Thomas Zilli

Learn something new every day! Never knew testosterone so frequently dropped post-RP. May explain why sometimes first PSA is undetectable but recurrence happens months later when T recovers. Or it is meaningless and just a factoid great to ask med students and residents.

#EAU26 @ChrisSweens1: the field is reaching a consensus in mHSPC. ADT + ARPI for nearly all patients, then personalize intensification: • SBRT for low-volume • Prostate RT in synchronous disease • Docetaxel if high-volume and chemofit 🕒 The hope for the future: biomarkers to guide therapy, global access, and drug prices coming down so evidence-based care becomes feasible worldwide. @uroweb @UroToday

Fair point about ARPI! I don't fully agree. To be clear, I am talking here about low-volume mHSPC. Few points: 1- I wouldn't say PEACE-1 showed no OS benefit. It doesn't prove a benefit, neither does it disprove one. HR for SOC+Abi +/-RT was 0.77 (Curves below). There is certainly a trend. I think we need a higher N for the ARPI subgroup. There was however a signicant improvement in CRFS. 2- In a NMA (@soum_roy_radonc) with Bayesian pairwise comparison, the best treatment was SOC+ARPI+RT, and was associated with reduced mortality wrt SOC+ARPI europeanurology.com/article/S0302-… 3- STOPCAP meta-analysis (including PEACE-1 data) showed an OS HR of 0.92 (0.84-1.0) for RT for all-comers, low and high-volume (Forest plot below). For low-volume, OS HR was 0.79 (0.67-0.93). annalsofoncology.org/article/S0923-… urotoday.com/conference-hig… So based on the above, I think it's safe to say that RT to the primary is beneficial for low-volume mHSPC treated with ADT +/- ARPI. PEACE-1 cannot rule out an OS benefit for the ADT+ARPI subgroup, mainly due to small N and Frequentist design. It does however prove a CRFS benefit. On another hand, a Bayesian comparison (NMA above) showed that these patients most likely benefit from RT. In light of these, I think it's hard to NOT recommend RT even with ARPI. Wondering what is the current practice at your institution. Also curious to know what other Rad-Onc colleagues think about this @pcaparker @soum_roy_radonc @drspratticus @tylersbrt @seanmmcbride @sbrtsean @alison_tree @vedangmurthy @piet_ost @paulsargos @jryckman3 @5_utr @adib_elio @protonstorey @docpriyamvada @_shankarsiva @albertobossial @amarukishan

#Debate: Optimal management of oligorecurrent disease: Too Late! Systemic Treatment. Presentation by @UrsulaVogl @EnteOspedaliero. #EAU26 written coverage by @zklaassen_md @GACancerCenter > bit.ly/4lpoRLT @Uroweb

☢️LuTectomy: Neoadj [¹⁷⁷Lu]Lu-PSMA-617 pre-RP in HR, localized PCa Ph 1/2 single-arm (n=20; f/u 46 mo) 🔹Eligibility • PSA >20 ng/mL, ISUP ≥3, or ≥cT2c • High uptake on [⁶⁸Ga]PSMA PET 🔹Treatment • 1 cycle (n=10) or 2 cycles (n=10) 5 GBq • Given ~6 weeks pre-RP 📌BCR: 50% (median BCR-FS: 32 mo) 📌After BCR • 70% salvage RT • 2 → mCRPC (enzalutamide) ⛔️No Gr 3–4 TRAEs ; 1 possible Gr 2 CKD @urotoday

For those who state ablative treatment has no side effects: 50% with TULSA had incontinence or impotence. Ignores salvage tx side effects which are critical to determine superiority. Kudos for running the trial. Based on these event rates hard to believe AS or SBRT wouldn’t be far superior. Happy to enroll to that trial!

Wanted to highlight our AASUR trial. Was an awesome multi-institutional collaboration. Especially grateful to @ThePCCTC and @UMichRadOnc team (@DrSpratticus, Jason Hearn, et al were our 2nd leading accruers). But a true team effort. And many thanks to @JNJInnovMed and @PCFnews for funding. TL;DR: in VHR localized PCa, a short course (6mo), ADT/ARPI regimen combined with 40/5 prostate-only SBRT had favorable toxicity profile, rapid T return, and, despite not meeting superiority threshold, BCR rates that looked similar to long course ADT historical controls. These patients were not DECIPHER-selected or PSMA PET staged. It may be that scADT/ARPI+RT would provide equivalent results in the vast majority of RT-treated VHR, localized dz. Obviously this would require confirmation in an appropriately sized NI trial. #radonc #pcsm

