Radiation Oncology

Prostate Cancer   

Questions discussed in this category



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...

Is there a benefit to one fractionation schedule v. the other?

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

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

If so, what dose? What if there is positive a PA lymph node but no signs of distal mets? 

Is there a dose response relationship, as suggested in the phase I MSKCC dose escalation study presented at ASTRO 2017?

There is a recent publication that nicely summarizes the molecular/genetic tests for prostate cancer (https://www.ncbi.nlm.nih.gov/pubmed/26123120). W...

Based on the updated results of the PCS IV trial is 18 months of ADT the new standard of care for men with high-risk prostate cancer treated with...

In the case of patients many years out from RP who have a slowly rising PSA, do you offer salvage RT while the PSA is still very low or follow the PSA...

If a patient who has undergone radical prostatectomy many years previously presents with biochemical failure and is found to have a nodule in the pros...

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

With biopsy-proven, negative systemic restaging disease, what dose and fractionation is appropriate if treating with IMRT? Should ADT generally b...

Would you consider this an indication to treat lymph nodes, if you would typically not do so?

How high would you try to boost those involved nodes if they are in a favorable location with respect to his rectum and small bowel? 

Is there an upper limit to offer definitive RT? Is it possible to have a PSA of 100-500 and still have only local disease?

Should the workup change with the PSA level (for example, >2 vs <2 ng/ml post-op PSA)?  Is there a PSA level for which salvage radiotherapy...

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

In the recent 10 year update of the ARO (adjuvant pelvic RT versus observation) trial, their definition of PSA failure was 2 successive rise...

Would a specific Gleason score, age, pathological feature, or PSA be an indication for covering the pelvic nodes? Would giving concurrent ADT affect y...

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

Does PSADT play a factor in your decision-making? If so, how specifically?  I've tended to wait until the PSA is 10-15, re-image, and then begin...

Are there certain situations where a hydrogel spacer is most useful based on treatment modality (SBRT, protons, brachy, etc) or other factors?

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

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

Guidelines dont seem to account for this possibility. Could it just be normal prostate tissue growing back that is leading to PSA, why just assume it ...

In starting prostate SBRT at an instutution, what are issues with the treatment that one should pay special attention to?

On what other factors should be considered in making a treatment recommendation for salvage radiation therapy?

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

With ultra-sensitive PSA, it's unclear to me whether a doubling from 0.01 to 0.02 or 0.02 to 0.04 is significant. Is there a certain value that you wo...

If a patient is deemed high risk enough to require hormones with RT in the salvage setting, how long would you maintain them on ADT? Would you extrapo...

When counseling patients with organ-confined prostate cancer, what rates of impotence, incontinence, rectal toxicity, and urethral stricture shou...

The optimal timing of post-prostatectomy RT in high-risk patients is debatable and currently the question of prospective randomized trials; however, g...

Do you use a particular cut-off? For example, someone in their 40's?

The patient has a positive bone scan (2 lesions), grade 4+5=9/10 prostate, and cancer cannot urinate without a catheter.

More specifically, which cardiac risk factors do you look for? Diabetes? Previous MI? Dyslipidemia? Peripheral vascular disease? CHF?

In general how do you counsel patients with high risk prostate cancer when choosing radiation verse prostatectomy? What numbers do you quote for ...

This is a patient who would have been an appropriate candidate for radiation upfront, but was managed with androgen deprivation therapy instead. On th...

Sometimes the scans don’t line up well because of differences in rectal and bladder fullness- any tips to optimize the fusion?

I ask this because I am seeing more and more patients who have had surgery despite presenting with high risk disease.

I know many do not treat the pelvis at all, but for those who do, what criteria do you use? Risk? Gleason? PSA? T stage?

And should special precautions be taken (such as dose reduction, prophylactic symptom management, etc)?


