Medical Oncology

Prostate Cancer   

Questions discussed in this category



If so, do you modify your external beam dose? 

Given the FDA approvals for PARP inhibitors and combinations in mCRPC, when do you obtain NGS for mCRPC? Do you have a preferred assay?

Only the mCRPC population was included in the Fizazi et al. study, but the FDA approval is for prevention of skeletal related events from any solid tu...

Which patients specifically benefit from both mpMRI and PET-PSMA?

How would it change your risk group or management? Does Decipher help further inform treatment?

I have a pair of patients with MRI+ and biopsy+ disease who have staging PSMA PET/CT that do not show disease within the prostate (or anywhere else).&...

When (if ever) would you consider immune checkpoint inhibitor up front? Would you be less inclined to offer triple drug therapy? (Some thought that ta...

If baseline testosterone is at castrate levels (e.g. <50), would you consider patient to have castrate-resistant disease?

In particular, in the modern era of multi-parametric prostate MRI and PSMA-PET, certain findings such as EPE, SVI, or pelvic lymphadenopathy may be no...

24 months ADT + abiraterone + definitive RT is indicated for cN1 disease but not for pN1 disease per NCCN. Can the data be extrapolated to this popula...

Notably, the patient presented with renal failure due to ureteral obstruction and hydronephrosis, receives hemodialysis, and has limited systemic opti...

Pretreatment PSA 25.3 with Gleason 4+3=7 and MRI suspicious for ECE. Eight months after pelvic nodal and prostate XRT to 79 Gy, PSA is 5.02 (down from...

A recent NCBD analysis (Rusthoven et al., PMID 27325855) suggests that the addition of prostate RT significantly improves survival compared to AD...

Specifically if metastatic risk estimate approached the failure rate in control arm of STAMPEDE for high-risk non-metastatic disease (69% MFS at 6 yea...

What imaging modality do you use (conventional, PSMA PET, etc.)? When do you image (ex: a PSA threshold or PSADT)?

Do you wait for radiographic progression? What is your preferred imaging modality for re-staging?

Current NCCN guidelines recommended not combining relugolix with these agents until more data is available.  Any drug interaction concerns or ot...

Would you treat with ADT if no metastatic disease? Does absolute PSA (e.g. PSA<2) inform decision?

Additional imaging of the potential lesions, biopsy or assume negative given normal PSMA PET/CT. 

Or would you proceed with cabazitaxel or other therapy? Initial chemo-hormonal therapy was ADT + Docetaxel x6 cycles.Docetaxel rechallenge at time of ...

Do you find the ibPFS endpoint sufficient to change practice for any or all patients, or will you await OS or other data/trials?

If yes, would you directly add olaparib at progression on abiraterone vs waiting to use abi/olaparib at a later line of therapy?

Would you offer adjuvant radiation? (Dose? Target?) vs Salvage? Would you add ADT? Would you add abiraterone? Would the number of lymph nodes involv...

Patient has ED unresponsive to cialis/viagra; would you recommend testosterone replacement therapy?

At what PSA would you become suspicious for biochemical recurrence and pursue restaging? Is there a threshold value? What imaging modality would you ...

Would you use it for initial staging or at time of biochemical recurrence?

Would you consider boosting the nodes?  What dose?  Would this change your recommendation for length of ADT?  

Would you consider chemotherapy, androgen blockade or triple therapy (chemo and AR targeting)?

Are there clinical features (post-op PSA, Decipher score, pN+, pT3, etc) that would inform your decision?

Do you worry about false negatives on PET, CT, MRI if ADT is started before the scan? Scheduling scans can sometimes book 2-4 weeks out. 

Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as ca...

PSA rose from 25 to 30 ng/mL over 6 months on darolutamide for M0 CRPC, prompting scans which showed oligometastatic disease to bone, not amenable to ...

GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease.  Prostate MRI pending. 

