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Articles by Robert Dreicer
Advanced Prostate Cancer: AUA/SUO Guideline Amendment (2026). Part II: Evaluation and Management of Metastatic Castration-Resistant Prostate Cancer.
Following completion of the 2025 Update Literature Review (ULR), the American Urological Association (AUA) incorporated new evidence generated since the 2023 publication of this Guideline via the AUA Amendment process. The summary presented herein represents Part II of the two-part series dedicated to addressing updated recommendations to provide a clinical framework for the evaluation and management of metastatic castration-resistant prostate cancer (mCRPC).
ASCO 2026: ProTACT: A First-in-Human, Phase 1 Dose Escalation and Expansion Study Evaluating the Safety, Tolerability, and Anti-Tumor Activity of [225Ac]Ac-FL-020, a PSMA-Targeted Radioconjugate, in Patients with mCRPC
(UroToday.com) The 2026 American Society of Clinical Oncology (ASCO) Annual Meeting was host to a prostate, testicular, and penile cancers poster session.
Incidental Brain Metastases From Prostate Cancer Diagnosed With PSMA PET/CT and MRI: A Case Series and Literature Review
1 Introduction In the United States, prostate cancer is the most common non-cutaneous malignancy in males [1]. Distant metastasis is present in 4%–25% of prostate cancer patients [2], but intracranial metastases are rare (0.6%–2.9%) and involve the meninges (66%) more commonly than the parenchyma (33%) [3]. Advanced prostate cancer (aPC) with small cell and neuroendocrine-transformed types are more frequently associated with intraparenchymal brain metastases (BMETS) [4].
Does Stereotactic Body Radiotherapy Offer Benefit in Localized Prostate Cancer?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Five-fraction SBRT was noninferior to standard radiotherapy for freedom from biochemical/clinical failure in patients with low- to intermediate-risk disease. Patients with low- to intermediate-risk prostate cancer have a number of potential management options including active surveillance (primarily for low-risk cancer) and surgery or radiotherapy with curative intent.
Adjuvant Immune Checkpoint Therapy for Muscle-Invasive Urothelial Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Adjuvant pembrolizumab improved disease-free survival in patients with high-risk urothelial cancer. Patients with muscle-invasive urothelial cancer following optimal therapy with cisplatin-based neoadjuvant chemotherapy and cystectomy remain at high risk for systemic failure, and those who are not candidates for perioperative chemotherapy are at even higher risk.
Perioperative Durvalumab for Muscle-Invasive Bladder Cancer?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Adding perioperative durvalumab to neoadjuvant gemcitabine-cisplatin and radical cystectomy improved overall survival. Cisplatin-based neoadjuvant chemotherapy can modestly improve overall survival (OS) in patients with muscle-invasive bladder cancer undergoing radical cystectomy.
Lu-PSMA-617 or a Change of ARPI for Taxane-Naive Metastatic Castration-Resistant Prostate Cancer?
Citations Morris MJ et al. 177Lu-PSMA-617 versus a change of androgen receptor pathway inhibitor therapy for taxane-naive patients with progressive metastatic castration-resistant prostate cancer (PSMAfore): A phase 3, randomised, controlled trial. Lancet 2024 Sep 15; [e-pub]. ( https://doi.org/10.1016/S0140-6736(24)01653-2) Mateo J and Zurita AJ. 177Lu-PSMA-617 for metastatic prostate cancer: Aiming for the right spot. 2024 Sep 13; [e-pub]. ( https://doi.org/10.1016/S0140-6736(24)01919-6)
ASCO 2024 Meeting Report
Robert Dreicer, MD, MS, MACP, FASCO Highlights of the latest research The 2024 American Society of Clinical Oncology (ASCO) annual meeting, held May 30 to June 3 in Chicago, highlighted important advances in treatment across a broad spectrum of malignancies. Here, NEJM Journal Watch Oncology and Hematology Associate Editor Robert Dreicer, MD, MS, MACP, FASCO, reviews key trials in GU cancers.
