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Ravi Madan @ravimadan.bsky.social · 14d

From The NCI #PSMA files

73 yo male PSA=17 PSADT=11.6mos
PSMA=5+ nodes in pelvis RP & torso
(All~5mm). Neg CT and bone scan

No🚫Treatment

1 yr later
PSA=40 PSADT=13.1 mos
PSMA stable across 2 scans over 12 mos

#PSMA+ #BCR #ProstateCancer is an indolent process-OK to monitor these pts

homer simpson is holding a hammer next to a sign that says caution

ALT: homer simpson is holding a hammer next to a sign that says caution

media.tenor.com

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Ravi Madan @ravimadan.bsky.social · 14d

One that allows questioning of the data with the intent of understanding it better as opposed to “amplifying” the original message.

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Ravi Madan @ravimadan.bsky.social · 22d

In short. Yes. I do think #serosal lesions on #PSMA in #BCR do not present an urgent clinical threat. We are evaluating this further on our ongoing study of Prospective PSMAs in BCR #ProstateCancer

www.clinicaltrials.gov/study/NCT055...

ClinicalTrials.gov

www.clinicaltrials.gov

1

Ravi Madan @ravimadan.bsky.social · Aug 21

More examples of indolent serosal findings emerging from our ongoing #PSMA imaging study in #BCR #ProstateCancer @theNCI which has enrolled over 140 patients and continues to enroll.

See link for more details

www.clinicaltrials.gov/study/NCT055...

ClinicalTrials.gov

www.clinicaltrials.gov

Ravi Madan @ravimadan.bsky.social · Aug 21

Not the first example of indolent serosal findings on #PSMA in #ProstateCancer

This pt with findings in 2018
tinyurl.com/29tpcddy
@ascocancer.bsky.social

This patient with serosal findings on the liver remains without parenchymal Mets in 2025. Went most of the 7 years without treatment.

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Ravi Madan @ravimadan.bsky.social · Aug 21

Important to distinguish #serosal findings on #PSMA 🩻vs. #parenchymal

Serosal lesions are better seen on #PSMA vs CT/MRI in #ProstateCancer but likely have an indolent course even with no 🚫therapy (even on the liver!)

Dr. Melissa Abel at el @natrevurol.nature.com

rdcu.be/eBwPs

Ominous-appearing serosal findings on PSMA imaging might belie indolent clinical course

Nature Reviews Urology - Understanding of metastatic prostate cancer is mainly defined by macroscopic findings, but prostate-specific membrane antigen (PSMA) PET has increased sensitivity. PSMA+...

rdcu.be

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Ravi Madan @ravimadan.bsky.social · Aug 4

Restaging w/ #PSMA Imaging in #mCRPC #ProstateCancer: When Seeing More Is Detrimental to Care

Sadly a year later this remains true & the frequency of this is 📈

@ascocancer.bsky.social @ascopost.bsky.social

ascopubs.org/doi/pdf/10.1...

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Ravi Madan @ravimadan.bsky.social · Jul 27

Agree. Important point. There has always been a reluctance to use chemo in #ProstateCancer

It underpins the lack of 2nd line treatments s/p ARPI data from 2015-2020ish

Could argue it’s efficacy after arpi is unstudied but not a reason not to use

Every treatment has its place

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Reposted by Ravi Madan

Ian Davis @profiand.bsky.social · Jul 26

We have known for more than 20 years that chemotherapy has clinically significant efficacy in metastatic #ProstateCancer #pcsm, including improved overall survival. It has not stopped working just because new agents are available or are being tested.

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Ravi Madan @ravimadan.bsky.social · Jul 27

Agree @profiand.bsky.social
#ProatateCancer

Would also suggest that PFS of 2 agents vs 1 without adequate crossover should always be superior and such a trial answers few ?s except toxicity which will undoubtedly be “manageable”

www.nature.com/articles/s41...

Progression-free survival end points in prostate cancer: are we truly making progress - Nature Reviews Urology

Recently, several therapeutic strategies in prostate cancer have been granted regulatory approval based on progression-free survival benefits alone, which is a relative change in the therapeutic devel...

www.nature.com

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Reposted by Ravi Madan

Ian Davis @profiand.bsky.social · Jul 26

Two opinions that to my surprise are either unpopular or not widely held:
1. The control arm of a randomised trial should be best standard of care.
2. A PFS benefit against an inactive comparator is not a major advance, if progressive disease is required for eligibility.

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Reposted by Ravi Madan

Tian Zhang, MD @tiansterzhangmd.bsky.social · Jul 19

Pleasure to highlight your work with #UroToday @ravimadan.bsky.social - as we all consider how best to treat PSMA avid disease.

Ravi Madan @ravimadan.bsky.social · Jul 18

Do #PSMA+ findings in #BCR #ProstateCancer require immediate treatment?

NO based on emerging data @theNCI

Appreciate @tiansterzhangmd.bsky.social & #Urotoday for the opportunity to discuss

Ongoing trial of PSMA scans in BCR is still enrolling shorturl.at/36nGQ

www.urotoday.com/categories-m...