Would you recommend surgery first or neoadjuvant therapy such as concurrent cisplatin/RT or another regimen?

Did you change your practice given the SRE results in the control arm of EORTC 1333 at ASCO 2021? When using bisphosphonates or denosumab, what dosin...

Do prior treatments for mHSPC change your thinking on whether or not to use sipuleucel-T?

Specifically, would you offer salvage radiation to a patient who underwent a prostatectomy with PLND and had a post-op PSA of 12 with pathology reveal...

What clinical scenario(s) do you find results to be the most beneficial?

Assuming patient received appropriate local therapy for brain metastases, which agent would you use?

What is the time window in which you would consider adding AR targeted therapy? Is there a time frame in which you would NOT consider introducing sin...

Is there an optimal strategy to minimize unnecesary steroid use?For example, pre-treatment dexamethasone or 3 day dexamethasone? Prednisone only conti...

Is there data and FDA approval for this indication? What about for nodal failure after radiation? 

How would a much higher risk cancer affect decision making? How would you treat him? 

Abstract 5014 at ASCO annual meeting 2019 showed superiority of PSMA-PET imaging over fluciclovine-PET imaging.  Are you utilizing these speciali...

Do you offer EPO and TPO support? Do you modify your systemic therapy up front or after subsequent cycles?

In the SPARTAN trial, median PSA at study entry was ~ 7. Does the MFS benefit extend to patients with low PSA(< 2 or < 1)?

For instance, if the fluclicovine scan shows a few small avid nodes not only in the pelvis but extending to the paraaortic region, would you treat the...

In a patient with a prior response to ADT and progression on taxane and platinum chemotherapy, would you consider AR directed therapy?

Per the ALSYMPCA study, they excluded patients with > 3cm lymphadenopathy. Patient is currently on enzalutamide and leuprolide and refuses docetaxe...

Does the STAMPEDE trial, showing a survival benefit with the addition of docetaxel to standard treatment, change the standard of care for high risk, n...

Treatment for small cell/neuroendocrine prostate is extrapolated from data on small cell lung cancer. It now appears that Carboplatin + Etoposide + At...

Are you directed by symptoms, PSA changes or do you have a standard schedule regardless of those factors?

Abstract LBA5_PR ‘Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCA): survival results from S...

Prospective International Randomized Phase II Study of Low-Dose Abiteraterone with Food versus Standard Dose Abiraterone In Castration-Resistant Prost...

For which patients would you consider addition of apalutamide or enzalutamide? How do you decide between the 2 drugs?

NCCN recommends to change therapy or maintain current therapy in this setting without further clarification. What thresholds would cause a change in t...

Would you initiate abiraterone or enzalutamide for the rising PSA or wait until the patient is symptomatic or has a new site of metastasis?

In patients with new bone pain and without any evidence of bone metastases receiving GnRH agonists, how do you manage pain symptoms?

Is there a role for salvage LN dissection or salvage RT to the node? And is there a role for systemic therapy (ADT or chemotherapy) in addition? If yo...

Two retrospective studies from Stanford showed that patients who received ADT had an increased risk of dementia and Alzheimer's. Is this finding ...

Do you use a PSA threshold, PSA doubling time, or only evidence of metastatic disease to trigger ADT? For those without rapid doubling time, do you ev...

Given recent advancements in the understanding of biological differences in prostate cancer patients of African vs. other ancestry, does your manageme...

If so, how do you sequence this with other therapies?  In addition, in the absence of an effect on radiographic PFS or serum PSA, how do you asse...

In situations where there is a significant risk of either local or nodal persistence/recurrence post prostatectomy with a rising PSA, or nodal involve...

A recent systematic review suggested that disease progression owing to a testosterone "flare" may not be a real phenomenon: http://www.ncbi.nlm.nih.go...

The role of adjuvant docetaxel with ADT following RT for high risk disease has been previously elucidated by RTOG 0521.  Following prostatectomy,...

