OncLive® On Air S14 Ep55: Advances in ADT Personalization and Molecular Imaging Shape Updated NCCN Prostate Cancer Recommendations: With Daniel Spratt, MD
Nov 25, 2025
Daniel Spratt, MD, dives into groundbreaking updates in prostate cancer treatment guidelines. He discusses the shift towards personalized androgen deprivation therapy (ADT) for localized cases and introduces the oral GnRH antagonist, relugolix. The conversation highlights molecularly guided options for metastatic CRPC and the impact of ADT on quality of life, including potential cardiovascular risks and financial toxicity. Spratt also predicts a future where biomarkers might help identify patients who could skip hormone therapy, pushing for innovative combinations in cancer care.
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Personalize ADT For Unfavorable Intermediate Risk
- Localized unfavorable intermediate-risk prostate cancer now warrants personalized ADT use based on age, comorbidities, and prognosis.
- Molecular imaging and staging improvements make many cases more favorable than previously thought.
Consider Relugolix As ADT Option
- Consider oral GnRH antagonist relugolix alongside traditional GnRH agonists for many disease states.
- Use relugolix when faster suppression and recovery or finite ADT courses are desirable.
Systemic Therapy Guided By Biology
- NCCN guidance now maps therapy choices to disease biology and location, including PARP, PSMA, radium, and metastasis-directed radiotherapy.
- Providers need clearer algorithms to integrate molecularly targeted, imaging-defined, and traditional options.