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Momentum at the Frontier: Prostate Cancer Advances of March 2026


Informed Prostate Cancer Support Group (IPCSG)  ·  Member Newsletter

March 2026 Volume 2026, Issue 3 San Diego, California Research & Clinical Trials Edition

March 2026 has delivered one of the most clinically consequential months in prostate cancer research in recent memory. From landmark overall survival results presented at the ASCO Genitourinary Cancers Symposium to first-in-human alpha emitter data, a $12 million research investment, and new FDA clearances for local therapy, the field has advanced simultaneously on multiple fronts — radiopharmaceuticals, precision genomics, epigenetic therapy, and focal ablation. This edition summarizes every major development our community needs to know about, with full citations and trial identifiers to aid your conversations with your oncologist. 

At a Glance

Summary of Key March 2026 Developments

Development Setting / Disease Stage Key Finding Status
PEACE-3 (OS) — Xtandi + Xofigo 1st-line bone-metastatic mCRPC 38.2 vs 32.6 mo OS; HR 0.76 (p=0.0096) Regulatory submission anticipated
CAPItello-281 — Capivasertib + Abi PTEN-deficient de novo mHSPC 33.2 vs 25.7 mo rPFS; HR 0.81 (p=0.034) Regulatory submission planned
225Ac-PSMA-Trillium (PAnTHa) mCRPC (heavily pretreated) PSA50 62%; ORR 42%; 71% at 125 kBq/kg Phase 1; advancing to Phase 2
WARMTH Act (225Ac-PSMA-617) mCRPC, post-Lu-177 eligible PSA50 57%; mOS 15.5 mo; mPFS 7.9 mo Retrospective; phase 3 trials needed
LUNAR Trial (PNT2002 + SBRT) Oligorecurrent prostate cancer mPFS 17.6 vs 7.4 mo; first RLT+SBRT RCT Published in JCO March 2026
UCLA ANDROMEDA — Lu-177 vs Ac-225 Oligorecurrent (1–5 PSMA-PET lesions) First head-to-head alpha vs. beta comparison Phase 2, enrolling
Alpha DaRT (Alpha Tau Medical) Locally recurrent prostate cancer FDA IDE approved; local salvage intent Phase I pilot, up to 12 patients
MEVPRO-1 & -2 — Mevrometostat mCRPC (post-abi and ARPI-naïve) Phase 3 trials of EZH2+enzalutamide enrolling Actively enrolling globally
PCF 2025 Challenge Awards Research funding $12M to 12 teams; AI, immunotherapy, combos Announced March 3, 2026
Vanquish Water Vapor (VAPOR 2) Intermediate-risk localized PCa 91% negative MRI at 6 mo; low AE profile FDA 510(k) cleared; enrolling ongoing

Symposium Report

ASCO Genitourinary Cancers Symposium 2026: Two Trials Reshape the Treatment Landscape

The 2026 American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium, held February 26–28 in San Francisco, set the agenda for prostate cancer care heading into the spring. Of the many presentations delivered, two Phase III trials generated immediate clinical discussion: the final overall survival (OS) readout from the EORTC 1333/PEACE-3 trial, and the quality-of-life data from the CAPItello-281 study of capivasertib plus abiraterone.

A third prostate cancer study — the first-in-human dose-escalation data for Bayer's 225Ac-PSMA-Trillium (BAY 3563254) — was presented by Dr. Fred Saad of the University of Montreal and is reviewed in the alpha-emitter section below. The phase 3 MEVPRO-1/MEVPRO-2 program for mevrometostat (Pfizer's EZH2 inhibitor) was also highlighted as an actively enrolling priority trial. Taken together, the symposium reinforced two defining themes: combinations that add survival months are achievable, and the era of biomarker-selected therapy has arrived in earnest.

