#EMBARK in #BCR #ProstateCancer: a Journey for Some but NOT Most By Dr. Melissa Abel et al. “EMBARK was a biomarker-selected study enrolling pts @ the greatest risk…based on PSADT…required a PSADT≤ 9 mos…data suggests the true benefits are in pts w/PSADT≤ 6mos” shorturl.at/MB0JN

April 10,2026 ALL GOOD THINGS…🥹 Thx🙏🏽 to the patients & so many amazing people @thenci & beyond in my 21+yrs Many good Friends on the Journey Dr. Melissa Abel continues the research:#PSMA+ #BCR & #cytokines #ProstateCancer #immunotherapy The future @ NCI is bright☀️

Some thoughts on the management of #BCR #ProstateCancer #EMBARK Coming 🔜 in The Oncologist w/Dr. Melissa Abel & Dr. Fatima Karzai “EMBARK In Biochemically Recurrent Prostate Cancer: A Journey for Some but not Most”

Appreciate the⚠️caution voiced by #PCWG4 @ascocancer.bsky.social #PSMA imaging in #ProstateCancer is not🚫ready for prime time to determine treatment failure (distinct from imaging PD) in clinical practice PSMA may harm pts if it leads to stopping a tx too quickly

Lots of zeal in #oncology for new tech to detect recurrence (eg ctDNA, molecular imaging) Sobering however to recall that it remains unclear if early detection improves outcomes @nejm This presumption remains unclear in #ProstateCancer w/#PSMA & #PSA x.com/dr_ravimadan...

Result never in doubt in #mCSPC #ProstateCancer given design Questions should focus on short & long term toxicity. Also is sequencing (w/deferred tox) in any way inferior❓ Talazoparib/Enzalutamide Shows Improved Radiographic PFS www.targetedonc.com/view/talazop...

Talazoparib/Enzalutamide Shows Improved Radiographic PFS in Metastatic Castration-Sensitive Prostate Cancer | Targeted Oncology - Immunotherapy, Biomarkers, and Cancer Pathways

Early results from TALAPRO-3 suggest that the combination of talazoparib and enzalutamide may redefine the treatment paradigm for HRR gene-mutated mCSPC, demonstrating that targeting DNA damage repair...

targetedonc.com

A rationale for #SBRT to #Oligomets in #PSMA+BCR is “delay #ADT” But this presupposes #PSMA+#BCR requires ADT/ARPI… What if that’s not the case & most PSMA+BCR #ProstateCancer was indolent? Thats what a study @theNCI shows @asco #Gu26 shorturl.at/IyBBT

Recently had a discussion on “#mentorship” Many mentors confuse it w/ hyperdelegation 1st clue picking a “mentor” Did they ever ask what YOU want to do❓ Too many “mentors” presume you want to be them-Do you❓ Choose your path w/someone who asks you the right

a cartoon minion with a question mark above his head

ALT: a cartoon minion with a question mark above his head

media.tenor.com

Thank you. Agree, PSMA and PSA are just phenotypic markers that are demonstrably dispensable as mPC evolves under environmental and treatment selective pressure.

Thank you. Could you expand? PSA response vs PSMA response - is one better?

Still in the Dark… #PCWG4 launched #GU26 w/aspirational reliance on #PSMA imaging for drug development But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging #PSMAdark @ascocancer.bsky.social @melissaabel20 et al rdcu.be/eKNQe

The #NCI past meets the present #GU26 @ascocancer.bsky.social Dr. Melissa Abel discusses emerging #PSMA tumor volume data with Dr. Harpreet Singh The emerging data is from a follow-up trial based on a trial Dr. Singh worked on during her time at the NCi

“Dry Mouth” remains a frequent toxicity w/#PSMA therapies #GU26; easy to discount which is why worth reviewing below There are no Grads 4/5 and grade 3 is TPN. Grade 2 is also no picnic for pts We need a better grading system & more data on reversibility #ProstateCancer @ascocancer.bsky.social

Ravi Madan@ravimadan.bsky.social · 5mo ago

Dr. Fred Saad presents #Trillium 225Ac-PSMA in #mCRPC phase 1 study Substantial amount of dry mouth observed including 30% grade 2. @ascocancer.bsky.social #GU26

Dr. Fred Saad presents #Trillium 225Ac-PSMA in #mCRPC phase 1 study Substantial amount of dry mouth observed including 30% grade 2. @ascocancer.bsky.social #GU26

Dr. Fred Saad presents #Trillium 225Ac-PSMA in #mCRPC phase 1 study Substantial amount of dry mouth observed including 30% grade 2. @asco #GU26

