Neeraj Agarwal, MD, FASCO

This episode reviews treatment intensification in metastatic castration-sensitive prostate cancer, focusing on why ADT plus an ARPI is the current backbone of care, what barriers still limit its use, and how clinicians think about triplet therapy, de-intensification, frail patients, and emerging biomarker-driven options such as PARP inhibitors.

Discover essential strategies for managing advanced prostate cancer, including team collaboration, systematic documentation, and patient care best practices.

Healthcare professionals discuss the growing preference for oral hormone therapy over injectables, emphasizing patient control and comfort in treatment choices.

Experts discuss the cardiovascular risks associated with androgen deprivation therapy, comparing relugolix and leuprolide's impact on coronary plaque formation.

Healthcare professionals discuss the challenges of staff turnover and the importance of communication and systematic notes to ensure patient safety.

Oncologists discuss the importance of guidelines like NCCN and ASCO for navigating cancer treatment complexities and insurance challenges.

Health care professionals discuss the vital role of pharmacy teams in managing complex patient care, emphasizing collaboration and medication safety.

Urologists discuss the importance of monitoring cardiovascular health in patients undergoing androgen deprivation therapy for prostate cancer.

Healthcare professionals discuss strategies to manage cardiovascular risks in cancer patients, emphasizing weight control, exercise, and collaboration with primary care.

Healthcare professionals discuss the importance of addressing quality of life and exercise for patients starting androgen deprivation therapy.

Recent trends show a significant increase in the use of combination therapies for advanced cancer, highlighting the need for ongoing education and adaptation.

Experts discuss the complexities of advanced imaging in cancer diagnosis, highlighting challenges with PET scans and the importance of accurate interpretation.

In this episode, ‘Strategic Use of ADT in mCSPC From Selection to Escalation,’ the multidisciplinary panelists explore the following questions: With multiple generations of ADT now available in advanced prostate cancer, including oral and injectable options, how do you determine which patients are appropriate candidates for which formulation of ADT? When selecting ADT as the backbone for doublet therapy in metastatic castration-sensitive prostate cancer (mCSPC), in which patients do you prefer the oral versus the injectable option? Which androgen receptor pathway inhibitor (ARPI) do you initiate first? Please explain your rationale. In mCSPC, how do you decide when to escalate from ADT–ARPI doublet to triplet therapy, and what patient or disease factors most influence that decision? How do you weigh potential benefits against added toxicity and contraindications? How does cumulative toxicity influence your willingness to escalate therapy or modify treatment plans?

Welcome back to another Urology Times Peer Exchange series. In this episode titled, ‘Treatment Selection in Advanced Prostate Cancer’, Drs. Paul Sieber, Alicia Morgans, Neeraj Agarwal, and Chad Ritch discussed the following question: When developing treatment plans for prostate cancer, what factors influence treatment selection?

Enzalutamide plus talazoparib significantly extended overall survival vs enzalutamide alone in mCRPC.

"We should not be preemptively reducing the dose for all our patients, because half of the patients will never develop grade 3/4 anemia," says Neeraj Agarwal, MD, FASCO.

"We see the overall survival, whether it is [in] all-comers, in HRR gene mutation-positive patients, or in HRR gene [mutation]-negative patients or [those] who did not have mutations, the overall survival is about 45 to 47 months," says Neeraj Agarwal, MD, FACS.

"A 14-month delay in disease progression is a very meaningful end point to our patients, because that basically means delay in symptoms, delay in fractures, [and] delay in pain in the castration-resistance setting," says Neeraj Agarwal, MD, FASCO.

"The primary end point was radiographic progression-free survival, which we reported in 2023, and we updated the radiographic progression-free survival data in 2025," says Neeraj Agarwal, MD, FASCO.