Advances in ADT Personalization and Molecular Imaging Shape Updated NCCN Prostate Cancer Recommendations: With Daniel Spratt, MD

Welcome to OncLive On Air®! I'm your host today, Jax DiEugenio.

OncLive On Air® is a podcast from OncLive®, which provides oncology professionals with the resources and information they need to provide the best patient care. In both digital and print formats, OncLive covers every angle of oncology practice, from new technology to treatment advances to important regulatory decisions.

In today’s episode, we had the pleasure of speaking with Daniel Spratt, MD, chair and professor in the Department of Radiation Oncology at Case Western Reserve University School of Medicine and a member of the Case Comprehensive Cancer Center in Cleveland, Ohio. Dr Spratt discussed key updates to the National Comprehensive Cancer Network (NCCN) Guidelines for prostate cancer, including how advances in molecular imaging, evolving systemic therapy options, and the integration of next-generation androgen deprivation therapy (ADT) are reshaping treatment recommendations across localized, recurrent, and advanced disease settings.

In our exclusive interview, Dr Spratt reviewed the shift toward more personalized use of ADT in patients with unfavorable intermediate-risk disease and highlighted the expanding role of the oral GnRH antagonist relugolix (Orgovyx), originally approved based on the phase 3 HERO trial (NCT03085095). He also discussed early real-world insights from the nearly 1,000-patient OPTICS registry (NCT05501704), which is evaluating relugolix use across disease states, treatment combinations, adherence patterns, and testosterone kinetics in routine practice.

Dr Spratt further addressed updates in metastatic hormone-sensitive disease, including the incorporation of darolutamide (Nubeqa) in the phase 3 ARASENS (trial NCT02799602), and reviewed contemporary approaches to metastatic castration-resistant prostate cancer, including the use of PARP inhibitors, lutetium Lu 177 vipivotide tetraxetan (Pluvicto) for PSMA-positive disease, and radium-223 (Xofigo) for bone-predominant metastases.

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