2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T7de,Grade group 5 (GG5) prostate cancer (PCa) carries a less favorable prognosis after standard-of-care (SOC) therapy, necessitating novel therapeutic approaches. High-dose rate brachytherapy (HDRBT) and androgen deprivation therapy (ADT) may modulate immune response in GG5 PCa, particularly in tumors with increased immune content. This study evaluated whether the addition of nivolumab to SOC was associated with improved disease control in patients with high-volume GG5 PCa, including those with oligometastatic disease. In this non-randomized phase II trial, 31 patients with localized or oligometastatic GG5 PCa and >30% positive biopsy cores were evaluated between September 2018 and April 2021. Patients received four doses of nivolumab (240 mg every 2 weeks) beginning 4 weeks prior to HDRBT, alongside ADT, HDRBT, and external beam radiation. The primary endpoint was to evaluate whether the 2-year freedom from biochemical recurrence (FFBR) rate would exceed a prespecified historical control rate of 75%. Among the 31 patients, the median follow-up was 38.8 months (IQR 31.0-46.5 months). The addition of nivolumab to SOC RT with ADT was associated with a 2-year FFBR rate of 90.3% (95% CI 74.3% to 98.0%) (median FFBR not reached), exceeding the prespecified historical control rate of 75% (one-sided p value from binomial test=0.024). Definitive and probable nivolumab-related toxicity included 6.3% acute grade 2 and 6.3% acute grade 3 adverse events (AEs), with no grade 4+ AEs observed. A higher Decipher immunosuppression score at diagnosis correlated with early pathologic response (p=0.005) and was independently associated with time to metastatic failure (p=0.044). Nivolumab combined with SOC was associated with encouraging FFBR in this high-risk GG5 PCa population and may represent a promising therapeutic intensification strategy. The Decipher immunosuppression score may serve as a predictive biomarker for response. These findings warrant further investigation in randomized trials.31:Ta2c, Background Grade group 5 (GG5) prostate cancer (PCa) carries a less favorable prognosis after standard-of-care (SOC) therapy, necessitating novel therapeutic approaches. High-dose rate brachytherapy (HDRBT) and androgen deprivation therapy (ADT) may modulate immune response in GG5 PCa, particularly in tumors with increased immune content. This study evaluated whether the addition of nivolumab to SOC was associated with improved disease control in patients with high-volume GG5 PCa, including those with oligometastatic disease. Methods In this non-randomized phase II trial, 31 patients with localized or oligometastatic GG5 PCa and >30% positive biopsy cores were evaluated between September 2018 and April 2021. Patients received four doses of nivolumab (240 mg every 2 weeks) beginning 4 weeks prior to HDRBT, alongside ADT, HDRBT, and external beam radiation. The primary endpoint was to evaluate whether the 2-year freedom from biochemical recurrence (FFBR) rate would exceed a prespecified historical control rate of 75%. Results Among the 31 patients, the median follow-up was 38.8 months (IQR 31.0–46.5 months). The addition of nivolumab to SOC RT with ADT was associated with a 2-year FFBR rate of 90.3% (95% CI 74.3% to 98.0%) (median FFBR not reached), exceeding the prespecified historical control rate of 75% (one-sided p value from binomial test=0.024). Definitive and probable nivolumab-related toxicity included 6.3% acute grade 2 and 6.3% acute grade 3 adverse events (AEs), with no grade 4+ AEs observed. A higher Decipher immunosuppression score at diagnosis correlated with early pathologic response (p=0.005) and was independently associated with time to metastatic failure (p=0.044). Conclusions Nivolumab combined with SOC was associated with encouraging FFBR in this high-risk GG5 PCa population and may represent a promising therapeutic intensification strategy. The Decipher immunosuppression score may serve as a predictive biomarker for response. These findings warrant further investigation in randomized trials. 32:Tb2c,Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen-deprivation therapy (ADT). To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy.33:T10b5, Importance Standard-of-care management of radiorecurrent prostate cancer (PCa) involves systemic therapy; however, some patients seek to avoid the adverse events (AEs) that are associated with androgen-deprivation therapy (ADT). Objective To determine outcomes of local therapy without systemic therapy for radiorecurrent PCa. Data Sources MEDLINE, Embase, Web of Science Core Collection, and Google Scholar were searched from inception up to May 2025. No date or language filters were used. Data were analyzed from June to November 2025. Study Selection Prospective and retrospective studies were selected that investigated local salvage therapies without concomitant systemic treatment for locally recurrent PCa after definitive radiotherapy. Eligible studies provided ADT-free survival (ADT-FS) and/or metastasis-free survival (MFS). Authors were contacted for additional data. Data Extraction and Synthesis This study was prospectively registered and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using Risk of Bias Assessment Tool for Nonrandomized Studies, version 2. Individual patient data were reconstructed from Kaplan-Meier curves or retrieved from authors. ADT-FS, MFS, and rates of AEs were pooled in a random-effects models. Main Outcomes and Measures Main outcomes were ADT-FS and MFS, which were modeled as pooled summary Kaplan-Meier curves, and rates of severe or worse AEs, which were modeled as proportions. Outcomes were stratified by treatment method. Results Thirty-one studies (4525 patients) were identified that assessed salvage high-dose–rate brachytherapy (HDR-BT; 336 patients), low-dose–rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials. Conclusions and Relevance The findings of this systematic review and meta-analysis suggest that local therapies alone have reasonable efficacy in well-selected patients with locally radiorecurrent PCa. ADT-free survival was maintained for more than three-quarters of patients at 2 years and more than half at 5 years. Approximately one in ten experience an early metastatic event. Rates of severe toxic effects were manageable, in particular for salvage HDR-BT, HIFU, SBRT, and cryotherapy. 34:T7ec,Most patients with high-risk localized prostate cancer (HRLPC) do not undergo stereotactic body radiotherapy (SBRT) in part because of the limited evidence of long-term outcomes. We report long-term efficacy and toxicity outcomes for men treated with SBRT for HRLPC. Individual patient data from ten prospective clinical studies evaluating SBRT for HRLPC across nine institutions were pooled in the Stereotactic Body Radiotherapy for High-Risk Localized Carcinoma of the Prostate consortium. The Kaplan-Meier method was used to estimate 5-yr biochemical recurrence (BCR) and distant metastasis (DM), stratified by receipt of intensified treatment (≥12 mo of androgen deprivation therapy [ADT] with extremely dose-escalated [≥8 Gy/fraction] prostate-directed SBRT). The impact of intensified treatment on BCR-free survival and DM-free survival was evaluated using multivariable Cox proportional hazards models. Late Common Terminology Criteria for Adverse Events grade ≥2 gastrointestinal (GI) and genitourinary (GU) toxicity was analyzed using time-to-event models. In 440 patients with a median follow-up time of 60.4 mo, 5-yr BCR and DM rates were 22% (95% confidence interval [CI] = 17-26%] and 9.2% (95% CI = 6.2-12%), respectively. In the 93 patients (21%) who received intensified treatment, 5-yr BCR and DM rates were 7.4% (95% CI = 1.7-13%) and 3.7% (95% CI = 0-7.9%), respectively. Receipt of intensified therapy was associated with a significant reduction in both BCR (hazard ratio [HR] = 0.38 [95% CI = 0.20-0.74], p = 0.005) and DM (HR = 0.43 [95% CI = 0.18-0.99], p = 0.049). For the overall cohort, 5-yr rates of grade ≥2 GU and GI toxicity were 23% (95% CI = 19-27%) and 10% (95% CI = 7-13%), respectively. Limitations include heterogeneous treatment techniques and the nonrandomized nature of the study. The safety and efficacy profile of SBRT for HRLPC remains favorable at long-term follow-up, and SBRT should be integrated into shared decision-making for treatment of HRLPC.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Androgen Deprivation Therapy: modality Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Androgen Deprivation Therapy (modality). Clinician-written summaries and actionable practice insights. 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not explicitly stated in the abstract.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.08.012","tag_type":"warning","value":"FRH data were derived from Hospital Episode Statistics (HES) in England only, limiting generalisability to other healthcare systems.","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.08.012","tag_type":"warning","value":"Study design is a secondary analysis; causal inference is limited by residual confounding (e.g., unrecorded bone-protective therapy use).","value_numeric":null},{"paper_doi":"10.1016/j.eururo.2026.08.012","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied because this finding directly counters prior meta-analytic signals suggesting ARPIs increase fracture risk, but it is based on a secondary analysis rather than a primary pre-specified endpoint.","value_numeric":null}],"summaries":{"what_studied":"This secondary analysis of two STAMPEDE phase 3 trials evaluated whether abiraterone-based treatment intensification (SOC+AAP ± enzalutamide) increased fracture-related hospitalisation (FRH) compared to standard of care (SOC) alone in 3,102 patients with newly diagnosed high-risk non-metastatic (M0) or metastatic (M1) prostate cancer in England, with up to 5-year follow-up.","key_result":"In M1 disease, 5-year FRH incidence was **lower** with SOC+AAP vs. SOC alone (22% vs. 30%; SDHR 0.77, 95% CI 0.59–0.99; p=0.04), and lower still with SOC+AAP+Enza vs. SOC alone (28% vs. 38%; SDHR 0.69, 95% CI 0.54–0.88; p=0.002); no significant difference was seen in M0 patients.","limitations":"- Only hospitalised fractures were captured, likely **underestimating** total fracture burden.