Phase III Trial — Final OS Results

PEACE-3: Radium-223 Added to Enzalutamide Extends Survival in Bone-Metastatic mCRPC

The definitive overall survival results from the EORTC 1333/PEACE-3 trial (NCT02194842) were presented as an oral abstract at ASCO GU 2026 by lead author Dr. Enrique Gallardo of Parc Tauli Hospital Universitari in Barcelona, and simultaneously published in the Annals of Oncology. The findings represent the culmination of a trial that enrolled 446 patients across 12 countries from 2015 to 2023.

The trial compared enzalutamide alone (160 mg/day) against enzalutamide combined with six cycles of intravenous radium-223 dichloride (Xofigo; 55 kBq/kg every 4 weeks) in men with metastatic castration-resistant prostate cancer (mCRPC) who had at least two bone metastases and were asymptomatic or mildly symptomatic. Use of a bone-protecting agent — either denosumab or zoledronic acid — was mandatory from March 2018 onward.

PEACE-3 Final OS Results — ASCO GU 2026 (Abstract #15)

  • Median OS, combination arm: 38.2 months (95% CI 33.1–44.8)
  • Median OS, enzalutamide alone: 32.6 months (95% CI 29.3–38.2)
  • Hazard ratio for death: 0.76 (95% CI 0.60–0.96; p=0.0096)
  • Reduction in risk of death: 24%
  • OS improvement: ~5.6 months median gain
  • Primary endpoint (rPFS): 19.4 vs. 16.4 months (HR 0.69; p=0.0009)
  • Median follow-up at final analysis: 58 months

ASCO discussant Dr. Evan Yu of the University of Washington and Fred Hutchinson Cancer Center noted the achievement in its proper context: achieving a statistically significant OS benefit in an era when patients are receiving multiple active agents is remarkably difficult. "When it occurs," Dr. Yu said, "I think it should be the default, and we need to think very hard about how to incorporate it into our practice."

IPCSG members with bone-dominant mCRPC who have not yet received enzalutamide should specifically ask their oncologist about this combination. It is important to note that bone protection (denosumab or zoledronate) was a mandatory companion in the trial, and the combination appears most effective when administered as what some investigators call a "quadruplet" — enzalutamide, radium-223, a bone-protecting agent, and continued androgen deprivation therapy.

"Based on this, enzalutamide plus radium-223 is an option for first-line treatment for mCRPC patients with bone metastasis. Combined with a bone-protecting agent, the combination should be considered a standard of care."

— Dr. Enrique Gallardo, ASCO GU 2026, Abstract #15

Safety data were consistent with prior analyses: grade ≥3 treatment-emergent adverse events occurred in 65.6% of combination patients versus 55.8% on enzalutamide alone. The most frequent serious events in the combination arm were hypertension (34%), fatigue (6%), fracture (5%), anemia (5%), and neutropenia (5%). The fracture rate in the combination arm was higher (24.3% vs. 13.4%), reinforcing the necessity of concurrent bone protection. No new safety signals were identified at the final database lock of January 12, 2026.

Separately, at the March 2026 Southeastern Section of the American Urological Association (SESAUA) Annual Meeting in San Juan, Puerto Rico, a sub-analysis by Dr. Murilo de Almeida Luz demonstrated that adding radium-223 to enzalutamide significantly accelerated PSA ≥90% response rates (50.5% vs. 34.1% at 6 months), and improved alkaline phosphatase normalization — a bone-health biomarker — strengthening confidence in the biological rationale for the combination.


Phase III Trial — Precision Oncology

CAPItello-281: Targeting PTEN Loss with Capivasertib Opens a New Door in Hormone-Sensitive Disease

The phase 3 CAPItello-281 trial (NCT04493853) evaluated capivasertib (Truqap; AstraZeneca), an oral pan-AKT inhibitor, combined with abiraterone (Zytiga), prednisone, and androgen deprivation therapy (ADT), versus placebo plus the same regimen, in patients with PTEN-deficient de novo metastatic hormone-sensitive prostate cancer (mHSPC).

