Topics:
Radiation Oncology • Genitourinary Cancers
After the results of RTOG 0232, would you be comfortable treating unfavorable intermediate risk prostate cancer with brachytherapy monotherapy?
Does this option need to be added to NCCN guidelines? How does the type of brachytherapy, HDR vs LDR, influence your recommendations? Does ADT play a role in your decision?
RTOG 0232 included cT1c-T2bN0M0, Gleason 2-6 and PSA 10-20 OR GS 7 and PSA < 10. With this definition, many unfavorable intermediated risk will be in the inclusion criteria. Results show COMBO (EBRT + Brachy) vs Brachy alone did not improve FFP but caused greater toxicity.
Answer from: Radiation Oncologist at Community Practice
We have moved to brachy alone if meets the above criteria as similar outcome and less morbidity.
Answer from: Radiation Oncologist at Community Practice
I concur with the excellent comments by Dr. @Anscher and add the following:The RTOG 0232 trial included patients with cT1c-T2bN0M0 disease with a Gleason score of 2-6 and PSA of 10-20 or with a Gleason score of 7 with a PSA <10. The majority of patients were T1, Gleason score 7, with PSA <...
Answer from: Radiation Oncologist at Community Practice
I typically get a PSMA PET in these patients and urge them to consider short course ADT along with either LDR or HDR with a preference for HDR.
Would a decipher score help you decide which UIR p...
Probably not at this point in time. It might sugge...
Decipher predicts more for the risk of DM and ther...