\n- No baseline bone mineral density or fracture-risk assessment was available.\n- Longitudinal bone-protective therapy use was not systematically recorded, which may confound results.","practice_takeaway":"Clinicians can reassure patients with metastatic prostate cancer that abiraterone-based intensification does not increase — and may actually reduce — fracture-related hospitalisation, likely through better control of bone metastases. Bone-protective strategies remain important, but ARPI-related fracture risk concerns should not deter treatment intensification in M1 disease."}},{"doi":"10.1016/s1470-2045(26)00304-9","pmid":"42697217","title":"An integrated lifestyle intervention for mitigation of adverse effects associated with androgen deprivation therapy for prostate cancer (STAMINA): a multicentre, randomised trial","journal_title":"The Lancet Oncology","journal_issn":"1470-2045","published_at":"2026-09-04T00:00:00.000Z","url":"https://doi.org/10.1016/s1470-2045(26)00304-9","source_score":77,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-12T06:20:02.251Z","updated_at":"2026-09-12T06:20:02.251Z","tags":[{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"modality","value":"Exercise and Lifestyle Intervention","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"sample_size","value":"n=700","value_numeric":700},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"warning","value":"All enrolled participants were male by design; findings are not applicable to other populations.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"warning","value":"The confidence interval is reported as '97.232% CI' rather than the conventional 95% CI — this unusual threshold appears intentional (likely Bonferroni-adjusted for dual primary outcomes) but may cause confusion when comparing effect sizes to other trials.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00304-9","tag_type":"warning","value":"The FACT-P minimally important clinical difference threshold is not stated in the abstract; clinicians should interpret the 4.5-point improvement in that context.","value_numeric":null}],"summaries":{"what_studied":"The STAMINA trial evaluated whether a 12-month supervised aerobic and resistance exercise programme combined with dietary advice, behavioural support, and gym membership (vs. Optimised Usual Care) improved cancer-specific quality of life and fatigue in men on androgen deprivation therapy (ADT) for prostate cancer across 15 NHS trusts in England.","key_result":"STAMINA lifestyle intervention was superior to Optimised Usual Care at 12 months: FACT-P improved by an adjusted mean difference of 4.5 points (97.232% CI 1.7–7.2; p=0.0004) and FACIT-F by 1.9 points (0.4–3.4; p=0.0068). Three serious adverse events occurred in the intervention group (all resolved); no treatment-related deaths.","limitations":"- 97% of participants were White, limiting generalisability to more diverse populations.\n- Participants were aware of treatment allocation (open-label), introducing performance bias risk.\n- Optimised Usual Care was an active comparator (not a true no-intervention control), which may underestimate absolute benefit of supervised exercise.","practice_takeaway":"Men on ADT for prostate cancer should be offered a structured supervised exercise and dietary advice programme: the STAMINA intervention produced meaningful improvements in quality of life and fatigue with a low serious adverse event rate. Clinicians now have a clear, guideline-aligned model to prescribe and integrate this intervention into routine NHS cancer care."}},{"doi":"10.1016/j.jaccao.2026.08.001","pmid":"42669076","title":"Identifying Patients With Prostate Cancer Who Benefit Most From Routine Cardiovascular Specialist Referral","journal_title":"JACC: CardioOncology","journal_issn":"2666-0873","published_at":"2026-08-30T00:00:00.000Z","url":"https://doi.org/10.1016/j.jaccao.2026.08.001","source_score":54,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-04T06:22:11.341Z","updated_at":"2026-09-04T06:22:11.341Z","tags":[{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"modality","value":"Cardiovascular Risk Reduction","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"sample_size","value":"n=2487","value_numeric":2487},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"warning","value":"All findings are from subgroup analyses; even though prespecified, they should be considered hypothesis-generating rather than definitive.","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"warning","value":"The diabetes subgroup interaction (P=0.054) narrowly missed conventional significance; the directional estimates are included but should not drive firm clinical conclusions.","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"warning","value":"The sHR finding that patients with normal baseline BP (sHR 4.85) appeared to have worse outcomes than those with elevated BP (sHR 0.86) in the intervention group is counterintuitive and may reflect small subgroup event counts or residual confounding — interpret with caution.","value_numeric":null},{"paper_doi":"10.1016/j.jaccao.2026.08.001","tag_type":"warning","value":"The trial is labeled RADICAL PC-2, suggesting a predecessor trial exists; comparative context with RADICAL PC-1 is not provided in this abstract.","value_numeric":null}],"summaries":{"what_studied":"Prespecified subgroup analyses of the RADICAL PC-2 pragmatic RCT (n=2,487) examined which prostate cancer patients — stratified by baseline cholesterol, blood pressure, and diabetes status — derived the greatest benefit from routine referral to a cardiologist or internist for CV risk-factor and lifestyle modification.","key_result":"Patients with total cholesterol >4 mmol/L had a win ratio of 1.75 (95% CI: 1.51–2.03) vs. 1.21 (95% CI: 0.89–1.64) for those ≤4 mmol/L (interaction P=0.016). Patients with normal BP (<130/80 mm Hg) at baseline had a striking sHR of 4.85 (95% CI: 1.65–14.26) for CV death/MI/stroke/HF vs. 0.86 (95% CI: 0.61–1.21) for those with elevated BP (interaction P=0.003); the diabetes interaction trended but did not reach significance (P=0.054).","limitations":"Subgroup analyses, even when prespecified, are hypothesis-generating and prone to type I error across multiple comparisons. The paradoxical finding that patients with already-elevated BP appeared to benefit less (sHR 0.86) than those with normal BP (sHR 4.85) warrants cautious interpretation. The diabetes interaction did not reach the conventional significance threshold.","practice_takeaway":"Prostate cancer patients with elevated cholesterol (>4 mmol/L) or uncontrolled BP may be the highest-yield targets for routine CV specialist referral. Clinicians should prioritize identifying these modifiable risk factors at the time of prostate cancer diagnosis or when initiating androgen-deprivation therapy."}},{"doi":"10.1002/cncr.70494","pmid":"42572469","title":"How low do you need to go? Association between various prostate‐specific antigen response measures and clinical outcomes in metastatic castration‐sensitive prostate cancer in the Veterans Health Administration data","journal_title":"Cancer","journal_issn":"0008-543X","published_at":"2026-08-10T00:00:00.000Z","url":"https://pubmed.ncbi.nlm.nih.gov/42572469/","source_score":55,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-17T13:33:07.267Z","updated_at":"2026-08-17T13:33:07.267Z","tags":[{"paper_doi":"10.1002/cncr.70494","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"brand","value":"Erleada","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"brand","value":"Nubeqa","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"brand","value":"Xtandi","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"brand","value":"Zytiga","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"condition","value":"Metastatic Castration-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"generic","value":"abiraterone","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"generic","value":"apalutamide","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"generic","value":"darolutamide","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"generic","value":"docetaxel","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"generic","value":"enzalutamide","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"sample_size","value":"n=4890","value_numeric":4890},{"paper_doi":"10.1002/cncr.70494","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"warning","value":"Generalizability is limited: the VHA population is predominantly older, male, and includes a high proportion of Black patients (29%), which may not reflect the broader mCSPC population.","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"warning","value":"Impact flag 'practice_changing' applied because PSA <0.2 ng/mL as the target metric directly contradicts the majority of current real-world physician practice (85% use % decline), though this is a retrospective observational study and causality cannot be established.","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"warning","value":"Plain language summary states data from 2018–2023 for index dates, while the methods section states VHA data from 2006–2024 — the broader date range reflects data availability, with index dates restricted to 2018–2023.","value_numeric":null},{"paper_doi":"10.1002/cncr.70494","tag_type":"warning","value":"Study sponsored by Pfizer and Astellas (codevelopers of enzalutamide); several authors are employees or shareholders of these companies — potential for sponsorship bias.","value_numeric":null}],"summaries":{"what_studied":"This retrospective cohort study used Veterans Health Administration data (2006–2024, index dates 2018–2023) to compare two PSA-response metrics — PSA nadir <0.2 ng/mL vs. ≥90% PSA decline within 9 months of ADT initiation — and their association with overall survival (OS) and disease progression in 4,890 men with mCSPC receiving ADT ± ARPIs, NSAAs, or docetaxel.","key_result":"Achieving PSA <0.2 ng/mL within 9 months was associated with a 54% lower risk of death (adjusted HR 0.46; 95% CI 0.40–0.54) and a 55% lower risk of disease progression (adjusted HR 0.45; 95% CI 0.40–0.50) vs. not achieving it; 3-year OS was ~78–83% vs. ~48–51%. In contrast, ≥90% PSA decline alone (without reaching <0.2 ng/mL) was not associated with improved OS or disease progression. ADT + ARPI nearly doubled the rate of achieving PSA <0.2 ng/mL vs. ADT alone (OR 2.36; 95% CI 1.97–2.83).","limitations":"- Retrospective VHA cohort; findings may not generalize beyond a predominantly older male veteran population.