Androgen-Deprivation Therapy Use and Duration in Postoperative Patients with Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Therapy recommendations need to take into account patients' risks for death and toxicities related to treatment. Radiotherapy (RT) combined with androgen-deprivation therapy (ADT) has long been the established standard of care for treating patients with localized or locally advanced prostate cancer. However, in men with biochemical failure after prostatectomy, the role of this combination is less well established.
Prostate Cancer Screening Guidelines for Black Men
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The Prostate Cancer Foundation issues the first set of stand-alone guidelines for screening Black men in the U.S. Sponsoring Organization: Prostate Cancer Foundation Black men have both an extremely high incidence of prostate cancer and a significantly higher lifetime risk of dying from it compared with other groups. Current screening guidelines typically include recommendations regarding Black men, but the recommendations are somewhat variable.
Clinical Management of Advanced Prostate Cancer: Where Does Radiopharmaceutical Therapy Fit in the Treatment Algorithm?
PSMA RADIOPHARMACEUTICAL THERAPY PSMA, also known as glutamate carboxypeptidase II and folate hydrolase 1 and encoded by the FOLH1 gene, is a transmembrane glycoprotein enzyme expressed at the cell surface of more than 90% of prostate cancers at a level up to 100- to 1,000-fold higher than in nonprostate tissues (41). Despite AR regulation of PSMA, expression has also been noted in a subset of AR-negative mCRPC (42).
From “Fairytale” to Reality? Paradigm Shift in Bladder Cancer Care
Recent advances in metastatic urothelial carcinoma care have meant that optimistic outcomes are “not as much of a fairytale,” says Robert Dreicer, MD, deputy director of the UVA Cancer Center and professor of medicine and urology at the University of Virginia School of Medicine in Charlottesville.
Paradigm Shift in the Management of Advanced Urothelial Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Compared with platinum-based chemotherapy, enfortumab vedotin plus pembrolizumab treatment led to better survival outcomes in patients with previously untreated advanced urothelial cancer. Platinum-based chemotherapy has long been the standard of care for metastatic urothelial cancer, with cisplatin eligibility determined based on clinical and laboratory features.
A Novel Inhibitor of Steroid-Hormone Biosynthesis in Advanced Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The agent showed antitumor activity in heavily pretreated patients in a phase 1/2 study. Multiple randomized trials have provided compelling evidence of an improvement in overall survival for patients with hormone-sensitive metastatic prostate cancer managed with androgen deprivation therapy (ADT) plus intensification with agents including abiraterone, enzalutamide, apalutamide, darolutamide, and docetaxel.
Molecularly Targeted Therapy in Advanced Urothelial Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing In patients with FGFR alterations who had disease progression after immune checkpoint inhibition, those treated with erdafitinib had longer survival than those treated with chemotherapy. The standard initial treatment for metastatic urothelial cancer has long been platinum-based chemotherapy, but only a small subset of patients achieve durable long-term disease control. While the EV-302 trial.
The Search Continues
Metastatic renal cell cancer remains an incurable, albeit treatable, disease, thus the search continues for effective adjuvant therapy for patients at
ASCO 2023 Meeting Report
Robert Dreicer, MD, MS, MACP, FASCO Highlights of the latest research The 2023 American Society of Clinical Oncology (ASCO) annual meeting, held June 2 to 6 in Chicago, highlighted important advances in treatment across a broad spectrum of malignancies. Here, Associate Editor Dr. Robert Dreicer reviews several key trials in in prostate and renal cancers.
Is There a Role for "Salvage" Immunotherapy in Advanced Renal Cell Cancer?
For untreated metastatic clear cell renal cancer, immune-checkpoint-based combinations with ipilimumab and nivolumab or an immune checkpoint inhibitor
First-Line Talazoparib plus Enzalutamide for Metastatic Castration-Resistant Prostate Cancer
The prior PROpel trial (NEJM Evid 2022;1:EVIDoa2200043) demonstrated the efficacy of adding a poly(ADP-ribose) polymerase (PARP) inhibitor (olaparib)
Outcomes When Cabozantinib Is Added to Ipilimumab/Nivolumab in Advanced Renal Cell Carcinoma
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Adding cabozantinib led to only modest improvement in progression-free survival among previously untreated patients.