At the ASCO 2016 annual meeting, results of the PRINCE trial were reported. A strategy of intermittent docetaxel was found to be non-inferior to conti...

 In a patient with node positive disease, treated definitively with radiation, should continuous or intermittent ADT be administered? If a patien...

Typically radium-223 is reserved for men with symptomatic bone disease after failure of multiple other therapies.  Is there a population of men w...

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...


Papers discussed in this category


Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-04-10

Lancet, 2016 Mar 19

Eur. Urol.,

Clinical cancer research : an official journal of the American Association for Cancer Research, 2015-09-01

Eur Urol, 2015 Jul 16

BJU Int, 2009 Feb

European urology, 2014-06

The New England journal of medicine, 2013-07-18

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-01-20

The New England journal of medicine, 2004-10-07

JAMA oncology, 2016-11-01

J. Nucl. Med., 2015 Jun 25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-04-01

Lancet Oncol., 2010-02-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-03-20

The Journal of urology, 2005-08

Mol Clin Oncol, 2015 May 04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-12-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-11-10

The Journal of urology, 1999-07

Annals of oncology : official journal of the European Society for Medical Oncology, 2009-03

Mayo Clin Proc, 2004 Oct

JNCI Cancer Spectr, 2019 Oct 21

N Engl J Med, 1994 Aug 11

The New England journal of medicine, 2018-05-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-06-20

The Journal of urology, 2002-09

Clinical cancer research : an official journal of the American Association for Cancer Research, 2009-01-15

Nature, 2005-12-08

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

The New England journal of medicine, 2001-12-06

Lancet, 2001-09-22

Breast Cancer Res. Treat., 2010-02-01

The Journal of urology, 1982-06

Cancer research, 2000-04-15

J. Clin. Oncol., 2009-04-01

Oncol. Rep., 2015-12-01

Nat Commun, 2015-04-01

PLoS ONE, 2016-01-01

J. Urol., 2002-04-01

Lancet Oncol., 2015 Sep 09

European urology, 2018-02

Lancet, 2018 Oct 18

The Lancet. Oncology, 2006-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-06-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-20

JAMA oncology, 2016-04

JAMA oncology, 2017-01-01

JCO Precision Oncology, 2017 May 31

The New England journal of medicine, 2016-08-04

NEJM Evidence, 2022 Jun 3

The New England journal of medicine, 2018-04-12

The New England journal of medicine, 2018-06-28

The New England journal of medicine, 2015-08-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-06-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-12-10

JAMA Oncol,

J Urol,

Urology, 2013-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-08-20

N. Engl. J. Med., 2019 Jun 02

Nat Rev Urol, 2014 Apr

Clinical cancer research : an official journal of the American Association for Cancer Research, 2013-07-01

N Engl J Med, 2010 Jul 29

N. Engl. J. Med., 2017-07-27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-04-10

Clinical cancer research : an official journal of the American Association for Cancer Research, 2016-03-15

Prostate Int,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Nat Rev Urol, 2017 Dec 12

Lancet, 2021 Dec 23

The New England journal of medicine, 2017-07-27

Ann. Oncol.,

The Lancet. Oncology, 2013-08

Eur Urol, 2017 Oct 23

J Clin Oncol, 2017 Jul 28

N. Engl. J. Med., 2019 May 31

J. Clin. Oncol., 2019 Jul 22

Lancet Oncol, 2019 Apr 12

AJR. American journal of roentgenology, 2019-10

JAMA oncology, 2019-06-01

Clin Nucl Med,

The Lancet. Oncology, 2019-03

JAMA Oncol,

European urology, 2018-08

N. Engl. J. Med., 2019 Sep 30

Lancet,

Eur. Urol., 2018 Jul 03

Lancet, 2019 Apr 11

J. Clin. Oncol., 2017 Dec 14

Eur. Urol., 2019 Jul 19

Lancet, 2008 Dec 16

Lancet, 2011-12-17

J Thorac Oncol. , 2019 Oct 17

Cancer, 2020 Feb 19

Clin Genitourin Cancer, 2019 Mar 13

N. Engl. J. Med., 2020 May 29

Clinical cancer research : an official journal of the American Association for Cancer Research, 2012-12-15