\n- Key confounders (tumor grade, disease volume) were unavailable in the administrative dataset.\n- Testosterone levels were not used to define castration sensitivity, and administrative coding inaccuracies may affect cohort classification.","practice_takeaway":"Clinicians should target a PSA nadir <0.2 ng/mL — not just ≥90% PSA decline — when assessing treatment response in mCSPC, as only the absolute threshold predicts improved survival and delayed progression. Adding an ARPI to ADT more than doubles the odds of reaching this target and should be considered the standard approach."}},{"doi":"10.1001/jamaoncol.2026.2781","pmid":"42560686","title":"Mathematical Biomarkers of Adaptive Therapy Outcomes in Prostate Cancer","journal_title":"JAMA Oncology","journal_issn":"2374-2437","published_at":"2026-08-06T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13448836/","source_score":27,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-14T13:24:47.031Z","updated_at":"2026-08-14T13:24:47.031Z","tags":[{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"brand","value":"Zytiga","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"condition","value":"Castrate-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"condition","value":"Metastatic Castrate-Resistant Prostate Cancer","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"generic","value":"abiraterone acetate","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"sample_size","value":"n=53","value_numeric":53},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"study_design","value":"Retrospective Modeling and Validation Study","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"warning","value":"Full text was inaccessible; the structured extraction is based solely on the abstract and results sections, which may omit important methodological details.","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"warning","value":"The brand tag 'Zytiga' is inferred from the generic 'abiraterone acetate'; the paper does not explicitly name the brand.","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"warning","value":"The mCRPC cohort is very small (n=13), so results—especially the OS association—should be interpreted with caution and require prospective validation.","value_numeric":null},{"paper_doi":"10.1001/jamaoncol.2026.2781","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously: while findings are novel and outperform standard metrics, the retrospective design and small sample size mean prospective confirmation is needed before routine clinical adoption.","value_numeric":null}],"summaries":{"what_studied":"This retrospective modeling and validation study developed mechanism-based mathematical biomarkers—derived from first-cycle PSA kinetics—to predict time to progression (TTP), mean daily dose, and overall survival (OS) under adaptive therapy in two independent cohorts: 40 patients with castrate-sensitive prostate cancer (CSPC) receiving intermittent androgen deprivation therapy, and 13 patients with metastatic castrate-resistant prostate cancer (mCRPC) receiving adaptive abiraterone acetate.","key_result":"In the CSPC cohort (n=40), the adaptive therapy score was strongly prognostic for TTP (HR 0.49; 95% CI 0.31–0.76; P=.002). In the mCRPC cohort (n=13), it correlated with TTP (Spearman ρ=0.76; P=.002) and was associated with prolonged OS—while standard PSA metrics (nadir, time to nadir, doubling time) showed no association with OS.","limitations":"- Very small mCRPC cohort (n=13) limits statistical power and generalizability.\n- Retrospective, nonrandomized design from historical trial data (enrollment as early as 1996) may not reflect current treatment practices.\n- Full text was not accessible; conclusions rely on abstract and results sections only.","practice_takeaway":"First-cycle PSA kinetics can be used to compute a mathematically derived adaptive therapy score that outperforms standard PSA metrics in predicting TTP and survival under adaptive therapy—consider this as a decision-support tool when personalizing adaptive treatment schedules for prostate cancer patients."}},{"doi":"10.1038/s41391-026-01145-0","pmid":"42557372","title":"Clinical and genomic determinants of extraordinary response and resistance to androgen receptor pathway inhibitors in men with metastatic androgen pathway modulator sensitive (APMS) prostate cancer","journal_title":"Prostate Cancer and Prostatic Diseases","journal_issn":"1365-7852","published_at":"2026-08-05T00:00:00.000Z","url":"https://doi.org/10.1038/s41391-026-01145-0","source_score":14,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-09T13:25:05.887Z","updated_at":"2026-08-09T13:25:05.887Z","tags":[{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"condition","value":"Metastatic Castration-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"generic","value":"abiraterone","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"generic","value":"apalutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"generic","value":"docetaxel","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"generic","value":"enzalutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"sample_size","value":"n=224","value_numeric":224},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"warning","value":"Molecular testing temporal windows differed between ER and NR groups (within 6 vs. 3 months of ARPI start), which may introduce minor confounding from treatment-emergent alterations.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"warning","value":"Results for some genes (BRCA2, SPOP, RAD21) are based on small numbers and should be interpreted cautiously; no correction for multiple testing was applied.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"warning","value":"Specific ARPIs used per patient are not individually detailed; the cohort likely includes enzalutamide, abiraterone, apalutamide, and darolutamide — drug-specific subgroup results are not reported.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01145-0","tag_type":"warning","value":"The 'androgen pathway modulator sensitive (APMS)' terminology follows PCWG4 conventions and is equivalent to the more familiar 'metastatic castration-sensitive' or 'hormone-sensitive' prostate cancer labels.","value_numeric":null}],"summaries":{"what_studied":"This single-institution retrospective study (Duke Health, 2015–2024) evaluated clinical and genomic predictors of exceptional response (ER; PFS >53.36 months) versus non-response (NR; PFS <10.41 months) to ADT plus ARPI in 224 men with metastatic androgen pathway modulator sensitive (APMS) prostate cancer, with molecular testing available in 154 (69%).","key_result":"TP53 alteration (PFS HR 1.60, OS HR 1.91) and MYC gain (PFS HR 2.01, OS HR 3.81; multivariable OS HR 4.41) independently predicted worse outcomes. Co-alteration of ≥1 tumor suppressor gene plus ≥1 proliferative gene strongly associated with NR (58% vs. 7.7% in ER, p=0.002). Low-volume disease (OR 12.4), ECOG 0, higher hemoglobin/albumin, and normal alkaline phosphatase predicted ER. Achieving PSA nadir <0.2 ng/mL within 12 months was seen in 100% of ER vs. 21% of NR and carried a >5-fold increased likelihood of exceptional response.","limitations":"- Single-institution design with potential selection bias and incomplete real-world data.\n- Molecular testing was heterogeneous (tissue NGS vs. cfDNA) and available in only 69% of APMS patients, likely enriched for those who progressed.\n- Small subgroup numbers for some genes (e.g., BRCA2, SPOP, RAD21) limit power; results are hypothesis-generating without multiple testing correction.","practice_takeaway":"Pre-treatment molecular profiling for TP53, MYC, and tumor suppressor gene co-alterations can help identify men with APMS at high risk of early ARPI failure — these patients may warrant closer monitoring or intensified treatment strategies. PSA nadir <0.2 ng/mL at 12 months is a practical early landmark to assess depth of response and long-term prognosis."