SPARC the conversation

In “SPARC initiative: The final consensus”, Dr. Jochen Walz (FR) emphasised, “PSMA theranostics in PCa is here to stay. Several publications have shown the benefits of using PSMA technology to improve the management of our patients. What we lack is a common language.” According to Dr. Walz, there is an absence of standardised and accepted reporting of PSMA-PET. Clear and standardised communication between nuclear medicine physicians and clinicians (e.g., urologists, medical oncologists, radiotherapists, etc.) is essential

“The summary of the consensus we generated and the reporting standards established concerning detection (i.e., looking for PCa in a patient that was not yet diagnosed with PCa similar to what mpMRI is doing nowadays) is that MRI is not first-line for detection. There might be cases of inconclusive MRI, the same with biopsy findings. Added information might be of value,” said Dr. Walz. He underscored that a biopsy is still necessary, “even if it is PI-RADS 5, SUV > 12; even if MRI and PSMA-PET results are negative, but there is a strong suspicion that the patient has PCa.”

Dr. Walz also provided the consensus on the standards of PSMA-PET reporting on primary staging, biochemical recurrence, and treatment response.

APCCC diagnostics disparities
In the first part of the presentation, “APCCC diagnostics: Agreements and disagreements”, medical oncologist Dr. Fabio Turco (CH) provided the aims of the APCCC, such as:

1. Gather recommendations on managing advanced PCa, especially in areas where evidence is scarce or conflicting, or if there is a different interpretation of evidence
2. Knowledge translation
3. Identify knowledge gaps

Prof. Goffin then discussed the APCCC Diagnostics 2025, which comprised 88 questions divided into six categories: how to diagnose PCa; how to stage PCa; biochemical recurrence; metastatic disease: What to do; monitoring metastatic PCa; and radioligand therapy and imaging. Prof. Goffin also shared some of the questions which resulted in disparities among recommendations. The APCCC Diagnostics 2025 paper is ongoing. The call for abstracts deadline is 23 November 2025.

Renewed interest in tracers

In his presentation “Advances in molecular imaging in renal cancer”, nuclear medicine physician Dr. Clément Bailly (FR) stated that there is limited performance of tracers in nuclear medicine for the diagnosis of kidney cancer, but there is renewed interest tracers, particularly in theranostics. He focused on Carbonic Anhydrase IX (CA IX), which is a cell-surface glycoprotein that contributes to pH regulation. He stated that CA IX expression in non-cancerous tissues is rare and generally confined to the epithelia of the stomach, gallbladder, pancreas, and intestine. The expression is notably induced by hypoxia, and is notably induced as a consequence of the inactivating mutation of the pHVL tumour suppressor protein.

(Re)watch the full presentations via the EMUC25 Resource Centre.

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During his presentation, “Lu-PSMA in mCRPC men not taxane pre-treated”, Dr. Andrea Farolfi (IT) emphasised that prostate-specific membrane antigen (PSMA)-targeted radioligand therapy (RLT) is gaining momentum globally. He added that new trials on PSMA RLT are coming soon.

Overall survival (OS) was not the primary point for both PSMAfore (phase 3) and ENZA-p (phase 2) trials. PSMAfore had a “weak” control arm (i.e.ARPI [androgen receptor pathway inhibitor] switch), while ENZA-p had an active control arm (i.e. SoC vs. SoC + Lu-PSMA-617).

PSMAfore had a cross-over allowed by trial design. There is proof of peer documentation of activity (e.g. cancer regression, delay progression) in taxane-naïve patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). In addition, Lu-PSMA-617 has a manageable safe profile and was well-tolerated. The trial provides data for use prior to docetaxel in patients with mCRPC.

In ENZA-p, there is evidence of enhanced anticancer activity on PSA-PFS (prostate-specific antigen-progression-free survival) in a well-chosen sub-population. Furthermore, the adaptive dosed Lu-PSMA-617 will provide data on toxicity and the correct dosage for each patient. OS and progression-free data collecting is ongoing.

In her presentation “PARP inhibitors for mCRPC: for all or for BRCA patients only?”, medical oncologist Dr. Elena Castro (ES) stated, “Precision oncology can only be realised if there is broad access to profiling and relevant treatment options. We need to identify who are the patients with biomarkers and this requires extensive access to tumour profiling and targeted therapies. This is an issue not only concerning GU cancers but across oncology in general. I believe it’s something we need to approach as a community to be able to implement the promise of precision oncology.”

Plenary Session 13 concluded with a presentation from medical oncologist Prof. Johann De Bono (GB) entitled “Novel targeted approaches in mCRPC”. He stated that multiple promising new precision medicine therapeutic strategies are in development and likely to lead to further advances in care (e.g. EG immunoconjugates, immunotherapy antibody constructs, CAR [chimeric antigen receptor]-T cells).

According to Prof. De Bono, holistic consideration of the patient and their disease needs to be considered which includes studies of microbiota and druggable tumour-stromal cell interactions. Microbiota may fuel tumour growth through generated metabolites. Myeloid and other stromal cells may secrete paracrine, druggable, factors that fuel tumour growth and induce T-cell exhaustion.

Check out the EMUC23 Resource Centre for session recaps and full presentations.

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