Treatment Holidays from Tyrosine Kinase Inhibitors in Advanced Renal Cell Carcinoma
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Compared with standard treatment schedules, holding treatment until evidence of disease progression did not lead to a clinically meaningful reduction in overall survival. Although less frequently used as monotherapy today, tyrosine kinase inhibitors (TKIs) in combination with immune checkpoint inhibitors continue to be a backbone in the initial management of patients with metastatic renal cell carcinoma.
New Insights into Therapy Selection for Metastatic Castration-Sensitive Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The benefits of triplet versus doublet regimens varied depending on the combination of agents and on disease burden in this meta-analysis.
Rucaparib vs. Standard-of-Care Therapies in Metastatic, Castration-Resistant Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Progression-free survival was longer with rucaparib than with physician's choice of therapy in patients with MCRPC and BRCA mutations. Based on practice-changing evidence, many patients with metastatic, castration-sensitive prostate cancer receive androgen deprivation therapy (ADT) intensification with agents such as abiraterone acetate, apalutamide, enzalutamide and docetaxel.
Is There a Role for Adjuvant Immunotherapy in High-Risk Resected Renal Cell Carcinoma?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing In patients with high risk for recurrence after nephrectomy, adjuvant nivolumab plus ipilimumab offered no disease-free survival advantage over placebo. Patients with renal cell carcinoma (RCC) and high-risk features who undergo partial or radical nephrectomy with curative intent have a significant (40%-50%) chance of systemic failure.
A New Therapeutic Option for BCG-Unresponsive Bladder Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing An immune-cell-activating interleukin-15 superagonist led to a complete response in 71% of patients. Patients with high-grade T1 or carcinoma in situ (CIS) bladder cancer who are unresponsive to treatment with intravesical bacillus Calmette-Guérin (BCG) have limited management options.
The Saga Continues
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Adjuvant atezolizumab was not associated with a disease-free survival benefit compared with placebo in the IMmotion010 trial. Patients with high-risk locoregional renal cell carcinoma have systemic failure rates greater than 50% after partial or radical nephrectomy. Most studies of adjuvant anti-VEGF tyrosine kinase inhibitors and mTOR inhibitors have failed to demonstrate clinical benefit.
Do Abiraterone or Enzalutamide Increase Risk for Metabolic and Cardiovascular Events?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Both agents were associated with increased risk for major events, but only abiraterone was associated with increased risk for minor events. Although androgen deprivation therapy (ADT) is the cornerstone for the systemic management of advanced prostate cancer, there is an associated elevated risk for both metabolic syndrome and major cardiovascular events.
Abiraterone plus Olaparib in Metastatic Castration-Resistant Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Addition of olaparib was beneficial, irrespective of the presence of homologous recombination repair gene mutation. Abiraterone and enzalutamide are widely used as initial therapy for patients with metastatic castration-resistant prostate cancer (mCRPC) both in those managed with androgen deprivation therapy (ADT) alone and in those given docetaxel intensification in the hormone-sensitive metastatic setting.
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The addition of short-course ADT to salvage radiotherapy was associated with improved outcomes. Following radical prostatectomy, 20% to 50% of men experience a detectable prostate-specific antigen (PSA) level, frequently referred to as biochemical recurrence.
ExpertPerspectives
expert roundtables Overview Molecular and genomic tests have the potential to add key prognostic data to the assessment of earlier-stage prostate cancer. Ongoing trials seek to validate the use of genomic risk stratification as a means of selecting patients for tailored therapeutic interventions. Q: How is the approach to high-risk, locally advanced disease evolving to incorporate genomics and molecular testing? Tanya B.
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The addition of abiraterone to ADT plus docetaxel was associated with increased overall and radiographic progression-free survival.
Robert Dreicer, MD, MS, MACP, FASCO, reviewing MRI screening with pre-emptive treatment in asymptomatic patients with evidence of epidural disease did not improve time to development of clinical SCC. Spinal cord compression (SCC) remains a true oncologic emergency, as loss of neurologic function has devastating effects on a patient's quality of life. Given the bone tropism of metastatic prostate cancer, it is not surprising that studies report an SCC incidence ranging from 7% to 24%.