}},{"doi":"10.1002/pros.70229","pmid":"42542970","title":"Treatment of Hot Flashes in Men With Prostate Cancer Undergoing Androgen Deprivation Therapy","journal_title":"The Prostate","journal_issn":"0270-4137","published_at":"2026-08-02T00:00:00.000Z","url":"https://doi.org/10.1002/pros.70229","source_score":12,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-06T13:22:03.101Z","updated_at":"2026-08-06T13:22:03.101Z","tags":[{"paper_doi":"10.1002/pros.70229","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"condition","value":"Hot Flashes","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"clonidine","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"cyproterone acetate","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"fezolinetant","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"gabapentin","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"generic","value":"oxybutynin","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Acupuncture","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Alpha-2 Agonist","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Antiandrogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Anticholinergic","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Cognitive Behavioral Therapy","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Estrogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Gabapentinoid","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Progestogen","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"modality","value":"Selective Serotonin Reuptake Inhibitor","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"sample_size","value":"n=35","value_numeric":35},{"paper_doi":"10.1002/pros.70229","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"study_design","value":"Systematic Review","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Fezolinetant is mentioned only as a future research direction; no efficacy data in this population are available from this review.","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Level of evidence set to 2 based on systematic review design; individual included studies likely vary widely in quality and design.","value_numeric":null},{"paper_doi":"10.1002/pros.70229","tag_type":"warning","value":"Sample size tag reflects the number of included studies (n=35), not individual patients — total patient numbers are not reported in the abstract.","value_numeric":null}],"summaries":{"what_studied":"Systematic review of pharmacological and non-pharmacological interventions for hot flashes in men with prostate cancer undergoing androgen deprivation therapy (ADT), based on 35 studies identified from a PubMed search of 469 papers.","key_result":"Across all blinded pharmacological trials, hot flash frequency fell by 21%–84% (placebo effect: 19%–30%). Hormonal agents (cyproterone acetate, estrogen/derivatives) showed the greatest efficacy; acupuncture and CBT offered modest benefit; dietary supplements (Dong Quai, soy protein, Salvia officinalis, Serelys Homme) appeared ineffective.","limitations":"- Only 35 of 469 papers were included, and the overall evidence base is limited in size and quality.\n- The review does not include newer agents like fezolinetant, which have not yet been evaluated in this population.\n- Study heterogeneity in outcomes (frequency vs. quality of life) limits direct comparisons across interventions.","practice_takeaway":"For men on ADT troubled by hot flashes, hormonal agents (cyproterone acetate or estrogen) are the most effective options but carry side effect risks — discuss these trade-offs with patients. Acupuncture or CBT are reasonable non-hormonal alternatives; routine use of dietary supplements is not supported."}},{"doi":"10.1016/j.euo.2026.07.004","pmid":"42493283","title":"The Price of Cure: Rethinking Success in High-risk Prostate Cancer","journal_title":"European Urology Oncology","journal_issn":"2588-9311","published_at":"2026-07-23T00:00:00.000Z","url":"https://doi.org/10.1016/j.euo.2026.07.004","source_score":9,"is_retracted":false,"is_open_access":null,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":false},"created_at":"2026-07-31T13:36:56.638Z","updated_at":"2026-08-01T13:21:49.661Z","tags":[{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"generic","value":"cabazitaxel","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Chemotherapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"modality","value":"Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"study_design","value":"Editorial","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"Impact flag 'practice_changing' reflects the editorial's explicit argument for reframing success criteria in high-risk prostate cancer trials, not a primary study finding.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or conclusions are available. All summary fields have been set to null as there is no source content to extract from. Full text is required to generate structured summaries, tags, or evidence-based takeaways.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"The 90% 9-year cancer-specific survival figure is attributed to the PEACE-2 trial (Fizazi et al., J Clin Oncol 2026); this is a referenced claim, not independently verified here.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"The editorial references a 65-year-old with ~18 years EU life expectancy as an illustrative example, not a study population.","value_numeric":null},{"paper_doi":"10.1016/j.euo.2026.07.004","tag_type":"warning","value":"This is a publisher page preview only — full editorial text was not available; summary is based solely on the abstract excerpt, reference list, and visible publisher page content.","value_numeric":null}],"summaries":{"what_studied":"This editorial commentary reflects on shifting treatment goals in very high-risk localized prostate cancer, arguing that traditional endpoints (cancer-specific survival, metastasis-free survival) no longer fully capture patient burden when 9-year cancer-specific survival now approaches 90% with contemporary multimodal therapy.","key_result":"In very high-risk localized prostate cancer treated with contemporary multimodal therapy, 9-year cancer-specific survival approaches 90% (referencing PEACE-2 trial data); the editorial argues that for a 65-year-old with ~18 years of remaining life expectancy, non-cancer mortality (cardiovascular, metabolic, age-related) increasingly dominates, shifting the central clinical question toward quality of life and treatment burden.","limitations":"This is an editorial/opinion piece with no original data; claims are based on referenced trial results and population-level life expectancy estimates, not a systematic review or primary analysis.","practice_takeaway":"When counseling patients with high-risk prostate cancer, consider that treatment intensification may offer diminishing survival returns relative to its burden on quality of life — endpoints like patient-reported outcomes and quality-adjusted survival deserve greater weight alongside cancer-specific endpoints."}},{"doi":"10.1016/s1470-2045(26)00178-6","pmid":"42372744","title":"SBRT plus abiraterone acetate and ADT versus abiraterone acetate and ADT in oligometastatic castrate-resistant prostate cancer (ARTO): long-term, unplanned overall survival analysis of an open-label, randomised, phase 2 trial","journal_title":"The Lancet Oncology","journal_issn":"1470-2045","published_at":"2026-06-29T00:00:00.000Z","url":"https://doi.org/10.1016/s1470-2045(26)00178-6","source_score":59,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-11T13:33:03.856Z","updated_at":"2026-07-11T13:33:03.856Z","tags":[{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"brand","value":"Zytiga","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"condition","value":"Oligometastatic Castrate-Resistant Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"generic","value":"abiraterone acetate","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Androgen Receptor Signaling Inhibitor","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"modality","value":"Stereotactic Body Radiotherapy","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"sample_size","value":"n=157","value_numeric":157},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The brand name 'Zytiga' is listed as the most common brand for abiraterone acetate, but the paper does not specify which brand was used.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The 'not reached' median OS in the experimental arm limits precise estimation of survival benefit magnitude.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"The overall survival analysis was unplanned; the power calculation was updated post-hoc before data unmasking, which introduces potential methodological bias and should be interpreted with caution.","value_numeric":null},{"paper_doi":"10.1016/s1470-2045(26)00178-6","tag_type":"warning","value":"This is a phase 2 trial conducted exclusively in Italy; results may not generalize to other populations or healthcare settings.","value_numeric":null}],"summaries":{"what_studied":"The ARTO trial evaluated whether adding SBRT (metastasis-directed therapy to all sites) to abiraterone acetate plus ADT improved overall survival versus abiraterone acetate plus ADT alone in patients with oligometastatic castrate-resistant prostate cancer (≤3 metastatic sites, no prior systemic therapy for mCRPC), with a median follow-up of 53 months.","key_result":"Median overall survival was 50 months in the control group vs not reached in the SBRT group (HR 0.55, 95% CI 0.33–0.92, p=0.021). Grade 3–4 infectious complications occurred in 5 control vs 0 SBRT patients; one treatment-related death (myocardial failure) occurred in the control group.","limitations":"- Phase 2 trial with a relatively small sample (n=157); overall survival analysis was unplanned and power calculation was updated post-hoc.\n- Open-label design introduces potential performance bias.\n- No race or ethnicity data were collected, limiting generalizability.","practice_takeaway":"In oligometastatic mCRPC with ≤3 sites, adding SBRT to abiraterone acetate plus ADT significantly improved overall survival at ~4 years of follow-up. Clinicians should consider MDT as part of the treatment strategy for eligible patients, pending confirmation in phase 3 trials."