In this Prostate Forum session, we welcome back Dr. Gary Ulaner, Director of Molecular Imaging and Therapy at the Hoag Family Cancer Institute and Professor of Radiology at USC. Dr. Ulaner is a national leader in prostate cancer molecular imaging and targeted therapy, and he returns to share important updates on PSMA-targeted imaging and therapy, with a focus on Lutetium-177 (Pluvicto) and its use alone or in combination with androgen receptor pathway inhibitors (ARPIs). Chapters 00:00 Introduction – Welcome and opening remarks 01:02 Molecular Imaging & Therapy Basics – How PSMA targeting works for imaging and treatment 05:15 Pluvicto and Clinical Impact – NEJM trial results, survival benefit, patient responses 06:04 Clinical Trials at Hoag – Actinium-225 PSMA (post-Pluvicto) and new Pluvicto ± ARPI trial (free medication provided) 11:16 Q&A: Practical Questions – PSA thresholds for PSMA PET, trial eligibility, out-of-state participation, side effects, quality of life Key Topics Molecular Imaging & Therapy Basics Dr. Ulaner begins with an overview of molecular imaging and therapy: cancer cells express targets such as PSMA (Prostate Specific Membrane Antigen), which can be bound by specially designed agents. When linked to imaging isotopes, these agents allow highly sensitive PET scans to detect prostate cancer. When linked to therapeutic isotopes, they deliver radiation directly to cancer cells, shrinking disease while sparing most normal tissue. Pluvicto and Clinical Impact The landmark NEJM trial established that Lutetium-177 PSMA-617 (Pluvicto) improves survival compared to standard care in metastatic castration-resistant prostate cancer. While not a cure, it significantly reduces tumor burden and extends life, with median benefit of about 4–6 months on average, and in some cases years of added survival. Dr. Ulaner emphasized that individual responses vary widely. Current and New Clinical Trials Two key clinical trials at Hoag are highlighted: • Actinium-225 PSMA trial: For patients who have already received Pluvicto and progressed. Actinium delivers alpha radiation (100x stronger than beta), often with fewer systemic side effects, though salivary gland toxicity (dry mouth) is more pronounced. This option may be preferable to chemotherapy for many patients. • Pluvicto ± ARPI trial (newly opened): For patients who have had one prior ARPI (abiraterone, enzalutamide, darolutamide, or apalutamide) and then progressed. Patients may receive Pluvicto alone or Pluvicto plus another ARPI. Importantly, Novartis provides the medication free of charge for participants. Practical Questions Answered The Q&A addressed: • When to order PSMA PET: After prostatectomy, a PSA ≥0.2 ng/mL usually qualifies. Post-radiation, thresholds depend on PSA rise above nadir. • Effect on treatment decisions: PSMA PET alters management in over 50% of biochemical recurrence cases, ~⅓ of high-risk newly diagnosed cases, and 10–15% of patients being evaluated for therapy. • Side effects: Pluvicto is generally well tolerated compared to chemotherapy. Actinium therapy has more dry-mouth issues but often less bone marrow toxicity. • Access to trials: Patients from outside California can enroll if they can travel to Hoag or to other sites nationwide as they open. • Hip replacements: Do not interfere with PSMA therapy or imaging. • Quality of life: Radioligand therapies usually provide “good months of life,” with relatively mild side effects compared to chemotherapy. Key Takeaways • Pluvicto is a proven life-extending therapy for advanced prostate cancer. • Actinium-225 PSMA offers a promising next step for patients progressing after Pluvicto. • New trials combining Pluvicto with ARPIs may improve outcomes, with drugs supplied at no cost. • PSMA PET imaging is transforming management, guiding both diagnosis and therapy selection. ============ 📌 About the Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and their families affected by prostate cancer. We host online support groups on the 2nd and 4th Tuesdays of each month, and feature presentations from medical experts on the 4th Thursday of most months. 💻 Learn More & Join Us 🌐 prostateforum.org 📺 Subscribe to our YouTube channel for monthly expert talks and fireside chats. 📧 Sign up for our free newsletter via our website to receive meeting updates. ⚠️ Disclaimer The information presented in this video is for educational purposes only. It is not medical advice. Always consult your healthcare provider before making treatment decisions.

