r. Jeremy Calais from UCLA provides updates on PSMA targeted theranostics (combination of therapeutic and diagnostic approaches) for prostate cancer. 00:00 Opening Remarks - Neal Berke, CEO Prostate Forum 01:39 Dr Calais 33:12 Q&A Links referenced in the Presentation: Radiology Connections at UCLA: https://www.uclahealth.org/medical-services/radiology/patient-resources/send-us-your-images-ucla-radiology-connections Theranostics Trials: https://www.theranostictrials.org/ Radiotheranostics: https://www.oncidiumfoundation.org/ Phase 3 trial using the copper based: https://clinicaltrials.gov/study/NCT06056830 https://www.urotoday.com/urinary-catheters-home/indwelling-catheters/complications/1134-urotoday/prostate-cancer/157739-clarity-receives-u-s-fda-fast-track-designation-for-cu-64-sar-bispsma-in-biochemical-recurrence-of-prostate-cancer.html https://www.claritypharmaceuticals.com/news/fda_amplify/ ## Key Points from Dr. Calais's Presentation: Dr. Calais discussed cancer molecular imaging, nanotechnology, and theranostics, with a focus on PSMA (Prostate Specific Membrane Antigen) targeted imaging and therapy. He explained how PET/CT imaging can be used for prostate cancer staging and restaging at different stages of the disease journey - from initial diagnosis to assess if cancer has spread beyond the prostate, during recurrence to locate where cancer has returned, and in advanced disease to evaluate therapy response and plan treatments. PSMA PET imaging targets a cell surface protein expression and has been shown to be superior to other imaging modalities like CT, bone scan, and other PET techniques in terms of sensitivity and diagnostic performance. The first PSMA agent was approved in December 2020, and now multiple commercial options are available from various vendors in the US and Europe. Dr. Calais noted that the different PSMA tracers behave similarly, with only minor differences, and are generally considered clinically equivalent. A limitation of PSMA PET is sensitivity - it still misses about 60% of micrometastases in pelvic lymph nodes that are too small to detect but can be seen under a microscope after surgery. Most prostate cancer cells express PSMA at high intensity, but about 10-15% do not express PSMA, which can be another limitation. Even with a negative scan, patients should still receive treatment if intended for cure, as microscopic disease may be present that's too small to detect. Dr. Calais reported that as of the previous Friday (March 28, 2025), the FDA approved Lutetium-PSMA therapy for metastatic castration-resistant prostate cancer patients pre-chemotherapy, meaning chemotherapy is no longer a requirement before receiving this treatment. Clinical trials are now exploring using PSMA therapy even earlier in disease progression, including in hormone-sensitive patients. Actinium is described as "the next big thing after Lutetium" - it's an alpha emitter that delivers much more energy in its radiation and may have more potent effects. Multiple trials are underway. Dr. Calais highlighted that combining PSMA therapy with AR (androgen receptor) directed therapy may be impactful, with promising data emerging. Regarding side effects, Dr. Calais confirmed the treatment is relatively side-effect free compared to chemotherapy, though it can cause fatigue and dry mouth in some patients. Salivary gland damage remains a side effect with no significant progress in prevention, and the damage is irreversible. However, with Previcto (Lutetium-PSMA), the effect is generally mild and rare. ## Additional Information: Dr. Calais mentioned that UCLA recently hosted a large PSMA conference with 300 attendees in person and 300 virtual participants, which included a patient sharing their experience with Lutetium-PSMA therapy. UCLA offers second opinions on PSMA scans and MRIs, with contact information provided during the meeting. When asked about PSA levels for PSMA scans, Dr. Calais explained that 0.2 is a reasonable threshold after surgery, but expectations should be adjusted based on PSA levels - at very low levels (0.1), one should expect potentially not seeing anything, while at higher levels (1.5), detection is more likely. Dr. Calais clarified that theranostics (therapeutic diagnostics) is used for other cancers beyond prostate cancer, but with different targeting agents specific to those cancers. ==== About the Prostate Forum ====== The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time, and Monthly Presentations from experts on the fourth Thursday of most months. All meetings are free and are open to anyone affected by prostate cancer – patients, family, friends.

00:00 Introduction 01:41 About Prostate Forum 02:58 Dr. Calais presents 34:58 Q&A Overview Clinical theranostics research is revolutionizing prostate cancer treatment by combining diagnostics and therapy into a single approach. This innova-tive field uses advanced imaging techniques to precisely locate cancer cells, followed by targeted therapies that directly attack those cells. By personalizing treatment, theranostics enhances accuracy and effective-ness, minimizing side effects. Join UCLA's esteemed physician, Dr. Jeremie Calais, to discover cutting-edge advancements in theranostics research. Dr. Calais will provide updates on radiopharmaceutical imaging and therapy targeting the Prostate Specific Membrane Antigen (PSMA), PLUVICTO, LOCAMETZ, ILLUCCIX, PSOLUMA, PYLARIFY and more. Learn how these breakthroughs can make a significant difference in your journey and the future of prostate cancer care. ==== About the Prostate Forum ====== Prostate Cancer? You are not alone. The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. Our goal is to listen, to inform, and to educate, so that people learn to advocate for themselves and become active collaborators with their medical teams in managing their own treatment. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time. At the Newly Diagnosed Group, every 2nd Tuesday at 5:00 pm Pacific Time, get help understanding your Prostate Cancer diagnosis. Learn what it means. Talk about your options. At the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time, share your concerns and experiences, and find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs - advanced treatment options are improving all the time. Monthly Presentations Experts in the treatment and management of Prostate Cancer share their knowledge and experience with us on the fourth Thursday of most months. All meetings are free and are open to anyone affected by prostate cancer – patients, family, friends. Visit the Prostate Forum website: prostateforum.org to: • Register to receive notices of meetings • Advocate for yourself: learn the language of prostate cancer. • Find resources for learning and treatment • Explore a library of a hundreds of expert presentations Our website address is: www.prostateforum.org

