA tumor fraction; low fractions can be indeterminate, and tissue may better detect copy-number changes like <strong>BRCA homozygous loss</strong>, linked to stronger PARP responses. Panel discussion highlights sequencing uncertainties, reimbursement challenges for off-label targeted drugs, and growing interest in combinations (including immunotherapy and bispecifics) despite toxicity concerns.

Keywords

Global Prostate Cancer Conference

PSMA radioligand therapy

Lutetium-177 (Lu-177)

Theranostics

Adaptive dosing and dosimetry

VISION trial

LUNAR trial

PARP inhibitors

Metastatic castration-resistant prostate cancer (mCRPC)

Repeat somatic testing (ctDNA)