Mini oral session – prostate, penile & testicular cancer

The mini-oral session on prostate, penile and testicular cancers at ESMO 2025 featured several presentations with direct implications for clinical practice. Three of the abstracts discussed in this session addressed strategies in the first-line treatment of patients with metastatic hormone-sensitive prostate cancer (mHSPC), where the central theme was how to optimize outcomes while preserving quality of life and minimizing toxicity. In this video, Dr Annelies Verbiest, medical oncologist at the University Hospital Antwerp, discusses the key takeaways from these trials together with a fourth study looking into the management of seminoma.

Previously, the AMPLITUDE trial established the role of combining the PARP inhibitor niraparib with abiraterone in patients with mHSPC harboring homologous recombination repair (HRR) gene alterations. While efficacy had already been demonstrated, concerns remained about the potential cumulative toxicity of long-term PARP inhibition. The quality-of-life results presented at this session were therefore reassuring. Although a small decline in quality-of-life was observed in the first months for patients receiving niraparib in addition to abiraterone, these differences disappeared after a few cycles, and overall quality-of-life between arms was comparable.¹ This suggests that adding niraparib is feasible and does not result in sustained deterioration in patient-reported outcomes, supporting its use in selected HRR-mutated patients.

Another clinically relevant contribution came from the STOPCAP meta-analysis, which pooled data from three randomized trials investigating local radiotherapy to the prostate in patients with de novo mHSPC.² While previous evidence from trials such as PEACE-1 had suggested that radiotherapy could delay the onset of genitourinary symptoms, the impact on overall prognosis remained less clear. The meta-analysis showed a consistent improvement in progression-free survival and a strong trend toward a benefit in overall survival, particularly in men with low metastatic burden and bulky primary tumors. Not surprisingly, no benefit was seen in patients with high-volume disease or multiple bone metastases on conventional imaging.²

The randomized phase III ARASAFE trial evaluated a reduced-intensity docetaxel regimen in patients receiving triplet therapy with docetaxel, ADT and darolutamide. Instead of the conventional six cycles of 75 mg/m2 docetaxel every three weeks, the experimental arm received 50 mg/m2 every two weeks for six months, resulting in a higher cumulative dose but lower per-administration intensity. The reduced-intensity regimen was associated with less hematological toxicity, lower rates of neutropenic fever and fewer fatal infections.³ However, important questions remain regarding the use of supportive care measures such as granulocyte colony-stimulating factor, as well as the impact on neuropathy, which was not reported. Efficacy analysis using PSA decline at the end of chemotherapy showed no significant difference between arms, though PSA was numerically lower with standard-intensity dosing.³

Beyond prostate cancer, long-term data from the SAKK 01/10 trial in stage II seminoma were presented.⁴ The standard treatment for these patients has long consisted of three cycles of BEP chemotherapy, an effective but highly toxic regimen with both acute and late toxicities including infertility, cardiovascular disease and secondary malignancies. SAKK 01/10 tested a de-escalation strategy of one cycle of carboplatin followed by involved-node radiotherapy. Initial reports of this trial demonstrated a favorable outcome in terms of acute toxicity and short-term efficacy. The newly presented eight-year follow-up confirmed durable disease control, with a 10-year PFS rate of 92.8% and minimal late toxicity. These results validate this de-escalation approach, which has also been adopted by the NCCN guidelines as an alternative to BEP in patients with stage II seminoma.