Marshall Strother

🚨 PROTEUS substudy (@EUplatinum): perioperative apalutamide + ADT improves event-free survival vs radical prostatectomy alone in high-risk/locally advanced #prostatecancer, 🧵 1/3 🚨 👥 408 pts, high-risk localized or locally advanced PCa, fit for surgery 📊 Open-label phase 3 substudy, randomized 1:3 💊 Perioperative (neoadj + adj) apalutamide + ADT (n=102) vs RP alone (n=306) ⏱️ Median f/u 37.4 mo ⭐️Event = BCR or imaging-based recurrence ✅ 3-yr EFS 63% vs 41%, HR 0.38 (0.26-0.55), p<0.001 ✅ MFS by conventional or PSMA PET 87% vs 78%, HR 0.49 (0.26-0.90) ✅ But MFS by conventional imaging alone: similar, 94% vs 92% (p=0.5) ⚠️Caution in interpretation - See thread 👇 🔗 doi.org/10.1016/j.eururo.202… @PCFnews @PCF_Science @urotoday @UrologyTimes @TylerSbrt @renalandurology @Uroweb @JackAndrewsMD

🚨 VOLGA: chemo-free durvalumab + enfortumab vedotin beat surgery alone in muscle-invasive #bladdercancer 🚨 @NEJM today 🧵1/2 👥 n=695, cisplatin-ineligible or declined MIBC 📊 Phase 3 RCT, 1:1:1 💊 Perioperative durva + EV vs durva + tremelimumab + EV vs radical cystectomy alone ⏱️ Estimates at 24 mo ✅ Durva + EV EFS 63.5% vs 45.1%, HR 0.51 (0.38-0.67), p<0.001 ✅ OS 78.4% vs 69.4%, HR 0.58 (0.40-0.83), p=0.003 ✅ Durva + treme + EV EFS HR 0.61 (0.47-0.80), but grade ≥3 AEs 79.5% vs 71.1% ⚠️ The 2 durvalumab arms were not compared head-to-head, so the CTLA-4 add is not clearly worth the added toxicity 🎯 Another cisplatin-free ADC + IO backbone for cisplatin-ineligible MIBC

🚨 MRI-first screening w/o contrast finds more ≥GG2 #ProstateCancer 🚨 @EurUrol 👥 759 pts randomized 📊 Biparametric MRI first vs MRI only if PSA ≥3 ⏱️ 15 min scan, no contrast ✅ csPCa detected: 4.6% vs 1.8% (RR 2.6, 95% CI 1.1-6.1) ✅ Several csPCa found in pts w/ normal PSA ⚠️ More biopsies in MRI-first arm (10.8% vs 5.2%) 🎯 A FAST⚡️ contrast-free MRI up front catches significant PCa a PSA screen might miss @PCF_Science @PCFnews @urotoday @UrologyTimes @UroOnc 🔗shorturl.at/NUI1i

🚨 JCOG1403: One dose. Within 24 hours. Meaningful benefit in RCT @TheLancetOncol 👉 After nephroureterectomy for UTUC, a single intravesical chemo/pirarubicin instillation ⭐️Improved 3-year relapse-free survival: 💉 60% vs 47% 📉 HR 0.67 🎯 NNT = 12 to prevent one bladder recurrence ⚠️ Grade 3 hematuria: 3% ➖ No overall survival benefit @SUO_YUO @UroOnc @renalandurology @urotoday @UrologyTimes 🔗shorturl.at/0iwl5

🚨CAN-2409 + RT: not just delaying PSA failure, reducing residual tumor in the gland.🚨 @TheLancetOncol 👉Phase 3, double-blind RCT 🧑‍🤝‍🧑745 pts w/ int/high-risk localized #prostatecancer ⚖️EBRT + intraprostatic CAN-2409/valacyclovir vs placebo. 💉CAN-2409 is a replication-defective adenoviral HSV-tk gene therapy injected into the prostate. 💊Valacyclovir acts as the prodrug to drive local tumor-cell kill + immune priming 📉 DFS improved: HR 0.70; median NR vs 86.1 mo. 🔬 Key nuance: DFS included local failure by centrally reviewed positive prostate biopsy, protocol biopsy ~2 yrs post-EBRT. 🎯 At 22–26 mo: positive biopsies 20% vs 36%; pCR 80% vs 63%. 🛡️ No major toxicity penalty: grade ≥3 TEAEs 8% vs 7%; no treatment-related deaths. 🔑CAN-2409 may not just suppress biochemical recurrence, it may deepen local tumor eradication after RT. @PCFnews @PCF_Science @urotoday @UrologyTimes 🔗shorturl.at/o3ZUq