Papers discussed in this category


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Int J Radiat Oncol Biol Phys, 2014 Apr 1

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BMJ, 2014-01-08

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JAMA, 2006 Nov 15

Pract Radiat Oncol, 2013 Oct-Dec

N Engl J Med, 2008 Mar 20

J Urol, 2011 Sep

Pract Radiat Oncol, 2013 Apr-Jun

J Clin Oncol, 2005 Feb 1

Lancet Oncol, 2006 Jun

Eur. Urol., 2011-05-01

Int J Radiat Oncol Biol Phys, 2014 Apr 1

Lancet, 2008 Dec 16

Lancet, 2011-12-17

J. Natl. Cancer Inst., 2015-07-01

J. Clin. Oncol., 2014-12-10

Urol Oncol, 2014 Apr

BJU Int., 2014-03-01

J. Clin. Oncol., 2015-03-10

J. Urol., 1998-01-01

Eur. Urol., 2014-03-01

BJU Int., 2015-10-01

N Engl J Med, 2011 Jul 14

Int J Radiat Oncol Biol Phys, 2010 Apr

JAMA, 2015 Sep 22-29

J Clin Oncol, 2008 Jun 20

J Urol, 2012 Jan

Int J Radiat Oncol Biol Phys, 2012 Sep 14

Cancer, 2014 Jun 15

Cancer, 2006 Jun 15

Int J Radiat Oncol Biol Phys, 2003 Mar 15

Urology, 2008 Nov

J Clin Oncol, 2004 May 15

Am J Clin Oncol, 2012 Jun 14

Int J Radiat Oncol Biol Phys, 2011 Jul 15

Int J Radiat Oncol Biol Phys, 2010 Jul 15

Front Oncol, 2011

J. Clin. Oncol., 1999-04-01

J. Clin. Oncol., 2016 Aug 15

N. Engl. J. Med.,

JAMA Oncol, 2017-10-01

Semin Radiat Oncol, 2013-07-01

Eur Urol, 2015 Jul 16

BJU Int, 2009 Feb

Eur Urol, 2014 Jun

J Clin Oncol, 2007 May 20

N Engl J Med, 2013 Jul 18

Lancet, 2016 Mar 19

J. Clin. Oncol., 2019 Mar 12

Eur Urol, 2011 Apr

Urology, 2001-11-01

J. Clin. Oncol., 2016-01-20

J. Nucl. Med., 2015 Jun 25

Int. J. Radiat. Oncol. Biol. Phys., 2015 Apr 23

J Clin Oncol, 2008 Apr 1

Lancet Oncol., 2010-02-01

J Clin Oncol, 2006 Mar 20

J. Urol., 2005-08-01

J Clin Oncol, 2002 Aug 1

J Clin Oncol, 2011 Jun 20

J Urol, 2002 Sep

Clin Cancer Res, 2009 Jan 15

Nature, 2005 Dec 8

J Clin Oncol, 1999 Jul

Lancet, 2015 Jan 3

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PLoS ONE, 2016-01-01

J. Urol., 2002-04-01

Eur. Urol., 2018-02-01

Lancet, 2018 Oct 18

N Engl J Med, 2015 Aug 20

JAMA, 2008 Jun 18

Int J Radiat Oncol Biol Phys, 2007 Nov 1

J. Clin. Oncol., 2015-06-20

J Clin Oncol, 2016 Feb 20

JAMA Oncol, 2016 Apr 1

JAMA Oncol, 2016 Oct 13

Int J Radiat Oncol Biol Phys, 2012 Jul 15

Int J Radiat Oncol Biol Phys, 2011 Jun 1

Urology, 2017-04-01

Int J Radiat Oncol Biol Phys, 1986 Mar

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

Front Oncol, 2017

Int J Radiat Oncol Biol Phys, 2008 Sep 1

Eur. Urol., 2017-11-08

Int J Radiat Oncol Biol Phys, 2008 Apr 1

Int J Radiat Oncol Biol Phys, 2014 Jul 1

Int J Radiat Oncol Biol Phys, 2016 Jul 1

Radiother Oncol, 2013-11-01

J Clin Oncol, 2011 May 20

Front Radiat Ther Oncol, 2011-01-01

Semin Radiat Oncol, 2016 Aug 31

J. Clin. Oncol., 2015 May 26

J. Clin. Oncol.,

Int J Radiat Oncol Biol Phys, 2012 Apr 1

Brachytherapy, 2016 Nov - Dec

Pract Radiat Oncol, 2018 Oct 11

Pract Radiat Oncol, 2017 Aug 16

J Contemp Brachytherapy, 2016 Oct

J. Clin. Oncol.,

Int J Radiat Oncol Biol Phys, 2012 Jul 1

Radiother Oncol, 2009 Apr

Semin Radiat Oncol, 2004-01-01

Pract Radiat Oncol, 2016 Nov 13