iiinova — where your digital self keeps evolving

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

“Given known tox of ADT-based strategies in #ProstateCancer, overtreatment of #BCR could… bring more near-term harms than benefits…individualized approaches…which factors in PSA in the context of PSADT… while excluding presumptive use of PSMA data…” shorturl.at/MB0JN

shorturl.at

EMBARK in biochemically recurrent prostate cancer: a journey for some but not most

EMBARK was a pivotal multi-institutional trial that sought to move the clinical paradigm for initiating enzalutamide with/without androgen deprivation ther

000

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

“enzalutamide &ADT present a…consideration for at-risk #BCR pts (likely PSA DT<6 mos min PSA of 1 ng/ml & few competing mortality risks) but…these characteristics represent a minority of pts...Most pts w/BCR can be monitored for yrs w/out therapy regardless of next-gen imaging” shorturl.at/MB0JN

110

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

110

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

shorturl.at

EMBARK in biochemically recurrent prostate cancer: a journey for some but not most

EMBARK was a pivotal multi-institutional trial that sought to move the clinical paradigm for initiating enzalutamide with/without androgen deprivation ther

000

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☀️

120

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”

010

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

030

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...

020

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

011

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

media.tenor.com

a cartoon minion with a question mark above his head

ALT: a cartoon minion with a question mark above his head

002

Reposted by Ravi Madan

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.

011

Reposted by Ravi Madan

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

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

111

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

030

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

031

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

More data on PSA Almost none on PSMA So I would not used PSMA “response” since all that really is telling us about fundamentally is #PSMA expression. #ProstateCancer @ascocancer.bsky.social #GU26

100

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

010

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

000

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

000

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

000

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

041

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

010

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

110

Reposted by Ravi Madan

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

Oh I like this… #GU26

021

Reposted by Ravi Madan

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

032

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

media.tenor.com

a man in a suit and tie is smoking a cigarette while sitting at a table .

ALT: a man in a suit and tie is smoking a cigarette while sitting at a table .

1122

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…”

021

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

020

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.”

020

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

020

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

020

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…”

020

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

020

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.”

021

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

040

Reposted by Ravi Madan

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.

052

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

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

000

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...

010

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

020

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...

020

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

Clinical and #Genomic Differences Between Advanced Molecular Imaging-detected and Conventional Imaging-detected Metachronous Oligometastatic Castration-sensitive #ProstateCancer @EUplatinum #PSMA www.sciencedirect.com/science/arti...

000

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

100

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

000

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

030

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 ⁉️🧐

000

Reposted by Ravi Madan

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

282

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

031

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

More information on the clinical trial & how to refer patients #ESMO25 #BCR #ProstateCancer Much more data to follow from this trial helping define who needs treatment in #PSMA+ BCR & who does NOT (which is most pts as the data demonstrate) Study link www.clinicaltrials.gov/study/NCT055...

clinicaltrials.gov

ClinicalTrials.gov

010

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

140