}},{"doi":"10.1038/s41391-026-01131-6","pmid":"42323390","title":"Efficacy and safety of darolutamide plus androgen-deprivation therapy in Black patients with metastatic hormone-sensitive prostate cancer from the phase 3 ARANOTE trial","journal_title":"Prostate Cancer and Prostatic Diseases","journal_issn":"1365-7852","published_at":"2026-06-20T00:00:00.000Z","url":"https://doi.org/10.1038/s41391-026-01131-6","source_score":9,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-24T13:21:37.952Z","updated_at":"2026-06-24T13:21:37.952Z","tags":[{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"brand","value":"Nubeqa","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"condition","value":"Metastatic Hormone-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"generic","value":"darolutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"modality","value":"Androgen Receptor Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"sample_size","value":"n=65","value_numeric":65},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"study_design","value":"Subgroup Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"warning","value":"Full safety data and secondary endpoints (e.g., overall survival, PSA response) were not reported in the available abstract text.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"warning","value":"Level of evidence assigned as '2' reflects the RCT source trial; the subgroup analysis itself carries inherently lower certainty.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01131-6","tag_type":"warning","value":"This is a subgroup analysis of only 65 Black patients (10% of the total trial), so the 49% rPFS risk reduction should be interpreted with caution due to limited statistical power.","value_numeric":null}],"summaries":{"what_studied":"This pre-specified subgroup analysis of the phase 3 ARANOTE trial evaluated darolutamide 600 mg twice daily plus ADT vs. placebo plus ADT in Black patients (n=65) with metastatic hormone-sensitive prostate cancer.","key_result":"In Black patients, darolutamide + ADT reduced the risk of radiological progression or death by 49% vs. ADT alone (rPFS benefit), consistent with the overall ARANOTE population (N=669).","limitations":"Small subgroup (n=65; only 10% of total trial population), limiting statistical power. Safety data detail is sparse in the abstract. No overall survival or PSA response data reported in the available text.","practice_takeaway":"Darolutamide + ADT appears to offer meaningful rPFS benefit in Black patients with metastatic hormone-sensitive prostate cancer, a historically underrepresented group in clinical trials. Clinicians can apply these findings with cautious confidence given consistency with the overall trial result."}},{"doi":"10.1016/j.annonc.2026.05.708","pmid":"42250604","title":"Multimodal Artificial Intelligence Prediction of Abiraterone Efficacy in Two STAMPEDE Phase 3 Trials of Non-Metastatic Very High-Risk Prostate Cancer","journal_title":"Annals of Oncology","journal_issn":"0923-7534","published_at":"2026-06-06T00:00:00.000Z","url":"https://doi.org/10.1016/j.annonc.2026.05.708","source_score":23,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-16T13:54:27.872Z","updated_at":"2026-06-16T13:54:27.872Z","tags":[{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"category","value":"Oncology","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"generic","value":"abiraterone","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"modality","value":"Androgen Biosynthesis Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"modality","value":"Digital Pathology AI Biomarker","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"sample_size","value":"n=1137","value_numeric":1137},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"study_design","value":"Post-Hoc Analysis of Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"warning","value":"Level of evidence set to 2 based on RCT data origin, but the post-hoc design technically downgrades inferential strength.","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"warning","value":"The 'practice_changing' impact flag is applied cautiously given the post-hoc design; prospective confirmation would strengthen this designation.","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"warning","value":"The study is a post-hoc analysis; the MMAI tool is not yet prospectively validated for this specific predictive use case.","value_numeric":null},{"paper_doi":"10.1016/j.annonc.2026.05.708","tag_type":"warning","value":"Two sequential STAMPEDE trials with no shared controls were pooled — subtle protocol differences between trials could influence pooled estimates.","value_numeric":null}],"summaries":{"what_studied":"A multimodal AI (MMAI) digital pathology model was evaluated as a predictive biomarker for abiraterone benefit in 1,137 non-metastatic, clinically very high-risk prostate cancer patients from two STAMPEDE phase 3 trials, randomized to long-term ADT (LT-ADT) alone vs. LT-ADT plus abiraterone; primary endpoint was metastasis-free survival (MFS).","key_result":"MMAI very high-risk patients (N=268, ~24%) had a large abiraterone benefit (HR 0.47; 95% CI 0.31–0.70; 5-yr MFS 62% → 81%), while MMAI standard high-risk patients (N=869) showed no significant benefit (HR 0.83; 95% CI 0.63–1.09; 5-yr MFS 82% vs. 84%); interaction p=0.02.","limitations":"- Post-hoc analysis of RCT data limits causal inference and requires prospective validation.\n- MMAI threshold (75th percentile) was pre-specified but derived from prior work, not this dataset.\n- Two sequential trials with no shared controls were pooled, introducing potential heterogeneity.","practice_takeaway":"MMAI scoring of diagnostic biopsy pathology could help identify the ~24% of very high-risk localized prostate cancer patients who derive clear MFS benefit from adding abiraterone to LT-ADT, potentially sparing the majority from unnecessary toxicity and cost. Prospective validation is needed before routine clinical use."}},{"doi":"10.1056/nejmoa2603878","pmid":"42223077","title":"Perioperative Apalutamide in High-Risk Localized Prostate Cancer","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-05-31T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2603878","source_score":367,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-13T15:34:49.030Z","updated_at":"2026-06-13T15:34:49.030Z","tags":[{"paper_doi":"10.1056/nejmoa2603878","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"brand","value":"Erleada","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"generic","value":"apalutamide","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"modality","value":"Androgen Receptor Inhibitor","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"sample_size","value":"n=2109","value_numeric":2109},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"warning","value":"Overall survival data were not reported; long-term survival benefit remains unconfirmed.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"warning","value":"PSMA-PET was used as an imaging modality for metastasis-free survival assessment, which may affect comparability with older trials that used conventional imaging only.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"warning","value":"The absolute 5-year metastasis-free survival difference (~4.7%) is statistically significant but modest — clinical significance should be weighed against the higher adverse event burden.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2603878","tag_type":"warning","value":"Trial was funded by Johnson & Johnson (manufacturer of apalutamide); sponsorship bias cannot be excluded.","value_numeric":null}],"summaries":{"practice_takeaway":"For patients with high-risk localized or locally advanced prostate cancer undergoing radical prostatectomy, adding perioperative apalutamide to ADT improves pathological response rates and metastasis-free survival. Clinicians should counsel patients about a meaningfully higher risk of grade 3–4 adverse events, particularly rash (~8–9% higher rate), when considering this regimen.","what_studied":"Phase 3, double-blind, placebo-controlled trial (PROTEUS) evaluating perioperative ADT + apalutamide (240 mg/day) vs. ADT + placebo for 6 cycles (28 days each) before and after radical prostatectomy with pelvic lymph-node dissection in 2,109 patients with newly diagnosed high-risk localized or locally advanced prostate cancer; median follow-up 61.7 months.","key_result":"Pathological complete response or minimal residual disease was significantly higher with apalutamide (8.9% vs. 1.0%; OR 10.17; 95% CI 5.27–19.64; P<0.001). 5-year metastasis-free survival favored apalutamide (78.2% vs. 73.5%; HR 0.80; 95% CI 0.67–0.96; P=0.02). Event-free survival, time to first subsequent treatment, and time to distant metastasis all significantly favored apalutamide (P<0.001 for each). Grade 3–4 adverse events occurred in 39.6% vs. 31.0%, driven primarily by higher rash rates.","limitations":"- Overall survival data are not yet reported; metastasis-free survival benefit (absolute difference ~4.7% at 5 years) is modest.\n- Industry-funded (Johnson & Johnson), introducing potential sponsorship bias.\n- Generalizability may be limited as PSMA-PET staging criteria evolved during the trial period."