A Personalized Approach to Treating GU Cancers
Key Points
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The POSEIDON meta-analysis of six trials that evaluated salvage radiation therapy after prostatectomy showed that patients with very low prostate-specific antigen (PSA) levels (<0.5 ng/mL) may be able to forego short-term androgen deprivation therapy (ADT) when receiving radiation.
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Careful patient selection should be considered based on factors such as PSA doubling time, time from surgery to recurrence, and disease characteristics at surgery.
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The phase 3 SunRISe-2 trial demonstrated that a novel bladder-implanted drug delivery device with immunotherapy did not improve bladder-intact event-free survival (EFS), confirming chemoradiation as the current standard for bladder preservation.
The treatment of genitourinary cancers has evolved toward a more personalized approach, integrating novel therapies to tailor care to each patient. At the 2026 ASCO Genitourinary Cancers Symposium, Natalie Reizine, MD, of UI Health, asked Sophia Kamran, MD, of Massachusetts General Hospital, which abstracts were most notable.
She expressed the most excitement about the POSEIDON meta-analysis, which was a pooled evaluation of six trials examining the role of androgen deprivation therapy (ADT) in the postoperative setting for patients receiving salvage radiation therapy after prostatectomy. The data showed that patients with very low PSA levels (<0.5 ng/mL) may be a subgroup in which salvage radiation alone could be sufficient, Dr. Kamran said.
However, PSA levels alone are not enough to make a treatment decision. Dr. Kamran said that factors such as PSA doubling time, whether the PSA reached an undetectable level following surgery, the time interval between surgery and biochemical recurrence, and the original tumor characteristics should also be considered.
“If the patient is presenting with very favorable characteristics, perhaps a long time from surgery to when they had a detectable PSA, it would be very reasonable to hold the hormone therapy and just go with radiation therapy,” she said.
In bladder cancer, Dr. Kamran discussed the negative results from the SunRISe-2 trial. The phase 3 study evaluated a novel intravesical drug delivery device combined with immunotherapy compared with standard chemoradiation for bladder preservation in muscle-invasive disease. However, it was stopped early after an interim analysis showed no improvement in bladder-intact EFS with the device. Based on these data, chemoradiation remains the standard for bladder preservation.