🚨Darolutamide shows lowest DDI risk: RECOmmEnD RW study (mHSPC) RECOmmEnD: 🇬🇧 RW study of ARPI DDIs in mHSPC PCa (n=315, 21 🇬🇧 centers; median 3 concomitant meds/pt) Darolutamide (vs Apa & Enza) had lowest: 🔹Potential DDIs: 18% vs 37–38% 🔹AEs due to concomitant meds: 0.1% vs 0.6–0.7% 🔹Advisories to avoid concomitant meds: 0.1% vs 1.9–2.5% 🔹Dose alterations of concomitant meds: 11% vs 22–32% @urotoday #EAU26

#EAU26 #Debate: Optimal management of de-novo oligometastatic disease: #Radiotherapy – treat all you can see. Presentation by @AmarUKishan @UCLA. Written coverage by @zklaassen_md @GACancerCenter > bit.ly/413XayS @Uroweb

📣@ChapinMD presents best systemic therapy trial +/- prostatectomy n=120 randomised phase II trial in #prostatecancer. No observed benefit for prostatectomy 🔪🩸. Ongoing recruitment for SWOG-1802, pls support this important clinical trial 👏🏽#pcsm #EAU26

(PRIMARY2 Trial) 🚨 @ButeauJames: PSMA-11 PET scan after an equivocal mpMRI (PI-RADS 2/3) cuts TP prostate biopsies by 50%. By using PRIMARY score, avoiding biopsies for PSMA-ve men and only targeted biopsies for PSMA-positive men—was non-inferior🔬👨‍⚕️ #ProstateCancer #EAU26 #pcsm

2/ The key finding: adding PSMA PET/CT to current standard-of-care halved the number of prostate biopsies. Biopsy was avoided in 49% of men, without missing clinically significant prostate cancer.

Diagnostic Value of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Staging Histological Subtypes of Invasive Bladder Cancer by Renee A.G. Lijnen et al Read the article: buff.ly/wjGnWUU We thank the authors for trusting #EUO with your work. @LAUrology_NL @TBoellaard @FraClaps @uroweb @mroupret @GPloussard @jteoh_hk @Ric_Campi @CaPsurvivorship @UroDocAsh @LauraMarandino @RenuEapen @Ecastromarcos @OncoAlert @Sciencedirect

The registrations are open: A) the first day only to meet GU Radonc professors of international board and attend key topic lectures, or B) all days to attend the entire adaptive practical course. Up to you. Waiting for you at: 👉summerschoolnegrar.com

Not registered yet? Take advantage of a 20% discount when registering for #IPCS26 #APCCC26 Events Details: 📍 Palazzo Congressi, Lugano, Switzerland 🎟️ Register here: onlineevent.ch/APCCC/2026 🎓 Credits requests: SGU – SSU, SSMO, SRO, SGMN apccc.org

International all-stars GU faculty!

🤓 One of our MOST READ ARTICLES (last 30 days)! Prognosis and Treatment Response in Aggressive-variant Prostate Cancer and Treatment-related Neuroendocrine Prostate Cancer: A Systematic Review and Meta-analysis by Martino Pedrani Full article: buff.ly/k3P3S3C We thank the authors for trusting #EUO with your important work! @PedraniMartino @Silke_Gillessen @uroweb @mroupret @GPloussard @jteoh_hk @Ric_Campi @CaPsurvivorship @UroDocAsh @LauraMarandino @RenuEapen @Ecastromarcos @OncoAlert @Sciencedirect

#CongresGFRU Coup de projecteur sur l’escalade de dose dans les formes à haut risque #prostatecancer 👉Quel fractionnement en 2026 ? C. Hennequin 👉Le boost par curiethérapie a-t-il encore sa place, les arguments @CarlSalembier #GFRU #radiotherapy #urology #lyon

ARTO Trial: Long-term overall survival analysis from a randomized phase II trial testing the benefit of SBRT addition to abiraterone acetate in oligometastatic #CRPC patients. Presentation by @GiulioFrancoli1 @AOUCareggi. #GU26 written coverage by @RKSayyid @UAUrology > bit.ly/4b2BKa8 @ASCO

@lalaniMD presenting cytoshrink data at #guasco26. IIT random metastatic rcc to +\- radiation with Nivo/ipi. No difference in outcomes however imbalances in study population and high freq of non ablative doses. Congrats to the study team for conducting this study.