}},{"doi":"10.1056/nejmoa2604126","pmid":"42223064","title":"PARP and Androgen-Signaling Inhibition plus ADT in Metastatic Prostate Cancer","journal_title":"New England Journal of Medicine","journal_issn":"0028-4793","published_at":"2026-05-30T00:00:00.000Z","url":"https://doi.org/10.1056/nejmoa2604126","source_score":366,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-05T13:22:53.741Z","updated_at":"2026-08-05T13:22:53.741Z","tags":[{"paper_doi":"10.1056/nejmoa2604126","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"brand","value":"Talzenna","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"brand","value":"Xtandi","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"category","value":"Medicine, General & Internal","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"condition","value":"Homologous Recombination Repair Gene Alteration","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"condition","value":"Metastatic Prostate Cancer","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"generic","value":"enzalutamide","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"generic","value":"talazoparib","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"modality","value":"Androgen Receptor Inhibitor","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"modality","value":"PARP Inhibitor","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"sample_size","value":"n=599","value_numeric":599},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"warning","value":"Overall survival results are from a pre-specified interim analysis and have not crossed the significance threshold; mature OS data are pending.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied based on the strong PFS result, but should be interpreted cautiously given immature OS data.","value_numeric":null},{"paper_doi":"10.1056/nejmoa2604126","tag_type":"warning","value":"The trial uses the term 'androgen pathway modulation-sensitive' (APMS) instead of the conventional 'castration-sensitive' or 'hormone-sensitive' — this is an emerging terminology shift that may affect cross-trial comparisons.","value_numeric":null}],"summaries":{"what_studied":"Phase 3 double-blind RCT (TALAPRO-3) evaluating talazoparib (0.5 mg/day) plus enzalutamide (160 mg/day) vs. placebo plus enzalutamide in 599 patients with metastatic androgen pathway modulation-sensitive (APMS) prostate cancer harboring homologous recombination repair (HRR) gene alterations, stratified by disease status, volume, and BRCA mutation status.","key_result":"At 3 years, imaging-based PFS was 77% (talazoparib) vs. 56% (control); HR 0.48 (95% CI 0.36–0.65; P<0.001). Overall survival at 3 years was 78% vs. 72% (HR 0.77; 95% CI 0.56–1.04) — not statistically significant at this interim analysis. Grade ≥3 anemia occurred in 51% of the talazoparib group; serious adverse events in 42% vs. 32%; two treatment-related deaths in the talazoparib arm.","limitations":"- Overall survival data are interim and not yet statistically significant (HR 0.77; 95% CI crosses 1.0), so a survival benefit remains unconfirmed.\n- Trial is restricted to patients with HRR gene alterations, limiting generalizability to unselected metastatic APMS populations.\n- Industry-funded (Pfizer), which may introduce bias risk.","practice_takeaway":"For patients with metastatic hormone-sensitive prostate cancer who harbor HRR gene alterations, adding talazoparib to enzalutamide plus ADT meaningfully reduces the risk of progression or death, but the high rate of grade ≥3 anemia (51%) demands proactive monitoring and dose-management planning. Await mature OS data before fully integrating this regimen into first-line practice."}},{"doi":"10.1038/s41391-026-01124-5","pmid":"42209844","title":"EMETPRO: a multicentric, international, retrospective analysis evaluating patients with metastatic hormone-sensitive prostate cancer with early progression","journal_title":"Prostate Cancer and Prostatic Diseases","journal_issn":"1365-7852","published_at":"2026-05-29T00:00:00.000Z","url":"https://doi.org/10.1038/s41391-026-01124-5","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-08T13:46:34.969Z","updated_at":"2026-06-08T13:46:34.969Z","tags":[{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"condition","value":"Metastatic Castration-Resistant Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"condition","value":"Metastatic Hormone-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"generic","value":"abiraterone","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"generic","value":"apalutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"generic","value":"darolutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"generic","value":"docetaxel","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"generic","value":"enzalutamide","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"modality","value":"Taxane Chemotherapy","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"sample_size","value":"n=401","value_numeric":401},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"study_design","value":"Retrospective Multicenter Registry Study","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"warning","value":"Specific ARPIs used are not broken down in the available abstract/results text; brand and generic tags reflect agents mentioned in the reference list and background context rather than confirmed per-patient data.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"warning","value":"The level of evidence is rated 4 given the retrospective, non-randomized, registry design.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"warning","value":"The study spans 2005–2023, meaning a substantial proportion of patients were treated before combination therapy (ARPI+ADT) became standard, which may confound comparisons between treatment groups.","value_numeric":null},{"paper_doi":"10.1038/s41391-026-01124-5","tag_type":"warning","value":"The total sample size of 401 is inferred by summing the three reported subgroups (201 + 124 + 76); the abstract does not explicitly state the total N.","value_numeric":null}],"summaries":{"practice_takeaway":"Patients with early progression on mHSPC therapy face very poor survival (median OS under 27 months) regardless of the subsequent mCRPC treatment used — no clear best next step has emerged. Clinicians should consider enrolling these patients in clinical trials, as optimal first-line mCRPC therapy remains an unmet need.","what_studied":"This multicentric retrospective registry (EMETPRO) evaluated 401 patients with metastatic hormone-sensitive prostate cancer (mHSPC) who had early progression (EP): ≤6 months on ADT+docetaxel or ADT+ARPI, or ≤9 months on ADT monotherapy, treated between 2005 and 2023 across international centers.","key_result":"Outcomes were poor across all groups. ADT monotherapy patients had median PFS 6.8 months and median OS 26.4 months. ADT+docetaxel patients had median PFS 4.9 months and OS 18.6 months. ADT+ARPI patients had median PFS 5.6 months and OS 19.5 months. Neither first-line mCRPC treatment choice nor genetic profile was associated with improved survival.","limitations":"Retrospective design with data spanning 2005–2023 introduces heterogeneity in treatment eras and standards. Genetic profiling was not available for all patients, limiting biomarker analysis. No randomization; treatment allocation was at physician discretion."}},{"doi":"10.1038/s41585-026-01149-4","pmid":"42209670","title":"Single-cell and spatial RNA sequencing in prostate cancer","journal_title":"Nature Reviews Urology","journal_issn":"1759-4812","published_at":"2026-05-28T00:00:00.000Z","url":"https://doi.org/10.1038/s41585-026-01149-4","source_score":1,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-08T13:46:36.905Z","updated_at":"2026-06-08T13:46:36.905Z","tags":[{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"condition","value":"Benign Prostatic Hyperplasia","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"condition","value":"Castration-Resistant Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"condition","value":"Metastatic Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"condition","value":"Neuroendocrine Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"modality","value":"Androgen Receptor Inhibitor","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"modality","value":"Single-Cell RNA Sequencing","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"modality","value":"Spatial Transcriptomics","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"warning","value":"Full article text was not accessible; structured data extracted from abstract and reference list only — key results reflect the abstract's claims, not detailed methods or data tables.","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"warning","value":"No specific patient numbers (N) are reported in the abstract; sample_size tag was omitted.","value_numeric":null},{"paper_doi":"10.1038/s41585-026-01149-4","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the review's characterization of scRNA-seq insights into therapy resistance mechanisms; direct clinical trial evidence is not presented in this review.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the applications of single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics in prostate cancer research, covering topics from normal prostate biology and benign prostatic hyperplasia to metastatic and castration-resistant disease, with focus on the tumour microenvironment, lineage plasticity, and therapy resistance.","key_result":"scRNA-seq and spatial transcriptomics have mapped complex epithelial, stromal, and immune cell interactions driving prostate cancer heterogeneity; key findings include identification of pre-existing castration-resistant-like cells in hormone-naïve tumours, JAK/STAT-driven lineage plasticity, immunosuppressive microenvironments in bone metastases, and bioinformatic inference of copy number variants enabling clonal evolution analysis.","limitations":"- Full text was not available; summary is based solely on the abstract and reference list, limiting depth of data extraction.\n- As a narrative review, no pooled statistics or effect sizes are provided.