Aaron Berger, MD

A panelist discusses how patients with high-risk localized prostate cancer receiving treatment intensification should complete an 18- to 24-month course of systemic therapy with radiation for optimal cure rates, rather than stopping early due to prostate-specific antigen (PSA) response alone.

A panelist discusses how different abiraterone formulations require specific steroid combinations—prednisone with traditional abiraterone and prednisolone with microformulation—and the importance of following labeling recommendations.

A panelist discusses how the choice between microformulation abiraterone and off-label low-dose regimens is often dictated by cost and insurance coverage rather than purely clinical considerations.

A panelist discusses how patients having difficulty with traditional abiraterone fasting requirements can be switched to microsized abiraterone (taken with food) or off-label low-dose abiraterone with low-fat breakfast, though adherence to dietary restrictions remains challenging.

A panelist discusses how, for high-risk localized prostate cancer with questionable lymph node involvement, radiation therapy combined with systemic treatment may be preferable to radical prostatectomy due to the ability to treat a wider field of potential microscopic disease.

A panelist discusses how genomic classifiers play a crucial role in determining whether treatment intensification with agents like abiraterone is beneficial for patients with high-risk localized prostate cancer.

A panelist discusses how a 62-year-old man with high-risk localized prostate cancer was treated with intensified therapy, including abiraterone plus radiation, but experienced tolerability issues with the traditional fasting formulation.

A panelist discusses how patient comorbidities like diabetes and liver disease influence abiraterone formulation selection, noting that some physicians worry about steroid effects on blood glucose and the importance of monitoring liver function.

A panelist discusses how food significantly affects abiraterone absorption, particularly fatty meals, which can increase absorption to dangerous levels, making the microformulation advantageous by eliminating fasting concerns.

A panelist discusses how adherence considerations are crucial when selecting between different abiraterone formulations, emphasizing that the microformulation offers flexibility by allowing administration with or without food compared with the traditional fasting requirements.

A panelist discusses how a man aged 74 years with mCRPC who progressed on enzalutamide was successfully treated with abiraterone, highlighting the importance of selecting the appropriate formulation based on patient adherence and lifestyle factors.

Panelists discuss how recent advancements in NMIBC treatment, including the approval of nadofaragene firadenovec, pembrolizumab, and intravesical therapies like TAR-200, have reshaped care for BCG-unresponsive patients, with promising developments and ongoing trials at AUA 2025 paving the way for more personalized and effective treatment strategies in the future.

Panelists discuss how leveraging resources such as patient assistance programs, insurance navigators, clinical trial databases, advocacy groups, and oncology support services can help overcome access barriers, ensuring that NMIBC patients receive timely access to novel treatments like nadofaragene firadenovec and pembrolizumab.

Panelists discuss how overcoming challenges such as cost, insurance coverage, regulatory hurdles, patient selection, and the need for education is crucial for improving access to novel therapies like nadofaragene firadenovec and pembrolizumab, ultimately enhancing outcomes for NMIBC patients.

Panelists discuss how recent trials, including KEYNOTE-057, QUILT-3.032, and CORE-001, highlight the promising efficacy, durability, and manageable safety profiles of novel treatments like pembrolizumab, nogapendekin alfa inbakicept, and nadofaragene firadenovec, while also exploring the potential of combination therapies and novel intravesical options like TAR-200 and UGN-102 for improving outcomes in non–muscle-invasive bladder cancer (NMIBC).

Panelists discuss how the ongoing ABLE-32 and ABLE-41 trials are exploring the efficacy and safety of nadofaragene firadenovec in different NMIBC patient populations, with ABLE-32 focusing on intermediate-risk patients and ABLE-41 examining real-world effectiveness and safety.

Panelists discuss how real-world data from a recent Mayo Clinic study confirms the promising efficacy and favorable safety profile of nadofaragene firadenovec in BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), highlighting high cystectomy-free and overall survival rates, with longer follow-up needed to assess response durability.

Panelists discuss how nogapendekin alfa, an intravesical immunotherapy that stimulates a localized immune response, combined with BCG therapy, provides a novel dual approach for treating BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC), targeting both local and systemic immune responses.

Panelists discuss how pembrolizumab, a PD-1 inhibitor, offers a systemic immunotherapy option for high-risk, BCG-unresponsive non–muscle-invasive bladder cancer (NMIBC) by enhancing the immune system’s ability to target cancer cells, with intravenous administration and careful monitoring for immune-related adverse effects.

Panelists discuss how recently FDA-approved therapies, including nadofaragene firadenovec, gemcitabine, and docetaxel, offer alternative treatment options for BCG-unresponsive high-risk non–muscle-invasive bladder cancer (NMIBC), each with distinct mechanisms and administration methods.

Panelists discuss how maintenance BCG therapy and vigilant surveillance are essential for sustaining disease control in NMIBC patients, with treatment schedules and monitoring tailored to individual risk and tolerance.

Panelists discuss how timely identification of BCG-unresponsive NMIBC through defined response criteria enables dynamic risk stratification and guides critical decisions about escalating care to alternative treatments.

Panelists discuss how specific tumor characteristics, such as papillary architecture and presence of carcinoma in situ, guide risk-adapted treatment decisions in non–muscle-invasive bladder cancer.

Panelists discuss how precise risk stratification in non–muscle-invasive bladder cancer enables physicians to tailor treatment and surveillance strategies based on individual patient risk profiles.

Closing out their discussion on how treatment and management of advanced prostate cancer affects their clinical practice, expert urologists consider how the therapeutic landscape continues to evolve and look toward future evolutions in care.

Key opinion leaders briefly review the key challenges in scheduling leuprolide administration for patients with advanced prostate cancer, including treatment delays, disease breakthrough, and insurance reimbursement, and share solutions to overcome these challenges.

Shared insight on the current state of telehealth and how its use affects treatment selection and followup for patients with advanced prostate cancer.

Experts in urology share a brief conversation on recent and future legislation for insurance coverage and reimbursement, considering how it may impact their management of prostate cancer.

A more focused discussion on the specific challenges physicians or patients may face when seeking coverage or reimbursement for GnRH agonists/antagonists in prostate cancer.

Centering discussion on insurance and reimbursement, key opinion leaders in prostate cancer management consider the current state of coverage for GnRH agonists/antagonists.