Progression to metastatic disease occurs in about half of all men who develop prostate cancer (PC), one of the most common cancers in men worldwide. Androgen deprivation therapy has been the mainstay therapy for patients with metastatic PC (mPC) since the 1940s. In the last decade, there has been unprecedented advancement in systemic therapies, e.g., taxane, androgen-signalling pathway inhibitors, and biomarker-driven targeted therapies for various stages of disease, resulting in overall survival improvement. Adding to ongoing controversies over how best to treat these patients is the recognition that ethnicity may influence prognosis and outcomes. This review discusses recent evidence for the impacts of Asian ethnicity specifically, which includes environmental, sociocultural, and genetic factors, on the approach to pharmacological management of mPC. Clear inter-ethnic differences in drug tolerability, serious adverse events (AEs), and genetic heterogeneity must all be considered when dosing and scheduling for treatment, as well as designing future precision studies in PC.

This study retrospectively evaluates the clinical outcomes of definitive volumetric modulated arc therapy (VMAT) for high-risk or very high-risk locoregional prostate cancer patients from an Asian institution. Consecutive patients who received VMAT (76 Gy in 38 fractions) between January 2017 and June 2022 were included. Whole pelvic radiotherapy (WPRT) (46 Gy in 23 fractions) was employed for clinically node-negative disease (cN0) and a Roach estimated risk of ≥15%, as well as simultaneous integrated boost (SIB) of 55–57.5 Gy to node-positive (cN1) disease. The primary endpoint was biochemical relapse-free survival (BRFS). Secondary endpoints included radiographic relapse-free survival (RRFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCSS). A total of 209 patients were identified. After a median follow-up of 47.5 months, the 4-year actuarial BRFS, RRFS, MFS and PCSS were 85.2%, 96.8%, 96.8% and 100%, respectively. The incidence of late grade ≥ 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 15.8% and 11.0%, respectively. No significant difference in cancer outcomes or toxicity was observed between WPRT and prostate-only radiotherapy for cN0 patients. SIB to the involved nodes did not result in increased toxicity. International Society of Urological Pathology (ISUP) group 5 and cN1 stage were associated with worse RRFS (p < 0.05). PSMA PET-CT compared to conventional imaging staging was associated with better BRFS in patients with ISUP grade group 5 (p = 0.039). Five-year local experience demonstrates excellent clinical outcomes. PSMA PET-CT staging for high-grade disease and tailored pelvic irradiation based on nodal risk should be considered to maximize clinical benefit.

Background: Neoadjuvant treatment for early-stage triple-negative breast cancer has been widely used, and the KEYNOTE-522 (KN522) regimen has become a standard of care for early-stage TNBC, with alternative treatment options including a dose-dense anthracycline/taxane-based regimen for patients without access to neoadjuvant immunotherapy. Nevertheless, real-world evidence in Chinese populations, especially high-risk cohorts such as older populations and those with substantial nodal burden, is limited regarding both efficacy and tolerability. This study describes the outcomes associated with neoadjuvant systemic therapy in a Hong Kong Chinese cohort. Objectives: This study aimed to describe the feasibility, treatment delivery, tolerability and safety of the KN522 regimen in stage I-III TNBC in a Chinese cohort in Hong Kong. Another cohort treated with dose-dense neoadjuvant chemotherapy, which is also a standard-of-care treatment alternative, is presented to provide context of local treatment practice. Methods: We conducted a retrospective observational cohort study of 59 patients with stage I-III TNBC who received neoadjuvant systemic treatment prior to breast surgery at a tertiary centre in Hong Kong between February 2022 and June 2025. The primary cohort received the KN522 regimen (n = 30). A contextual reference cohort received dose-dense epirubicin/cyclophosphamide followed by paclitaxel (n = 29) to describe local treatment patterns. Descriptive outcomes included pathological complete response (pCR), treatment delivery, adverse events, surgery completion, and exploratory event-free survival (EFS). Analyses were primarily descriptive; between-cohort comparisons were exploratory in nature. Results: Fifty-nine patients were included overall: 30 treated with the KN522 regimen and 29 treated with dose-dense neoadjuvant chemotherapy. In the KN522 cohort, the median age was 56 years, 80.0% of patients were postmenopausal, and 33.3% had N3 disease. Pathological complete response occurred in 13 of 30 patients (43.3%; exact 95% CI 25.5–62.6%). Grade ≥3 chemotherapy-related adverse events occurred in 15 patients (50.0%), immune-related adverse events occurred in 11 patients (36.6%), and Grade 3 or higher immune-related adverse events occurred in four patients (13.3%). Pembrolizumab was suspended in six patients (20.0%), while all 30 patients proceeded to definitive surgery. In the dose-dense chemotherapy cohort, the pCR rate was 31.0%, with a grade ≥3 chemotherapy-related adverse event rate of 20.7%, and all patients proceeded to definitive surgery. Conclusions: In this descriptive real-world single-centre Hong Kong study, the neoadjuvant KN522 regimen was feasible in Chinese patients with early TNBC, although treatment-related toxicity and treatment modification were common. The observed pCR rate was lower than that reported in the original KN522 trial, possibly reflecting differences in patient selection and real-world treatment delivery patterns. Larger multi-centre studies are needed to evaluate outcomes in Chinese and other Asian populations.