\n- Covers a rapidly evolving field; findings from cited studies vary widely in sample size, tissue type, and analytical methods.","practice_takeaway":"Clinicians should be aware that scRNA-seq is revealing therapy-resistance mechanisms—such as pre-existing CRPC-like cells and lineage plasticity—that bulk genomics misses, which may soon inform patient stratification and selection of TME- or lineage-targeted therapies. Spatial transcriptomics adds architectural context that could refine biomarker development for aggressive histologies like cribriform and neuroendocrine prostate cancer."}},{"doi":"10.1097/ju.0000000000005131","pmid":"42171515","title":"First-Line Systemic Treatments of Metastatic Hormone-Sensitive Prostate Cancer: Updated Systematic Review and Network Meta-Analysis","journal_title":"Journal of Urology","journal_issn":"0022-5347","published_at":"2026-05-22T00:00:00.000Z","url":"https://doi.org/10.1097/ju.0000000000005131","source_score":8,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-08-14T13:24:59.421Z","updated_at":"2026-08-14T13:24:59.421Z","tags":[{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"brand","value":"Erleada","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"brand","value":"Nubeqa","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"brand","value":"Pluvicto","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"brand","value":"Xtandi","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"brand","value":"Zytiga","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"condition","value":"Metastatic Hormone-Sensitive Prostate Cancer","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"abiraterone","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"apalutamide","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"capivasertib","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"darolutamide","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"docetaxel","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"enzalutamide","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"lutetium-177 PSMA-617","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"generic","value":"niraparib","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"AKT Inhibitor","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"Androgen Receptor Pathway Inhibitor","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"PARP Inhibitor","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"Radioligand Therapy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"modality","value":"Taxane Chemotherapy","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"sample_size","value":"n=18689","value_numeric":18689},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"study_design","value":"Network Meta-Analysis","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"warning","value":"Biomarker-driven trials (AMPLITUDE, CAPItello-281, PSMAddition) were excluded from the NMA due to selected populations and evaluated qualitatively only; OS results are immature for all three.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"warning","value":"PARPi+ARPI+ADT OS data were not available for inclusion in the NMA; OS benefit for this triplet remains unknown.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"warning","value":"Several included trials had open-label designs, introducing risk of bias in investigator-assessed progression endpoints.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the high-certainty subgroup finding for docetaxel triplet in high-volume disease and the emerging biomarker-driven data; the all-comer analysis does not confirm a practice change for unselected patients.","value_numeric":null},{"paper_doi":"10.1097/ju.0000000000005131","tag_type":"warning","value":"The NMA grouped all ARPIs (abiraterone, apalutamide, darolutamide, enzalutamide, orteronel, rezvilutamide) as a single class to preserve network connectivity; class-level effects may mask agent-specific differences.","value_numeric":null}],"summaries":{"what_studied":"This updated systematic review and network meta-analysis (NMA) compared the efficacy and safety of first-line systemic combination therapies for metastatic hormone-sensitive prostate cancer (mHSPC) across 23 RCTs (n=18,689), searched through March 2026. Outcomes included progression-free survival (PFS), overall survival (OS), and severe adverse events (AEs), with a separate systematic review of biomarker-driven trials (AMPLITUDE, CAPItello-281, PSMAddition).","key_result":"No triplet regimen showed a statistically significant OS benefit over ARPI+ADT in all-comers. However, **docetaxel+ARPI+ADT** significantly improved OS in high-volume disease (HR 0.76, 95% CI 0.61–0.95; high certainty). For PFS, docetaxel+ARPI+ADT (HR 0.66, 95% CI 0.43–1.01; moderate certainty) and PARPi+ARPI+ADT (HR 0.55, 95% CI 0.23–1.34; low certainty) showed clinically relevant but non-significant trends vs. ARPI+ADT. In biomarker-selected populations: niraparib+abiraterone improved rPFS in HRR-mutated mHSPC (HR 0.63); capivasertib+abiraterone improved rPFS in PTEN-deficient mHSPC (HR 0.81); Lu-177-PSMA+ARPI+ADT improved rPFS in PSMA-positive mHSPC (HR 0.72); OS data remain immature for all three.","limitations":"- Direct head-to-head comparisons between key triplet regimens were unavailable, requiring reliance on indirect NMA contrasts with interstudy heterogeneity.\n- Combining radiographic and clinical PFS endpoints introduced heterogeneity; earlier trials used conventional imaging vs. more sensitive modalities in recent trials, risking stage migration bias.\n- PARPi-, PSMA-, and AKT-based evidence comes from single trials with immature OS data and small phase II samples, yielding low or very low certainty.","practice_takeaway":"For patients with **high-volume mHSPC**, docetaxel+ARPI+ADT offers a proven OS benefit (HR 0.76; high certainty) and should be preferred. For patients with specific biomarkers (HRR mutation, PTEN loss, or PSMA-positive disease), targeted intensification with PARPi, AKT inhibitor, or radioligand therapy respectively shows rPFS benefit—but OS data are still maturing, so treatment decisions must weigh distinct toxicity profiles against uncertain long-term gains."}},{"doi":"10.1111/bju.70305","pmid":"42117295","title":"Biochemical Recurrence Irradiation or Observation (\n BRIO\n ) in patients with prostate cancer: protocol for a randomised control trial","journal_title":"BJU International","journal_issn":"1464-4096","published_at":"2026-05-12T00:00:00.000Z","url":"https://doi.org/10.1111/bju.70305","source_score":12,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-18T13:25:34.974Z","updated_at":"2026-05-18T13:25:34.974Z","tags":[{"paper_doi":"10.1111/bju.70305","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"category","value":"Urology & Nephrology","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"condition","value":"Biochemical Recurrence","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"condition","value":"Prostate Cancer","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"modality","value":"Androgen Deprivation Therapy","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"modality","value":"Multiparametric MRI","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"modality","value":"PSMA-PET/CT","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"modality","value":"Salvage Radiotherapy","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"sample_size","value":"n=312","value_numeric":312},{"paper_doi":"10.1111/bju.70305","tag_type":"sex","value":"male","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the trial's potential to shift standard of care, not a confirmed result.","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"warning","value":"The one-sided alpha of 0.15 is unconventional and more lenient than standard thresholds; clinicians should weigh this when interpreting future results.","value_numeric":null},{"paper_doi":"10.1111/bju.70305","tag_type":"warning","value":"This is a trial protocol paper — no outcome data are yet available; all efficacy figures cited are projections used for power calculations.","value_numeric":null}],"summaries":{"what_studied":"The BRIO trial (NCT06378866) is a randomised controlled trial enrolling 312 men with biochemical recurrence (PSA 0.2–1.5 ng/mL) after radical prostatectomy who have no evidence of disease on mpMRI or PSMA-PET/CT, comparing immediate salvage radiotherapy (±6 months ADT) vs. observation with image-guided therapy at radiographic progression over 5 years.","key_result":"No results yet — this is a trial protocol. The study is powered at 80% to detect an HR of 0.5 for metastasis-free survival (projected 5-year metastasis-free proportion: 80.7% control vs. 89.8% SRT arm) based on 30 metastasis events.","limitations":"- One-sided type I error rate of 0.15 is relatively permissive, which may limit the strength of any positive finding.\n- Relatively small event target (n=30) may reduce precision of the hazard ratio estimate.\n- Optional ADT use in both arms introduces potential confounding, addressed only partially by a 12-month landmark analysis.","practice_takeaway":"Clinicians managing post-prostatectomy BCR with negative mpMRI and PSMA-PET/CT should be aware that the standard practice of immediate salvage RT is being formally tested against watchful waiting — enrollment in or awareness of BRIO results will be important before defaulting to reflexive SRT in this imaging-negative subgroup."