PSMA radioligand therapy moves earlier: PSMAddition meets its endpoint in hormone-sensitive disease

The edition in brief

PSMAddition randomised 1,144 men with PSMA-positive metastatic androgen-pathway-modulator-naive prostate cancer to lutetium-177 PSMA-617 added to ADT plus an ARPI, or to ADT plus ARPI alone. Radiographic progression-free survival improved with a hazard ratio of 0.72, and the primary endpoint was met at the second interim analysis. Median rPFS was not reached in either arm and overall survival is immature, so this establishes delayed progression rather than longer life. Dry mouth affected 46% against 4%, and grade 3 or worse events 51% against 43%. GETUG AFU 18 reported ten-year outcomes for dose-escalated radiotherapy at 80 Gy against 70 Gy, both with long-term ADT, in high-risk disease. Progression-free survival at ten years was 83.6% against 72.2%, hazard ratio 0.56. Late grade 3 toxicity was 8% against 7% — the benefit widened with time while toxicity did not. The EAU has published its 2026 prostate cancer guideline update covering screening, diagnosis and local treatment, alongside a 2026 update on urological infections. A network meta-analysis of overactive bladder drugs put vibegron ahead for urgency episodes and mirabegron ahead for frequency, on five studies. And a randomised trial found 4.7Fr ureteric stents more comfortable than 6Fr, at the cost of more early dislodgement.