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BMC Cancer, 2014 Sep 15

JAMA Oncol,

Eur Urol, 2019 Feb 28

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005-02-01

Urology, 2001-08

The New England journal of medicine, 2017-02-02

Lancet Oncol., 2016-06-01

JAMA Oncol, 2020 Mar 26

Lancet, 2020 Sep 28

Lancet Oncol,

Lancet Oncol,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-11-01

JAMA Oncol, 2021 Feb 18

The New England journal of medicine, 2012-09-06

Radiother Oncol, 2020 Apr 01

The Lancet. Oncology, 2012-02

International journal of radiation oncology, biology, physics, 2016-11-01

Cancer, 2018-07-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-02-01

Oncologist, 2020 Dec 03

Urology, 2000-11-01

Abdom Radiol (NY), 2019 Aug 29

Lancet, 2021 May 07

N. Engl. J. Med., 2016-10-13

J Urol, 2020 Apr 13

Eur J Nucl Med Mol Imaging, 2020 Aug 12

J Urol,

N. Engl. J. Med., 2009-06-11

Lancet Oncol, 2010 Oct 07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-04-10

Prostate Cancer Prostatic Dis, 2020 May 13

The Lancet. Oncology, 2018-11

The Prostate, 2019-09

J Urol, 2020 Dec 28

Lancet Oncol, 2020 Mar 27

Clinical genitourinary cancer, 2018-06

Cancer treatment and research communications, 2019

Prostate Cancer Prostatic Dis, 2020 Feb 28

Cancer, 2019 Dec 1

Nat Rev Urol, 2021 Apr 06

Eur Urol, 2020 Dec 03

Pancreas, 2010-08

American journal of clinical and experimental urology, 2014

The Prostate. Supplement, 1998

The Prostate, 2001 May 15

Clinical nuclear medicine, 2017 Jan

The New England journal of medicine, 2019-03-28

Clin Cancer Res, 2019 Sep 11

Lancet Oncol, 2019 Oct 16

JAMA Oncol,

J Urol, 2021 Feb 26

Journal of the National Comprehensive Cancer Network : JNCCN, 2014-05

Proceedings of the National Academy of Sciences of the United States of America, 2011-06-07

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2017-01

European journal of nuclear medicine and molecular imaging, 2018-11

European urology oncology, 2018-05

J Nucl Med, 2021 Dec 16

J Nucl Med, 2018 Dec 14

Eur J Nucl Med Mol Imaging, 2019 Nov 15

Eur J Nucl Med Mol Imaging, 2019 Dec 26

JAMA Oncol,

J Urol, 2021 Feb 03

J Nucl Med, 2020 Jan 10

Clin Cancer Res, 2021 Feb 23

N Engl J Med, 2020 Apr 28

Prostate cancer and prostatic diseases, 2018-04

JCO Precis Oncol, 2020

Lancet Oncol, 2019 Sep 09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-11-01