}},{"doi":"10.1136/jitc-2025-013906","pmid":"42082271","title":"Phase II trial of combination radiation, hormone, and immunotherapy in grade group 5 prostate cancer","journal_title":"Journal for ImmunoTherapy of Cancer","journal_issn":"2051-1426","published_at":"2026-05-05T00:00:00.000Z","url":"https://doi.org/10.1136/jitc-2025-013906","source_score":30,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-05","doi":"10.1136/jitc-2025-013906","days":"14","issn":"2051-1426","rank":"9","field":"Clinical Medicine","score":"30","category":"Immunology","categories":["Immunology"],"_categories":["Immunology"]},"pubmed":{"doi":"10.1136/jitc-2025-013906","title":"Phase II trial of combination radiation, hormone, and immunotherapy in grade group 5 prostate cancer.","journal":"Journal for immunotherapy of cancer","methods":"","results":"Among the 31 patients, the median follow-up was 38.8 months (IQR 31.0-46.5 months). The addition of nivolumab to SOC RT with ADT was associated with a 2-year FFBR rate of 90.3% (95% CI 74.3% to 98.0%) (median FFBR not reached), exceeding the prespecified historical control rate of 75% (one-sided p value from binomial test=0.024). Definitive and probable nivolumab-related toxicity included 6.3% acute grade 2 and 6.3% acute grade 3 adverse events (AEs), with no grade 4+ AEs observed. A higher Decipher immunosuppression score at diagnosis correlated with early pathologic response (p=0.005) and was independently associated with time to metastatic failure (p=0.044).","abstract":"$30","keywords":["Biomarker","Genitourinary Cancer","Immunotherapy","Prostate Cancer","Radiotherapy/radioimmunotherapy"],"pubmed_id":"42082271","conclusions":"","publication_date":"2026-05-05T00:00:00"},"crossref":{"DOI":"10.1136/jitc-2025-013906","URL":"https://doi.org/10.1136/jitc-2025-013906","ISSN":["2051-1426"],"link":[{"URL":"https://syndication.highwire.org/content/doi/10.1136/jitc-2025-013906","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":"e013906","type":"journal-article","issue":"5","score":1,"title":["Phase II trial of combination radiation, hormone, and immunotherapy in grade group 5 prostate cancer"],"author":[{"given":"John Michael","family":"Bryant","sequence":"first","affiliation":[{"name":"Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"},{"name":"Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA"}]},{"given":"Maria","family":"Sandoval","sequence":"additional","affiliation":[{"name":"Radiation Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Ryan","family":"Putney","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Purvish","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Esther N","family":"Katende","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Angelina","family":"Fink","sequence":"additional","affiliation":[{"name":"Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Syeda Mahrukh","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Youngchul","family":"Kim","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Vivian","family":"Yin","sequence":"additional","affiliation":[{"name":"Biostatistics and Bioinformatics, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Jingsong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA"}]},{"given":"Jong 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Treat these results as hypothesis-generating; the Decipher immunosuppression score signal needs validation in randomized studies."}},{"doi":"10.1001/jamaoncol.2026.1023","pmid":"42060279","title":"Local Salvage Therapy Alone for Local Recurrence of Prostate Cancer After Radiotherapy","journal_title":"JAMA Oncology","journal_issn":"2374-2437","published_at":"2026-04-30T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13133724/","source_score":57,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-06","doi":"10.1001/jamaoncol.2026.1023","days":"14","issn":"2374-2437","rank":"10","field":"Clinical Medicine","score":"57","category":"Oncology","categories":["Oncology"],"_categories":["Oncology"]},"pubmed":{"doi":"10.1001/jamaoncol.2026.1023","title":"Local Salvage Therapy Alone for Local Recurrence of Prostate Cancer After Radiotherapy: A Systematic Review and Meta-Analysis.","journal":"JAMA oncology","methods":"","results":"Thirty-one studies (4525 patients) were identified that assessed salvage high-dose-rate brachytherapy (HDR-BT; 336 patients), low-dose-rate brachytherapy (LDR-BT; 92 patients), stereotactic body radiotherapy (SBRT; 213 patients), radical prostatectomy (sRP; 1476 patients), cryotherapy (1621 patients), high-intensity focused ultrasonography (HIFU; 677 patients), or mixed methods (110 patients). Prospective studies comprised approximately one-fourth of the evidence (1055 patients); however, none were identified for sRP. Pooled 2-year and 5-year ADT-FS (2887 patients) were 76.8% and 55.2%, respectively. Pooled 2-year and 5-year MFS (3425 patients) were 90.4% and 75.2%, respectively. Rates of severe or worse AEs (2308 patients) ranged from 14% for LDR-BT, 13% for sRP, 5% for HDR-BT, 5% for HIFU, 4% for SBRT, and 2% for cryotherapy. Risk of bias concerns primarily regarded patient selection. Limitations included a lack of randomized clinical trials.","abstract":"$32","keywords":[],"pubmed_id":"42060279","conclusions":"","publication_date":"2026-04-30T00:00:00"},"crossref":{"DOI":"10.1001/jamaoncol.2026.1023","URL":"https://doi.org/10.1001/jamaoncol.2026.1023","ISSN":["2374-2437"],"link":[{"URL":"https://jamanetwork.com/journals/jamaoncology/articlepdf/2848244/jamaoncology_miszczyk_2026_oi_260016_1776800868.0938.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Local Salvage Therapy Alone for Local Recurrence of Prostate Cancer After Radiotherapy"],"author":[{"given":"Marcin","family":"Miszczyk","sequence":"first","affiliation":[{"name":"Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria"},{"name":"Collegium Medicum, Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland"}]},{"given":"Federico","family":"Mastroleo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy"},{"name":"Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy"}]},{"given":"Anna","family":"Kujawska","sequence":"additional","affiliation":[{"name":"Department of Urology and Oncological Urology, Poznan University of Medical Sciences, Poznań, Poland"}]},{"given":"Adam","family":"Gurwin","sequence":"additional","affiliation":[{"name":"University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, Wroclaw, Poland"}]},{"given":"Giulia","family":"Marvaso","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy"},{"name":"Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy"}]},{"given":"Tamás","family":"Kói","sequence":"additional","affiliation":[{"name":"Centre for Translational Medicine, Semmelweis University, Budapest, Hungary"},{"name":"Institute of Mathematics, Department of Stochastics, Budapest University of Technology and Economics, Budapest, Hungary"}]},{"given":"Giorgio","family":"Calleris","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Turin, Italy"}]},{"given":"Marnix","family":"Rasing","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"}]},{"given":"Joseph","family":"Chin","sequence":"additional","affiliation":[{"name":"Department of Urology, Western University, London Health Sciences Centre, London, Ontario, Canada"}]},{"given":"Donald","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, UNIO Healthcare Partners, San Diego, California"}]},{"given":"Arjun","family":"Nathan","sequence":"additional","affiliation":[{"name":"Division of Surgery and Interventional Science, University College London, London, England"},{"name":"Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England"}]},{"given":"Max","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"},{"name":"Radiotherapiegroep Deventer, Deventer, the Netherlands"}]},{"given":"Jochem","family":"van der Voort van Zyp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands"}]},{"given":"Pocharapong","family":"Jenjitranant","sequence":"additional","affiliation":[{"name":"Department of Urology, Western University, London Health Sciences Centre, London, Ontario, Canada"}]},{"given":"George","family":"Hruby","sequence":"additional","affiliation":[{"name":"Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia"},{"name":"Department of Radiation Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia"}]},{"given":"Timo F. 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The impact_flag 'practice_changing' reflects the authors' stated recommendation for integration into shared decision-making, but the non-randomized design means formal practice-change status awaits RCT confirmation.","value_numeric":null}],"summaries":{"what_studied":"Pooled individual patient data from 10 prospective studies across 9 institutions evaluated long-term efficacy and toxicity of SBRT for high-risk localized prostate cancer (HRLPC) in 440 men, with a median follow-up of 60.4 months; a key subgroup (n=93, 21%) received intensified treatment (≥12 months ADT plus ≥8 Gy/fraction SBRT).","key_result":"At 5 years, overall BCR rate was 22% and distant metastasis (DM) rate was 9.2%; intensified treatment cut BCR to 7.4% and DM to 3.7%, with multivariable analysis showing HR 0.38 for BCR (p=0.005) and HR 0.43 for DM (p=0.049); grade ≥2 GU and GI toxicity rates were 23% and 10%, respectively.","limitations":"- Non-randomized, pooled design limits causal inference for the intensified-treatment benefit.\n- Heterogeneous treatment techniques across 10 studies and 9 institutions may introduce confounding.\n- No direct comparison arm with conventional fractionation or standard-of-care EBRT.","practice_takeaway":"SBRT appears safe and effective for high-risk localized prostate cancer at 5 years, and should be included in shared decision-making discussions. Combining SBRT with ≥12 months of ADT and dose-escalated fractionation (≥8 Gy/fraction) was linked to substantially lower biochemical recurrence and metastasis rates."}}],"initialOffset":24,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"modality","value":"Androgen Deprivation Therapy"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Modalities","href":"/hub/tag/modality"},{"name":"Androgen Deprivation Therapy"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"modality","hub_tag_value":"Androgen Deprivation Therapy"}}}]]

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