PTEN (phosphatase and tensin homolog) is a tumor suppressor gene whose loss is one of the most common molecular alterations in advanced prostate cancer. When PTEN is absent, the PI3K/AKT pathway is constitutively activated — providing an independent survival signal that standard androgen receptor pathway inhibitors (ARPIs) cannot suppress. Approximately 25.3% of patients screened (1,519 of 6,003) had PTEN-deficient tumors, illustrating how critical molecular testing is to identify who can benefit.

CAPItello-281 Key Results — ASCO GU 2026 (Abstract #14)
  • Median rPFS, capivasertib arm (n=507): 33.2 months
  • Median rPFS, placebo arm (n=505): 25.7 months
  • Improvement in median rPFS: 7.5 months
  • Hazard ratio: 0.81 (95% CI 0.66–0.98; p=0.034)
  • OS data: Immature; HR 0.90 (95% CI 0.71–1.15; p=0.401) — trend favors capivasertib
  • Subgroup finding: Greater PTEN loss (100% vs. ≥90%) associated with greater treatment benefit (HR 0.68)
  • Notable biology: ~2/3 of patients developed radiographic progression without a PSA rise

Dr. Daniel J. George of Duke Cancer Institute, who presented the patient-reported outcome data at ASCO GU 2026, emphasized that the FACT-P functional well-being score remained stable throughout, despite early transient declines in physical well-being associated with on-target capivasertib toxicities — primarily diarrhea (52%), hyperglycemia (38%), and rash (35%). These effects were typically manageable with supportive care and dose modification, with discontinuation rates remaining relatively low.

The pivotal finding that two-thirds of patients with PTEN-deficient tumors develop castration resistance without a PSA rise is clinically critical for our community: PSA alone cannot reliably monitor disease in this population. Regular imaging surveillance is essential for patients harboring this genetic alteration.

"Capivasertib in combination with abiraterone represents a potential first-in-class targeted treatment for patients with PTEN-deficient mHSPC — a relatively new unmet need population with poor prognosis."

— Dr. Daniel J. George, Duke Cancer Institute, ASCO GU 2026

AstraZeneca has indicated the full results will be shared with global regulatory agencies. Capivasertib is already FDA-approved for use in hormone receptor-positive, HER2-negative advanced breast cancer. A regulatory submission for the prostate cancer indication is anticipated based on these data. IPCSG members with newly diagnosed metastatic hormone-sensitive disease should ask their physicians whether PTEN testing is appropriate.


Radiopharmaceuticals — Alpha Emitters

The Alpha Emitter Era Arrives: 225Ac-PSMA-Trillium, Actinium Clinical Data, and the Push Toward Earlier Use

If March 2026 has a defining theme in prostate cancer oncology, it may be the rapid maturation of alpha-emitting radiopharmaceuticals as a treatment class — and growing enthusiasm for moving them into earlier disease states, well before castration resistance sets in.

Bayer's PAnTHa Study: First-in-Human 225Ac-PSMA-Trillium Results

Bayer reported results from the ongoing global Phase 1 first-in-human dose-escalation PAnTHa study (NCT06217822), evaluating 225Ac-PSMA-Trillium (BAY 3563254) — a next-generation targeted alpha therapy — at ASCO GU 2026. Lead investigator Dr. Fred Saad presented the findings.

225Ac-PSMA-Trillium has a distinctive architecture: a highly specific PSMA-targeting small molecule combined with an albumin-binding domain (to optimize tumor uptake and retention) and a MacroPa chelator holding the alpha-emitting actinium-225. This structural design is intended to maximize tumor irradiation while limiting salivary gland toxicity — the dose-limiting concern for all PSMA-targeted alpha therapies.