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The addition of darolutamide to androgen deprivation therapy plus docetaxel increased survival. For most patients with hormone-sensitive metastatic prostate cancer (HSMPC), androgen deprivation therapy (ADT) intensification with docetaxel, abiraterone, enzalutamide, or apalutamide is the standard of care, based on compelling survival benefit demonstrated in phase III studies.
Evolving Management for Locally Advanced Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing ADT intensification with next-generation hormonal therapy was associated with increased survival compared with ADT alone. Men with high-risk non-metastatic prostate cancer are frequently managed with external beam radiotherapy (EBRT) along with two to three years of androgen deprivation therapy (ADT).
Does Androgen Deprivation Therapy Reduce Severity of COVID-19 in Prostate Cancer Patients?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing All-cause 30-day mortality was not improved in infected patients receiving ADT versus those not receiving ADT. Early in the pandemic, a variety of reports suggested that androgen deprivation therapy (ADT), a widely used treatment for men with advanced prostate cancer, might decrease the severity of COVID-19 in prostate cancer patients infected with SARS-CoV-2.
Novel Treatment for von Hippel-Lindau-Related Clear Cell Renal Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The HIF-2α inhibitor belzutifan showed promising results in a phase 2 trial. Patients with von Hippel-Lindau (VHL) disease, which is caused by germline pathogenic variations in the VHL gene, have a high incidence of clear cell renal cancer (ccRC) in addition to a myriad of extra-renal manifestations, including hemangioblastomas of the central nervous system (CNS) and pancreatic neuroendocrine tumors.
Evolving Role of PSMA PET/CT in Clinically Localized Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing In men with intermediate- to high-risk prostate cancer, PSMA PET/CT imaging may inform prostatectomy decisions. Conventional imaging for prostate cancer - computed tomography (CT) scans of the abdomen and pelvis and bone scans - has long been used to determine the presence or absence of metastatic disease in men with clinically localized disease with high-risk features.
Impact of Exercise on Disease Progression in Men with Localized Prostate Cancer
Robert Dreicer, MD, MS, MACP, FASCO, reviewing The ERASE trial found benefits from a 12-week high-intensity interval training program. An increasing number of men with low-risk prostate cancer are being managed with active surveillance in lieu of immediate, local curative intent therapy, although up to 55% of these men will undergo definitive intervention within 10 years.
Evaluating the Efficacy of Sabizabulin in The Treatment of Metastatic Castration-Resistant Prostate Cancer - Robert Dreicer
Read the Full Video Transcript Alicia Morgans: Hi, my name is Alicia Morgans, and I am a GU Medical Oncologist at Dana-Farber Cancer Institute. I am so excited to have here with me today, a good friend and colleague Dr. Rob Dreicer, who is the Deputy Director of the UVA Cancer Center, as well as being a Professor of Medicine and Urology, and the Director of solid tumor oncology all at UVA in Charlottesville, Virginia. Thank you so much for being here with me today.
Adjuvant Therapy for High-Risk Kidney Cancer: Paradigm Shift?
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Pembrolizumab shows promise as adjuvant therapy in renal-cell carcinoma, this interim analysis finds. Patients with locally advanced renal cell carcinoma undergoing curative-intent nephrectomy remain at risk for systemic failure. Studies testing first-generation immunotherapy agents and a variety of tyrosine kinase inhibitors (TKIs) failed to demonstrate benefit, and routine practice is to manage patients expectantly with surveillance imaging.
Targeting Advanced Prostate Cancer Patients with PTEN Loss
Robert Dreicer, MD, MS, MACP, FASCO, reviewing Combined AKT and androgen-receptor pathway inhibition improved progression-free survival in patients with PTEN loss. Despite improvements in therapy options and survival for metastatic castration-resistant prostate cancer (mCRPC), it remains an incurable disease. Next generation therapies targeting the androgen receptor (AR) have proven value, but development of resistance to agents such as abiraterone is universal.
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