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Ravi Madan @ravimadan.bsky.social · 13/04/2026

#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

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Ravi Madan @ravimadan.bsky.social · 10/04/2026

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☀️

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Ravi Madan @ravimadan.bsky.social · 09/04/2026

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”

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Ravi Madan @ravimadan.bsky.social · 06/04/2026

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

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Ravi Madan @ravimadan.bsky.social · 21/03/2026

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...

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Ravi Madan @ravimadan.bsky.social · 16/03/2026

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

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Ravi Madan @ravimadan.bsky.social · 12/03/2026

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

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Craig Gedye @craiggedye.bsky.social · 01/03/2026

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

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Craig Gedye @craiggedye.bsky.social · 27/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 28/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 28/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 27/02/2026

“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

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Ravi Madan @ravimadan.bsky.social · 27/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 27/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 27/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 27/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 26/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 26/02/2026

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

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Ian Davis @profiand.bsky.social · 25/02/2026

Oh I like this… #GU26

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Ian Davis @profiand.bsky.social · 25/02/2026

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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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…”

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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.”

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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…”

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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

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Ravi Madan @ravimadan.bsky.social · 25/02/2026

🔜 #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.”

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Ravi Madan @ravimadan.bsky.social · 13/02/2026

With #GU26 approaching 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 @ the NCI will share this data @ #GU26 @ascocancer.bsky.social

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American Society of Clinical Oncology @ascocancer.bsky.social · 04/02/2026

It’s the story of a group of experts, who are bringing insights on the latest science... Announcing our lineup of experts who'll serve as #GU26 Featured Voices, sharing which abstracts they’re most interested in, putting the findings into context & taking you along for the journey.

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Ravi Madan @ravimadan.bsky.social · 24/12/2025

Happy Holidays from your friends at the National Cancer Institute and NIH

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Ravi Madan @ravimadan.bsky.social · 22/12/2025

Daily reminder: #PSMA doesn't show everything... 100 pts w/#BCR #ProstateCancer s/p previous PSMA radioguided surgery ▶️median PSA=0.9 ‼️91% recur@ median 11.4mos ‼️47%w/ distant recurrence beyond pelvis Important for pts to be aware of these data jnm.snmjournals.org/content/66/1...

jnm.snmjournals.org

Pattern of Failure in Patients with Biochemical Recurrence After PSMA Radioguided Surgery

Prostate-specific membrane antigen (PSMA)–targeted radioguided surgery (RGS) is evolving as a new treatment modality for patients with early biochemical recurrence of prostate cancer and disease limit...

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Ravi Madan @ravimadan.bsky.social · 04/12/2025

What’s high risk #BCR #ProstateCancer? PSA DT:best predictive biomarker in BCR; required for BCR trials PSMA 🤷🏻‍♂️undefined role EMA says HR is <12 months EMBARK says <9 mos Per @NCI BCR WG the data is most c/w <6 mos (see sankey👇 of MFS with NO therapy) shorturl.at/HeEMh @ascocancer.bsky.social

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Ravi Madan @ravimadan.bsky.social · 14/11/2025

👏🏼Interesting study #SBRT+/-#LuPSMA @ascocancer.bsky.social ⭐️Innovative design w/limited dosing of LuPSMA #oligorecurrent #ProstateCancer ❓What if all pts were MTD-Naive 🤔important differences in 🔑baseline characteristics favor combo 🤔PFS criteria w/❓clinical value ascopubs.org/doi/pdf/10.1...

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Ravi Madan @ravimadan.bsky.social · 11/11/2025

Lots of ❓s in defining benefits of “#oligomet” or “#MDT” therapy in #ProstateCancer ❓ADT+/-ARPI? How long? ❓PFS vs Eugonadal PFS? ❓how many mets? Where? 🔑❓what imaging 🩻❓ #PSMA mets🚫🟰CT/Bone scan mets shorturl.at/n3JwU Std of Care? Or just something we can do?

Not all PSMA+ BCR is oligo mets and PSMA+ BCR is very different than mCSPC. Imaging platform matters for patients and outcomes when defining “oligomets” but trials are very inconsistent on this key issue.

Ref for image: https://ascopubs.org/doi/10.1200/JCO-25-01693

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Ravi Madan @ravimadan.bsky.social · 05/11/2025

We don’t need to fear the Dark in #ProstateCancer But we will have to acknowledge that #PSMA targeted therapy will likely impact the sensitivity of #PSMA imaging This likely impacts the desire to use PSMA in restating (still unclear how to do that) & drug development #PSMAdark

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Ravi Madan @ravimadan.bsky.social · 28/10/2025

#PSMA+BCR That is how @theNCI #BCR Working Group unanimously agreed to define pts w/PSMA findings & neg CT/bone scan after definitive tx Retains all that is known about #BCR while drawing a distinction vs. mCSPC More than semantics for #ProstateCancer pts & clinicians @ascocancer.bsky.social

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Ravi Madan @ravimadan.bsky.social · 23/10/2025

#EMBARK #BCR📈 #ProstateCancer I have a forrest plot ? 2 subgroups w/LACK of clear benefit are⬆️CV risk(competing mortality-logical) But why would pts under⬇️65 not🚫 have clear benefit? This is a subgp where competing mortality shouldn’t be an issue & Tx should help ⁉️🧐

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Ravi Madan @ravimadan.bsky.social · 14/10/2025

As #ESMO25 brings new data on #PSMA it may be time to consider what happens when you target a surface antigen in cancer. How will that impact diagnostic sensitivity of that target? #PSMAdark #ProstateCancer #theranostics Dr Abel et al @natrevurol.nature.com @ascocancer.bsky.social rdcu.be/eKNQe

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Ravi Madan @ravimadan.bsky.social · 19/10/2025

#EMBARK #ESMO25 creates the need to risk stratify pts Here is data published last year which demonstrates that #ProstateCancer specific death is rare among unselected #BCR pts. EMBARK Tx is for high risk pts (eg PSA DT<6mos) tinyurl.com/y69hb5ue

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Ravi Madan @ravimadan.bsky.social · 18/10/2025

Lots @ #ESMO25 re: #BCR #ProstateCancer but over-treatment of this indolent disease remains an important issue How does #PSMA imaging factor in? See poster #2393P presented by @HelenMoonMD Saturday +PSMA findings in BCR pts shouldn’t be the reason to treat as rPD is rare @1yr

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Ravi Madan @ravimadan.bsky.social · 14/10/2025

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Ravi Madan @ravimadan.bsky.social · 26/09/2025

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

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Ravi Madan @ravimadan.bsky.social · 04/08/2025

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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Ian Davis @profiand.bsky.social · 27/07/2025

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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