PAnTHa Phase 1 — Key Efficacy Data (ASCO GU 2026)
  • PSA50 response rate (overall cohort): 62%
  • PSA50 in high PSMA-expressing patients: 93%
  • Objective response rate (ORR) at 125 kBq/kg dose: 71% (confirmed + unconfirmed)
  • Confirmed ORR across full cohort: 42%
  • Disease control rate: ~80% across all dose levels
  • ctDNA clearance at 125 kBq/kg: 36% — mirrored PSA responses
  • Tolerability: Grade ≥3 events limited to lymphopenia and anemia; xerostomia, fatigue, nausea predominantly Grade 1–2

Dr. Saad noted these results support advancing 225Ac-PSMA-Trillium to the next phase of development, and Bayer confirmed this intention in accompanying press communications. The company emphasized that targeted alpha therapy is a "strategic pillar of precision oncology" for the company.

WARMTH Act: Lancet Oncology Retrospective Confirms 225Ac-PSMA-617 Activity

Concurrently reported in coverage throughout early March 2026 was a landmark retrospective multicenter study — the WARMTH Act — published in Lancet Oncology, examining 488 patients with mCRPC treated with 225Ac-PSMA-617 (8 MBq intravenously) across seven international centers.

This dataset remains the largest real-world evidence base for actinium-225 PSMA therapy. The population was heavily pretreated: 66% had received docetaxel, 39% abiraterone, 39% enzalutamide, and 32% prior lutetium-177 PSMA therapy. The results demonstrated a meaningful antitumor effect even in this exhausted population, with a PSA50 response in 57% and any PSA decline in 73% of patients. Median overall survival was 15.5 months and median progression-free survival was 7.9 months. Dry mouth (xerostomia) occurred in 68% of patients after the first cycle and remains the most clinically limiting side effect.

Dr. Fred Saad on Earlier Intervention with Alpha Emitters

In a March 6, 2026 interview published by Targeted Oncology, Dr. Saad articulated the overarching strategic question now driving the field: why wait until castration resistance to deploy these powerful agents? He pointed to emerging evidence that lutetium-177 is already being studied in the hormone-sensitive setting, and argued that the biological logic favors treating micrometastatic disease earlier — before the tumor acquires the adaptive mechanisms that make later-stage disease so difficult to control.

"Intervening before patients become castration resistant — before the disease reaches its lethal phase — makes biological sense. Alpha emitters could eradicate microscopic foci of disease while the patient is best equipped to tolerate treatment."

— Dr. Fred Saad, University of Montreal, Targeted Oncology, March 6, 2026

UCLA ANDROMEDA Trial: Lutetium-177 vs. Actinium-225 Head-to-Head

UCLA Health launched the ANDROMEDA trial in January 2026 — the first study to directly compare lutetium-177-PSMA-617 and actinium-225-PSMA-617 head-to-head when added to stereotactic body radiotherapy (SBRT) in men with oligorecurrent prostate cancer (1–5 spots on PSMA PET scan). Lead investigator Dr. Amar Kishan, Executive Vice Chair of Radiation Oncology at UCLA, noted: "While we have previously shown that adding lutetium-177-based therapy to SBRT can prolong survival without progression, we think actinium-225 may be even more effective at targeting microscopic disease." Results are eagerly awaited.

Alpha Tau Medical: Alpha DaRT FDA IDE Approval — Radium-224 for Local Recurrence

In a related development, Alpha Tau Medical announced receipt of FDA Investigational Device Exemption (IDE) approval to initiate a pilot study of Alpha DaRT — an implant-based alpha-radiation therapy using radium-224 impregnated sources delivered directly into tumors — for patients with locally recurrent prostate cancer. The pilot study will enroll up to 12 patients across US sites, with PSA biochemical recurrence (Phoenix definition) as the enrollment criterion and safety as the primary endpoint. This adds an important local salvage option to an otherwise systemically dominated research landscape.


