Prostate Cancer   

Questions discussed in this category



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

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

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

What dose constraint would you use for the neobladder? Small bowel constraint of 54Gy? Or would you recommend observation or ADT alone or low dose RT ...

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...

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...

Based on the RADICALS-RT trial presented at ESMO, can RT be omitted in post op prostate patients in favor of salvage RT? If not which group of patient...

Will your recommendation change if there is suspicious/confirmed locally recurrent nodule in the prostate bed?

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

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...

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...

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

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...

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?

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 ...

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...

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...

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...

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...

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...

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


International journal of radiation oncology, biology, physics, 2005-04-01

Int J Radiat Oncol Biol Phys, 2005 Sep 1

International journal of radiation oncology, biology, physics, 2004-06-01

International journal of radiation oncology, biology, physics, 2007-08-01

International journal of radiation oncology, biology, physics, 2014-04-01

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

Int. J. Radiat. Oncol. Biol. Phys., 2012-12-01

European urology, 2013-12

CA Cancer J Clin, 2010 May-Jun

J Natl Cancer Inst, 2010 Jan 6

BJU international, 2014-12

JAMA, 2011-12-07

Cancer, 2013 May 15

International journal of radiation oncology, biology, physics, 2010-11-01

American journal of clinical oncology, 2016-02

Radiother Oncol, 2013-01-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-03-20

Eur. Urol., 2009-05-01

The American journal of surgical pathology, 2005-09

The New England journal of medicine, 2012-07-19

BMJ, 2014-01-08

International journal of radiation oncology, biology, physics, 2012-05-01

International journal of radiation oncology, biology, physics, 2012-02-01

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

JAMA, 2006-11-15

Practical radiation oncology, 2013

N Engl J Med, 2008 Mar 20

The Journal of urology, 2011-09

Practical radiation oncology, 2013

Urologic oncology, 2014-04

BJU international, 2014-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-03-10

J. Urol., 1998-01-01

Eur. Urol., 2014-03-01

BJU international, 2015-10

The New England journal of medicine, 2011-07-14

International journal of radiation oncology, biology, physics, 2010-04

JAMA, 2015

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-06-20

The Journal of urology, 2012-01

International journal of radiation oncology, biology, physics, 2013-03-15

Cancer, 2014-06-15

Cancer, 2006 Jun 15

International journal of radiation oncology, biology, physics, 2003-03-15

Urology, 2008-11

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

Lancet, 2016 Mar 19

Eur. Urol.,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-05-15

American journal of clinical oncology, 2014-06

International journal of radiation oncology, biology, physics, 2011-07-15

International journal of radiation oncology, biology, physics, 2010-07-15

Frontiers in oncology, 2011

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

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1999-04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-10-20

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

JAMA Oncol, 2017-10-01

Seminars in radiation oncology, 2013-07

Eur Urol, 2015 Jul 16

BJU Int, 2009 Feb

European urology, 2014-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-05-20

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

JAMA Oncol, 2020 Aug 27

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

European urology, 2011-04

Urology, 2001-11

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

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

Brachytherapy, 2020 Apr 21

Int. J. Radiat. Oncol. Biol. Phys., 2020 Jan 24

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

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

European urology, 2018-02

Lancet, 2018 Oct 18

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

JAMA, 2008-06-18

International journal of radiation oncology, biology, physics, 2007-11-01

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

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

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

Int J Radiat Oncol Biol Phys, 2012 Jul 15

International journal of radiation oncology, biology, physics, 2011-06-01

Lancet, 2008 Dec 16

Lancet, 2011-12-17

Urology, 2017-04

Int J Radiat Oncol Biol Phys, 1986 Mar

Frontiers in oncology, 2017

International journal of radiation oncology, biology, physics, 2008-09-01

European urology, 2018-07

International journal of radiation oncology, biology, physics, 2008-04-01

International journal of radiation oncology, biology, physics, 2014-07-01

International journal of radiation oncology, biology, physics, 2016-07-01

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2013-11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-05-20

Frontiers of radiation therapy and oncology, 2011

Semin Radiat Oncol, 2016 Aug 31

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

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

J. Clin. Oncol., 2015 May 26

J. Clin. Oncol.,

Nat Rev Urol, 2014 Apr

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

International journal of radiation oncology, biology, physics, 2012-04-01

Brachytherapy, 2016

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

Prostate Int,

Practical radiation oncology, 2018

Practical radiation oncology, 2018

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

Journal of contemporary brachytherapy, 2016-10

International journal of radiation oncology, biology, physics, 2012-07-01

Radiother Oncol, 2009 Apr

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

Ann. Oncol.,

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

J. Clin. Oncol., 2019 Jul 22

Semin Radiat Oncol, 2004-01-01

Practical radiation oncology, 2017

JAMA Oncol,

The Lancet. Oncology, 2019-03

BJU international, 2012-10

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

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

,

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, 2014-12-10