Vedang Murthy: Abiraterone for High-Risk Prostate Cancer in the PSMA-PET Era – STAMPEDE-Like Cohort Analysis
Vedang Murthy, Professor GU-Radiation Oncology at Tata Memorial Centre Mumbai, posted on X:
“This one began with a nagging doubt.
We’ve all seen the rising enthusiasm for adding Abi to RT + ADT for high-risk prostate cancer, driven by STAMPEDE trial. But in the PSMA-PET era, is this systemic intensification always necessary?
Our latest study, now published in Prostate Cancer journal, takes a closer look at a “STAMPEDE-like” cohort, staged with PSMA-PET, treated with dose-escalated RT + long-term ADT but without abiraterone.
What we did?
- 170 patients with high-risk or node-positive prostate cancer (Matched to STAMPEDE High Risk)
- All staged with PSMA-PETCT
- Hypofractionated RT (EQD2 ~82 Gy), WPRT where appropriate
- ≥2 years of ADT
- No ARTA.
What we found (over 65 months median f/u):
- 6-year MFS: 80.7%
- PCSS: 95.8%
- OS: 94.4%
- Similar to the STAMPEDE + abiraterone arm
What this means? In patients staged with PSMA-PET and treated with Augmented WPRT RT, the incremental benefit of adding Abi may be modest.
Of course, this doesn’t mean never use abiraterone. But it raises an important point: Better imaging and SOC local therapy may allow more selective use Abi.
What this means?
In patients staged with PSMA-PET and treated with Augmented/intensified WPRT RT, the incremental benefit of adding abiraterone may be modest
We hope this adds nuance to personalising Rx for HR Ca Prostate—balancing benefit, cost, access, and toxicity.”
Piet Ost, Radiation Oncologist at Iridium Network Antwerp, shared this post on X, adding:
“The question everybody is asking: do all very high risk pts need intensification and could PSMA PET help us?
Vedang Murthy retrospectively assesses what everybody is asking. We will try to to do so prospectively in the Thunder trial.”
Title: Abiraterone for “STAMPEDE-Like” cohort of high-risk prostate cancer in the PSMA-PET era: too much, too early?
Authors: Vedang Murthy, Asesh Samanta, Priyamvada Maitre, Prashant Nayak, Pallavi Singh, Archi Agrawal, Amit Joshi, Gagan Prakash
Read The Full Article at Prostate Cancer.
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