Published Trial Results — March 2026

UCLA LUNAR Trial Published in JCO: PSMA Radioligand Therapy Doubles Progression-Free Survival in Oligorecurrent Disease

On March 12, 2026, UCLA Health published results from the LUNAR trial in the Journal of Clinical Oncology. This Phase 2 randomized study enrolled men with oligorecurrent prostate cancer — disease that returned in a small number of new lesions after initial treatment — and tested whether adding PNT2002 (a lutetium-177-PSMA-617 radioligand drug) before stereotactic body radiotherapy (SBRT) could control hidden tumors beyond those visible on PSMA PET imaging.

LUNAR Trial Key Results (JCO, March 12, 2026)
  • Median progression-free survival, PNT2002 + SBRT: 17.6 months
  • Median progression-free survival, SBRT alone: 7.4 months
  • PFS improvement: More than doubled (2.4× longer without disease progression)
  • Primary benefit: Delays time to need for hormonal therapy
  • Study significance: First randomized trial to show PSMA radioligand therapy has a role in oligorecurrent (earlier) disease

"This is the first randomized trial to show that PSMA-targeting radioligand can significantly delay progression when added to metastasis-directed radiation," said Dr. Amar Kishan. "It gives patients more time before needing hormonal therapy, which can carry significant side effects such as fatigue and bone loss." Dr. Jeremie Calais, senior author and director of the Ahmanson Translational Theranostics Division at UCLA, added that the trial showcased the "full potential of PSMA-based theranostics technologies" by leveraging both PSMA PET imaging for precise targeting and radioligand therapy to treat microscopic disease invisible on PET.


Epigenetic Therapy — Phase 3 Trials Active

Mevrometostat: Epigenetic Targeting of EZH2 Enters Phase 3 with Two Pivotal Trials

Pfizer's mevrometostat (PF-06821497) — a potent, selective oral inhibitor of EZH2, a histone methyltransferase — continues to attract attention as a potential new mechanism to overcome androgen receptor pathway inhibitor (ARPI) resistance. EZH2 is overexpressed in castration-resistant prostate cancer and promotes disease progression through multiple mechanisms: silencing tumor suppressor genes, activating AR transcriptional programs, and driving neuroendocrine transdifferentiation.

Phase 1b/2 data, presented at ASCO GU 2025 and continuing to be discussed at 2026 conferences, showed mevrometostat combined with enzalutamide achieved a median rPFS of 14.3 months versus 6.2 months for enzalutamide alone in post-abiraterone mCRPC — a 49% relative reduction in risk of progression. PSA50 response rates were 34% versus 15%. On the strength of these data, Pfizer launched two Phase 3 trials, both actively enrolling as of March 2026:

Trial NCT# Population Comparator N (Target)
MEVPRO-1 NCT06551324 mCRPC, post-abiraterone Enzalutamide or docetaxel (physician's choice) ~600
MEVPRO-2 NCT06629779 mCRPC, ARPI-naïve Enzalutamide + placebo ~900

Both trials use mevrometostat at 875 mg twice daily (with food) and enzalutamide at 160 mg daily. The primary endpoint in each is blinded independent central review–assessed radiographic PFS. Dr. Neeraj Agarwal of the Huntsman Cancer Institute has been highlighted as a lead investigator on this program.

For IPCSG Members: If you have progressed on abiraterone and have not yet received enzalutamide, MEVPRO-1 may be relevant. Contact your oncologist or clinicaltrials.gov (NCT06551324 / NCT06629779) to assess eligibility. UCSD is among the global sites.

Research Funding — Announcement

Prostate Cancer Foundation Awards $12 Million in 2025 Challenge Grants

On March 3, 2026, the Prostate Cancer Foundation (PCF) announced the recipients of its 2025 Challenge Awards — $12 million distributed across 12 multi-institutional, cross-disciplinary research teams tackling the most pressing unsolved problems in prostate cancer care.