Still in the Dark… #PCWG4 launched @ascocancer.bsky.social #GU26 w/aspirational reliance on #PSMA imaging for drug development But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging #PSMAdark @melissaabel20 et al rdcu.be/eKNQe

Drs. Melissa Abel & Alexandra Sokolova chair the #GU26 chair this evening Rapid Abstract Presentations in #ProstateCancer @ascocancer.bsky.social

Poster A14 #GU26 @ascocancer.bsky.social One key bit of data missing in the context of #PSMA+ #BCR #ProstateCancer management in the wake of the #EMBARK data is how does #PSA Doubling Time interface w/ #PSMA Pet findings. Dr. Melissa Abel from #NCI will share this data today

PosterA4 #GU26 @ascocancer.bsky.social #BCR #ProstateCancer study @thenci 🩻PSMA➡️ 3 mos Enza💊➡️PSMA🩻 PSA control=days below baseline=clinical benefit🔵 PSA⬇️88-100%🟠 #PSMA Tumor Volume🟢 🚨PSMA-TV⬇️s/p Enza does NOT predict benefit These data in PSMA responders raise❓for adaptive designs

Oh I like this… #GU26

Ravi Madan@ravimadan.bsky.social · 5mo ago

🔜 #GU26 @ascocancer.bsky.social How to approach a vast meeting w/so much data? Look beyond data that repackages known truths but do NOT really advance understanding Common examples: 1. Less cancer is better than more cancer 2. Responders do better 3. More treatments vs. less improves PFS

You’ve just beautifully summarised the vast majority of “🚨BREAKING NEWS! 🚨” papers and social media posts that come out of so many major meetings these days. We definitely need to do better. #GU26

🔜 #GU26 @ascocancer.bsky.social How to approach a vast meeting w/so much data? Look beyond data that repackages known truths but do NOT really advance understanding Common examples: 1. Less cancer is better than more cancer 2. Responders do better 3. More treatments vs. less improves PFS

a man in a suit and tie is smoking a cigarette while sitting at a table .

ALT: a man in a suit and tie is smoking a cigarette while sitting at a table .

media.tenor.com

🔜 #GU26 @ascocancer.bsky.social #ProstateCancer liver mets are lethal Finding at risk pts may be valuable “Using this unique approach we have identified a candidate gene signature for detection of LM in advanced PCa using platforms such as EV-based liquid biopsy. Further studies are underway…”

🔜 #GU26 @ascocancer.bsky.social “These findings… highlight the need for larger… studies to validate the prognostic value of PSMA-guided disease stratification & ensure its generalizability across diverse populations.” Agree!! Need more #PSMA data less presumption in #ProstateCancer

🔜 #GU26 @ascocancer.bsky.social Provocative early data “#Microplastics were found in tissue samples from 9/10 pts w/ #prostatecancer…w/greater concentration in tumor tissue compared to benign tissue. Additional research is in progress to study the link between MNPs w/prostate carcinogenesis.”

🔜 #GU26 @ascocancer.bsky.social “Detection of nodal and distant metastases below the Phoenix threshold challenges the current reliance on biochemical criteria to trigger imaging.” Contemporary ❓But does early #PSMA+ #BCR #ProstateCancer require tx? Probably not based on data from the NCI @ #GU26

🔜 #gu26 @ascocancer.bsky.social Would be good to see long term impact of ⬆️ PFS “The addition of #enzalutamide to standard ADT resulted in an improvement of PFS following SRT, warranting a phase 3 trial... and did not identify new safety concerns.” #ProstateCancer

🔜 #GU26 #ProstateCancer @ascocancer.bsky.social Important New trial guidance is valuable but important to distinguish from clinic practice recommendations “#PCWG4 expands guidance on patient & tumor profiling, as well as therapy development, to include both ADT sensitive & resistant settings…”

🔜 #GU26 @ascocancer.bsky.social Key to note IHC+ synaptophysin/chromogranin (seen in #ProstateCancer adenocarcinoma and small cell) alone should not exclude pts from Lu-PSMA Also highlights continue conflation of terms of #NEPC & small cell, the latter being truly virulent but also rare

🔜 #GU26 @ascocancer.bsky.social PFS benefit less than I would have expected… “The median (95% CI) PFS was 14.7 (11.7–21.3) mos among pts in the concomitant ARPI cohort vs 12.5 (11.5–13.6) months in the no concomitant therapy. Ongoing follow-up… on long-term clinical outcomes, including OS.”