BJU international, 2014-12

The Journal of urology, 2002-09

Lancet, 2020 Sep 28

BMC cancer, 2019-06-13

J Clin Oncol, 2022 Mar 15

N Engl J Med, 2022 Feb 17

Prostate, 2022 Jun 08

Br J Cancer, 2008 Feb 12

Lancet,

Eur Urol, 2015 Dec 17

BJU Int, 2016 Nov 12

International journal of radiation oncology, biology, physics, 2006-07-15

J Nucl Med, 2021 Jun 24

Oncotarget, 2017 Feb 25

Eur Urol, 2020 Jun 09

JAMA Oncol,

BJU Int, 2022 Apr 03

Int J Radiat Oncol Biol Phys, 2020 Sep 11

Lancet Oncol, 2022 Jan 17

Prostate Int, 2019 Feb 22

J Clin Oncol, 2021 Jan 26

J Urol, 2019 Sep 06

Lancet,

AJR Am J Roentgenol, 2022 Jun 29

Eur Radiol, 2022 Aug 08

Urology,

Clin Nucl Med,

Skeletal Radiol, 2014 May 20

Eur J Nucl Med Mol Imaging,

International journal of radiation oncology, biology, physics, 2019-06-01

Eur Urol, 2021 Apr 03

Lancet Oncol, 2013 Jan 04

Int. J. Radiat. Oncol. Biol. Phys., 2017-06-01

Radiother Oncol, 2012 Feb 16

Lancet Oncol, 2021 Jan 18

Prostate Cancer Prostatic Dis, 2021 Feb 10

Prostate Cancer Prostatic Dis, 2022 Mar 15

J Urol, 2019 01

Urology, 2021 Oct 06

Eur Urol Oncol, 2020 Aug 15

JAMA Netw Open, 2021 Jul 01

JAMA, 2005-09-14

JAMA oncology, 2018-06-14

Int J Radiat Oncol Biol Phys, 2021 Nov 03

Eur Urol, 2021 Dec 23

Int J Radiat Oncol Biol Phys, 2000 Sep 01

Radiother Oncol, 2021 Feb 13

J Clin Oncol, 2023 Apr 27

Front Oncol, 2022 Mar 29

Brachytherapy, 2022 May 04

Pract Radiat Oncol, 2023 Jul 11

Nature reviews. Urology, 2018-04

N Engl J Med, 2021 Jun 23

Lancet, 2019 Jun 18

Int J Radiat Oncol Biol Phys, 2015 Jul 15

J Clin Oncol, 2019 Dec 12

J Clin Oncol, 2021 Jan 10

J. Clin. Oncol., 2016-05-20

Lancet Oncol., 2018 Dec 19

Lancet Oncol, 2015 Feb 19

Eur J Cancer, 2020 Dec 03

Prostate, 2020 Feb

BJUI Compass, 2021 Jan 05

Lancet, 2022 Apr 08

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10

Eur Urol Oncol, 2022 May 20

J Clin Oncol, 2021 Dec 20

Int J Radiat Oncol Biol Phys, 2023 May 02

J Clin Oncol, 2023 Mar 23

The Lancet. Oncology, 2018-02

Lancet Oncol, 2019 Dec

The Lancet. Oncology, 2019 Sep 29

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2021 Nov 10

Annals of oncology : official journal of the European Society for Medical Oncology, 2023 Jul 01

Lancet (London, England), 2023 Jun 04

Eur Urol, 2018 Sep 25

Eur Urol, 2015 May 21

JAMA oncology, 2023 Jun 01

International journal of radiation oncology, biology, physics, 2019-08-01

Lancet, 2021 Feb 11

Eur J Nucl Med Mol Imaging, 2023 Jul 05

BJU Int, 2021 Dec 13

J Urol, 2021 Jan 27

Eur Urol, 2020 Jan 08

Int J Radiat Oncol Biol Phys, 2019 Oct 10

EJNMMI physics, 2023 Feb 09

The Lancet. Oncology, 2014-05

The New England journal of medicine, 2023 Oct 19

Health and quality of life outcomes, 2020 May 12

European urology, 2015 Feb 14

International journal of cancer, 2022 May 16

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2022 Oct 27

The Lancet. Oncology, 2023 Sep 12

Future oncology (London, England), 2023 Oct 26

Cancer medicine, 2022 Jul 24

European urology, 2022 Apr 18

The New England journal of medicine, 2018-05-10

The New England journal of medicine, 2020 Mar 05

J Clin Oncol, 2021 Jan 20

JAMA oncology, 2023 Mar 01

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2020 Jan 10

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2023 Jun 08