How can AI transform prostate cancer treatment decisions? In this Prostate Forum fireside chat, Dr. Calvin Chao of Artera explains how their groundbreaking AI-powered test predicts outcomes and guides therapies like radiation, hormone therapy, and abiraterone. A must-watch for patients, caregivers, and clinicians seeking the latest in precision medicine. In this special session hosted by the Prostate Forum Advanced Support Group, we welcome Dr. Calvin Chao, Vice President of Medical Science at Artera. Dr. Chao shares exciting updates from the recent ASCO meeting, highlighting how Artera’s AI-driven prostate test is shaping the future of precision medicine in prostate cancer care. 00:00 Meet Dr. Chao 00:30 Q&A The discussion covers: • How the Artera AI platform uses digital biopsy slide analysis with machine learning to predict outcomes and guide treatment decisions. • The difference between prognostic risk assessments (likelihood of distant metastasis or mortality) and predictive biomarkers (who benefits from specific therapies like short-term ADT with radiation). • Results from landmark studies, including RTOG clinical trials and the STAMPEDE trial, showing how the Artera test can identify patients most likely to benefit from treatments like abiraterone. • Practical implications for patients considering active surveillance, radiation, or hormone therapy. Dr. Chao also answers audience questions about long-term outcomes, use of older pathology slides, PET imaging, and how the test applies in real-world decision-making. 📌 About the Prostate Forum of Orange County The Prostate Forum of Orange County (PFOC) is a nonprofit, volunteer-run support and education group for men and their families affected by prostate cancer. We host online support groups on the 2nd and 4th Tuesdays of each month, and feature presentations from medical experts on the 4th Thursday of most months. Our goal is to provide reliable information, expert insight, and a welcoming community where patients, survivors, and caregivers can share experiences and learn together. 💻 Learn More & Join Us 🌐 prostateforum.org 📺 Subscribe to our YouTube channel for monthly expert talks and fireside chats. 📧 Sign up for our free newsletter via our website to receive meeting updates. ⚠️ Disclaimer The information presented in this video is for educational purposes only. It is not medical advice. Always consult your healthcare provider before making treatment decisions. 🙏 Support Our Mission If you find our programs helpful, please consider supporting the Forum through donations or by spreading the word to others who may benefit.

00:00 Introduction 00:13 Dr. Lee presents 15:50 Q&A Overview Dr. Lee discusses recent advances in radiation oncology at City of Hope. Key developments include advanced radiotherapy devices, integration of imaging and artificial intelligence, and comprehensive cancer care. These advancements reflect City of Hope's commitment to staying at the forefront of radiation oncology, utilizing state-of-the-art technologies to improve cancer treatment outcomes. ==== 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. Kishan speaks about emerging technologies and promising developments. He focuses on SBRT (MRI-guided radiation) advances, MIRAGE early results (the 2023 publication — two-year results coming this fall), issues with ViewRay, and the next frontier, e.g., the newly opened HEATWAVE trial. 00:00 Introduction 00:30 Dr. Kishan - Update on SBRT 22:00 Q&A 27:00 About 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

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.

What you don't know can hurt you – never more so than following a cancer diagnosis. Private patient advocates find information you need to make decisions about care. Look to them for assistance with doctors, treatments, and insurance coverage. AnnMarie McIlwain, CEO of Patient Advocators, talks to the Advanced/Recurrent Support Group of the Prostate Forum about how patient advocates, whether personal or professional, can bring clarity , effectiveness, and determination to what is often a frightening and confusing time for prostate cancer patients. 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