Sections: 00:00 Introduction 00:52 Dr. Ulaner - fun facts about him and his "students"! 03:10 Introducing the "key-lock" metaphor 18:52 Trials available at Hoag 27:55 Q&A with Dr. Ulaner 49:42 Wrap-up from Prostate Forum Overview Dr. Ulaner discusses the use of molecular imaging and therapy in treating prostate cancer, using a metaphor of keys and locks to explain the process. Cancer cells have specific targets (locks), and scientists develop binding agents (keys) linked to radioisotopes. Low-energy radioisotopes enable imaging via PET scans, while high-energy radioisotopes can kill cancer cells. At Hoag Hospital, clinical trials focused on prostate-specific membrane antigen (PSMA), a target on prostate cancer cells. The Polaris scan, using Fluorine-18, successfully detected metastatic disease not visible on conventional scans, aiding in accurate staging and treatment. Examples showed Polaris identifying hidden metastatic sites, allowing for targeted radiation therapy and significant PSA reduction. PSMA-targeted therapy with Lutetium-177, a high-energy emitter, demonstrated improved survival rates compared to standard care. Hoag Hospital's ongoing trials include imaging newly diagnosed intermediate-risk prostate cancer and using Copper-64 PSMA for higher-risk cases. These advanced techniques are enhancing prostate cancer treatment by providing precise and effective imaging and therapy options. ==== About the Prostate Forum ====== Prostate Cancer? You are not alone. The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. Our goal is to listen, to inform, and to educate, so that people learn to advocate for themselves and become active collaborators with their medical teams in managing their own treatment. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time. At the Newly Diagnosed Group, every 2nd Tuesday at 5:00 pm Pacific Time, get help understanding your Prostate Cancer diagnosis. Learn what it means. Talk about your options. At the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time, share your concerns and experiences, and find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs - advanced treatment options are improving all the time. Monthly Presentations Experts in the treatment and management of Prostate Cancer share their knowledge and experience with us on the fourth Thursday of most months. All meetings are free and are open to anyone affected by prostate cancer – patients, family, friends. Visit the Prostate Forum website: prostateforum.org to: • Register to receive notices of meetings • Advocate for yourself: learn the language of prostate cancer. • Find resources for learning and treatment • Explore a library of a hundreds of expert presentations Our website address is: www.prostateforum.org

Dr. Kuftinec follows Greg, a representative prostate cancer patient, in his prostate cancer journey. She explains Greg's risk factors, his initial diagnosis, and some of the advanced technologies that are now available to Greg to monitor and manage his condition. Sections: 00:00 Introduction 02:30 Meet Greg - Overview of Prostate Cancer 06:00 Screening 17:40 Diagnostic Imaging 29:32 Q&A 55:10 About Prostate Forum The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. Our goal is to listen, to inform, and to educate, so that people learn to advocate for themselves and become active collaborators with their medical teams in managing their own treatment. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time. You are not alone. At the Newly Diagnosed Group, every 2nd Tuesday at 5:00 pm Pacific Time, get help understanding your Prostate Cancer diagnosis. Learn what it means. Talk about your options. Advanced treatment options are improving all the time. Share your concerns and experiences. Find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs at the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time. Monthly Presentations Experts in the treatment and management of Prostate Cancer share their knowledge and experience with us on the fourth Thursday of most months. All meetings are free, and open to anyone affected by prostate cancer – patients, family, friends. Visit the Prostate Forum website: prostateforum.org to: • Register to receive notices of meetings • Advocate for yourself: learn the language of prostate cancer. • Find resources for learning and treatment • Explore a library of a hundreds of expert presentations

