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GU Cancers 2026 | Implementing PCWG4 guidance to refine endpoints in prostate cancer

Andrew Armstrong, MD, MS, Duke Cancer Institute, Durham, NC, highlights the importance of bringing Prostate Cancer Working Group 4 (PCWG4) guidelines into clinical practice. These guidelines establish endpoints for response, progression, and survival, and inform clinical protocols, regulatory decisions, and patient benefit, aiming to identify which patients benefit most from specific therapies and how to monitor their progress. This interview took place at the 2026 ASCO GU Cancers Symposium in San Francisco, CA.

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Transcript

And today’s talk focused on endpoints, bringing Prostate Cancer Working Group 4 guidelines into the clinic. And I started with a case presentation of a patient of mine who experienced PSA imaging discordant progression, which means a cancer that grew without making much PSA. That is a common phenomenon. Fully a quarter of patients who are treated for metastatic castration-resistant prostate cancer or hormone-sensitive disease who develop radiographic progression will do so without a rising PSA, and that’s a phenomenon we’re increasingly recognizing...

And today’s talk focused on endpoints, bringing Prostate Cancer Working Group 4 guidelines into the clinic. And I started with a case presentation of a patient of mine who experienced PSA imaging discordant progression, which means a cancer that grew without making much PSA. That is a common phenomenon. Fully a quarter of patients who are treated for metastatic castration-resistant prostate cancer or hormone-sensitive disease who develop radiographic progression will do so without a rising PSA, and that’s a phenomenon we’re increasingly recognizing. We developed guidelines called Prostate Cancer Working Group 4, which develop endpoints around response, progression, metastasis-free survival, progression-free survival, establishing biomarkers for validation in prospective studies. These guidelines tend to inform all of the clinical protocols that companies and academics use in the next 10 years to inform regulatory decisions, but also can help inform patient benefit. We’re trying to distill out which patients benefit most from which therapies and how to monitor and track their progress over time.

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