PSMA PET in Biochemical Recurrence: When to Treat vs When to Wait - Ravi Madan

Tian Zhang interviews Ravi Madan about a prospective study monitoring PSMA PET-positive biochemically recurrent prostate cancer patients. The trial enrolls patients with PSA > 0.5 and negative convent...

www.urotoday.com

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Ravi Madan @ravimadan.bsky.social · Jul 18

Do #PSMA+ findings in #BCR #ProstateCancer require immediate treatment?

NO based on emerging data @theNCI

Appreciate @tiansterzhangmd.bsky.social & #Urotoday for the opportunity to discuss

Ongoing trial of PSMA scans in BCR is still enrolling shorturl.at/36nGQ

www.urotoday.com/categories-m...

PSMA PET in Biochemical Recurrence: When to Treat vs When to Wait - Ravi Madan

Tian Zhang interviews Ravi Madan about a prospective study monitoring PSMA PET-positive biochemically recurrent prostate cancer patients. The trial enrolls patients with PSA > 0.5 and negative convent...

www.urotoday.com

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Ravi Madan @ravimadan.bsky.social · Jun 4

Correct abstract link
@ascocancer.bsky.social #asco25
#BCR #ProstateCancer #PSMA

meetings.asco.org/abstracts-pr...

Program Guide – ASCO Meeting Program Guide

meetings.asco.org

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Ravi Madan @ravimadan.bsky.social · Jun 4

Great discussions #ProstateCancer posters #ASCO25 @ascocancer.bsky.social

#PSMA+ #BCR is indolent & pts do NOT require urgent therapy in most cases

We should be ⚠️ cautious about over-treatment

🔗shorturl.at/NtxdF

Trial continues to accrue @theNCI

www.clinicaltrials.gov/study/NCT055...

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Ravi Madan @ravimadan.bsky.social · Jun 4

Most expected #Arches 5 yr follow up data to be pro-forma #ASCO25
@ascocancer.bsky.social

But then this data popped up 👀
Less clear benefit of Enza+ADT in low volume #mCSPC

Should this raise ?s for #mCSPC intensification w/#parp & #LU-psma

Implications for over treating PSMA+ recurrence?

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Ravi Madan @ravimadan.bsky.social · Jun 4

It remains disappointing that (unlike the Lu-PSMA trials) the #PARP inhibitor trials do not include cross over and thus continue to leave the key question of sequence unanswered. This limits understanding of clinical optimization
#AMPLITUDE #ASCO25 @ascocancer.bsky.social

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Ravi Madan @ravimadan.bsky.social · May 29

How to discern important new data @ ASCO?

Look beyond data that repackages known truths but do NOT really advance our understanding

Common examples:

1. Less cancer is better than more cancer

2. Responders do better

3. More treatments vs. less improve PFS

Happy #ASCO25
@ascocancer.bsky.social

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Ravi Madan @ravimadan.bsky.social · May 29

Around this time of year we see the “How should #oncology #fellows navigate the ASCO mtg?” advice.

My take:
👉🏽Very Carefully 🤓

Distinguish science from showmanship and make sure the substance of a presentation aligns with the “take home message”

Happy ASCO ☺️
@ascocancer.bsky.social
#ASCO25

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Ravi Madan @ravimadan.bsky.social · May 22

Rorschach Test for #ProstateCancer in 2025

Treat w/your favorite approach +/- your 2nd favorite approach?

Or acknowledge lack of data supporting long term benefits in this case & defer tx?

@theNCI continues to enroll #BCR pts on #PSMA monitoring trial

www.clinicaltrials.gov/study/NCT055...

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Ravi Madan @ravimadan.bsky.social · May 15

Case from the #NCI #PSMA files

67 yo w/#BCR #ProstateCancer
4 yrs s/p RP (declined salvage)
PSA=1.0
PSA DT=11 mos(“high risk”per European criteria)
PSMA shows only 6 mm obturator node next to ureter (SUVmax=26)
—no treatment
18 months later PSA is 1.1
LN=8mm
No new findings on PSMA

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Reposted by Ravi Madan

Josh Lang @joshlangmd.bsky.social · Mar 17

Do these clinical trial failures demonstrate a failure of traditional pre-clinical models to reflect the human disease?

In addition to the complete avoidance of biomarker-driven clinical trials to find the subset of patients that would benefit.? @asharpmedonc.bsky.social @pcf-science.bsky.social

Ravi Madan @ravimadan.bsky.social · Mar 17

Dr. Susan Slovin from MSK asks some key questions regarding #ProstateCancer #Immunotherapy

@ascocancer.bsky.social

ascopubs.org/doi/10.1200/...

Immune Checkpoint Combos in Metastatic Castration-Resistant Prostate Cancer: Where Are We Going, What Are We Doing, and Why?

ascopubs.org

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Ravi Madan @ravimadan.bsky.social · Mar 17

Good ?s @joshlangmd.bsky.social

Would say both issues are contributing factors to these study results.

I would also say that the failure of one immune strategy should not be considered representative of all #immunotherapy and all stages of #ProstateCancer

Ravi Madan @ravimadan.bsky.social · Mar 17

Dr. Susan Slovin from MSK asks some key questions regarding #ProstateCancer #Immunotherapy

@ascocancer.bsky.social

ascopubs.org/doi/10.1200/...

Immune Checkpoint Combos in Metastatic Castration-Resistant Prostate Cancer: Where Are We Going, What Are We Doing, and Why?

ascopubs.org

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