Advancing Precision Medicine: EpiSwitch PSE Prostate Cancer Screening Test Designed to confirm the presence of prostate cancer, the EpiSwitch Prostate Screening test, known as the PSE, confirms the presence of prostate cancer—whether symptoms are present or not. This technological advancement empowers urologists with important information when deciding if a patient should undergo a biopsy or opt for continued monitoring via active surveillance. Sections: 00:00 Introduction 01:00 Dr. Heaton - EpiSwitch 21:20 Q&A The Prostate Forum of Orange County (prostateforum.org) is an all- volunteer organization that has been providing support to prostate cancer patients for more than thirty years. Our goal is to listen, to inform, and to educate, so that people learn to advocate for themselves and become active collaborators with their medical teams in managing their own treatment. The Forum hosts monthly online support meetings (via Zoom) on the second and fourth Tuesday of most months, beginning at 5:00 pm Pacific Time. You are not alone. At the Newly Diagnosed Group, every 2nd Tuesday at 5:00 pm Pacific Time, get help understanding your Prostate Cancer diagnosis. Learn what it means. Talk about your options. Advanced treatment options are improving all the time. Share your concerns and experiences. Find out what other Prostate Cancer warriors are saying and thinking. Learn about resources, advances, and breakthroughs at the Advanced/Recurrent Group Group every 4th Tuesday, beginning at 5:00 pm Pacific Time. Monthly Presentations Experts in the treatment and management of Prostate Cancer share their knowledge and experience with us on the fourth Thursday of most months. All meetings are free, and open to anyone affected by prostate cancer – patients, family, friends. Visit the Prostate Forum website: prostateforum.org to: • Register to receive notices of meetings • Advocate for yourself: learn the language of prostate cancer. • Find resources for learning and treatment • Explore a library of a hundreds of expert presentations COME TALK TO US. WE'VE BEEN THROUGH IT.

Click "more..." to see links to each section. WHERE IS THE CANCER? Most of prostate cancer is invisible on MRI. To treat prostate cancer, doctors need to balance sparing healthy tissue and to preserve quality of life while minimizing the risk of leaving cancer behind. This is a challenging balancing act when it's not clear where all the prostate cancer is within the prostate. Fortunately, there is now Unfold AI. Sections: 00:00 Introduction to Avenda Health's Unfold AI 01:59 About Prostate Forum of Orange County PFOC 04:11 Unfold AI - Carolyn Reul 11:30 Dr. Kasraeian - Using Unfold AI 23:31 Q&A 59:59 Chat about AI in Medicine Unfold AI FAQ What is an Unfold AI Analysis? Using a patient's standard of care data (MRI, fusion biopsy, pathology and PSA) and artificial intelligence, Unfold AI generates a heatmap or Cancer Estimation Map (CEM) that visualizes where the cancer is in 3D, significantly outperforming MRI's ability to identify exactly where all the cancer resides in the prostate. Why does seeing the extent of cancer matter? It is important to know the location and how far cancer extends in order to make a truly informed decision about a patient's course of treatment. For example, the information provided by Unfold AI can aid your physician in surgical planning by providing a map of your cancer location relative to other important anatomical structures. Who qualifies for Unfold AI? Unfold AI is available for patients who have not started a prostate cancer treatment and have been diagnosed with Gleason Grade 2 (GG2) or greater. Unfold AI can provide a better understanding of cancer location and extent so patients and physicians can decide the best course of treatment. How do I get an Unfold AI analysis? Currently Unfold AI is only available in the United States. Visit our Find a Doctor (https://avendahealth.com/unfold-ai-finder/) page to find an available provider. We are working to make Unfold AI available throughout the United States. How much does Unfold AI cost? Unfold AI is a new prostate cancer test that is not yet covered by insurance. We are working to standardize prices across the country. We recommend speaking directly to your doctor to understand the cost of the analysis. How reliable is an Unfold AI analysis? Unfold AI is based on 100,000's of patient data points gathered over 10-years of research and validated in multiple clinical studies (https://avendahealth.com/category/publication/). These studies show that Unfold AI has superior accuracy against all current methods of determining cancer location and how far it extends. Our proprietary artificial intelligence algorithms used to analyze prostate cancer are FDA-cleared. How is Unfold AI helpful after a prostate cancer treatment has been selected? Unfold AI is an invaluable tool for planning and guidance of prostate cancer treatments. For example: • For active surveillance - Unfold AI can help guide repeat biopsies • For prostatectomy - Unfold AI can aid in surgical decision making and planning • For focal therapy - Unfold AI can determine how much of the prostate to treat • Lastly, for radiotherapy - Unfold AI can help determine what areas to focus radiation Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Dr. Ulaner provides an exciting update on the use of Prostate Specific Membrane Antigen (PSMA) technology in the management of Prostate Cancer. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Dr. Metzger reviews the Clinical Practice Guidelines from the NCCN, containing recommendations for the prevention, diagnosis, and management of prostate cancer across the continuum of care. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

"This is not Your Father's Prostate Cancer." Dr. Marks talks about the revolutionary advances in detection of prostate cancer, and the target biopsy program at UCLA and elsewhere. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Prostate cancer harbors biomarkers that are used for molecular diagnosis to achieve the most current and personalized treatment for patients. This presentation introduces the concept of biomarkers in prostate cancer, their role in personalized cancer care, and how these are tested for. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with online (Zoom) meetings on the second and fourth Tuesday of most months, beginning at 5:00 p. Pacific Time. Our website address is: www.prostateforum.org

Dr. Alter discusses ExoDx, a simple urine test that helps decide if a biopsy for prostate cancer is indicated. Prostate Forum of Orange County is a Southern California Prostate Cancer Support Group, with monthly evening meetings with featured speakers on 4th Thursday evenings, starting at 6 pm. Our website address is: www.prostateforum.org