The funded projects span artificial intelligence tools for improved pathology diagnosis and risk prediction, novel immunotherapies designed to overcome treatment resistance, and new combinations of radiation therapy with targeted drugs. PCF President and CEO Gina Carithers noted the urgency of the investment: prostate cancer cases are rising 4.8% year over year, with a significant proportion presenting at high-risk or advanced stages.

"The Challenge Awards program enables researchers to work across disciplines and institutions in ways that traditional funding mechanisms do not support," said Andrea K. Miyahira, PhD, Vice President of Global Research and Innovation at PCF. Past awards in this program contributed foundational science that eventually led to two of today's most impactful treatments: PARP inhibitors and PSMA-targeted radioligand therapy. The complete list of 2025 award recipients is available at pcf.org.


Local Therapy — FDA Clearance

FDA Clears Vanquish Water Vapor System for Intermediate-Risk Prostate Cancer

On December 2, 2025 (with ongoing clinical discussions continuing through March 2026), the FDA granted 510(k) clearance to the Vanquish Water Vapor System (Francis Medical) for prostate tissue ablation in intermediate-risk localized prostate cancer — making it one of the few ablative technologies approved for cancer-risk stratified disease.

The clearance was supported by 12-month data from the prospective VAPOR 2 trial (NCT05683691), now enrolling 235 patients at 26 US sites. At 6 months, 91% of the first 110 eligible patients showed no targeted MRI-visible intermediate-risk disease following a single Vanquish procedure. Critically, no device-related serious adverse events were reported, and rates of urinary incontinence and erectile dysfunction were low — addressing the quality-of-life concerns that often drive treatment decisions in this patient population.

"Patients with intermediate risk prostate cancer currently weigh oncologic risk with quality of life in their treatment decision making," said Dr. Arvin George, Director of Prostate Cancer Programs at Johns Hopkins Brady Urological Institute and a VAPOR 2 co-principal investigator. Most patients reported no pain and rapidly resumed daily activities. Longer-term data will support a pre-market approval submission for a broader indication.


Editor's Note

What This Means for Our Community

March 2026 offers a rare convergence: Phase III survival data, first-in-human alpha emitter signals, molecular biomarker breakthroughs, and expanded local therapy options, all arriving nearly simultaneously. For IPCSG members across the disease spectrum — from newly diagnosed localized disease to heavily pretreated mCRPC — there is something meaningful in each of these developments.

The most actionable steps members can take right now: (1) Ask your oncologist about PTEN testing if you have de novo metastatic hormone-sensitive disease. (2) If you have bone-dominant mCRPC and have not yet received enzalutamide, ask about radium-223 combination eligibility based on PEACE-3. (3) If you have progressed on abiraterone and wonder about next steps, ask about mevrometostat trial eligibility. (4) If your PSA is rising after local therapy, PSMA PET imaging now has both diagnostic and therapeutic implications under study in the LUNAR and ANDROMEDA frameworks.

As always, IPCSG encourages all members to bring these findings — including the specific trial numbers and data points summarized here — to your next physician appointment. Informed patients drive better conversations, and better conversations save lives.

References & Sources

Formal Citations — March 2026 Edition
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    https://www.annalsofoncology.org/article/S0923-7534(25)00203-0/fulltext
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    https://www.urotoday.com/conference-highlights/asco-gu-2026/
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    https://www.oncologynewscentral.com/prostate-cancer/mevrometostat-combo-posts-strong-data
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    https://clinicaltrials.gov/study/NCT06551324
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    https://ascopubs.org/doi/10.1200/JCO.2025.43.5_suppl.TPS287
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    https://www.pcf.org/prostate-cancer-foundation-announces-2025-challenge-awards/
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    https://www.urologytimes.com/view/fda-grants-510-k-clearance-to-vanquish
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    https://grandroundsinurology.com/highlights-from-asco-gu-2026-capitello-281/
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    https://www.targetedonc.com/view/asco-gu-2026-preview-highlights-of-key-trials
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