How do you interpret recent large retrospective analyses comparing radical prostatectomy vs. radiation for prostate cancer?
There have been numerous comparisons of RT vs. RP from a variety of study teams with various conclusions, and it often seems like the principal conclusion of the study is best predicted by the subspecialty from which the authors originated (urology vs. radiation oncology). As the question partially ...
I have noted that the patients that I see for post-op/salvage RT more often than not did not get a radiation oncologist consultation at the time of initial diagnosis. I would say that about 3/4 of the patients I see for salvage only saw a urologist at initial diagnosis. This is a very common occurre...
A classic question with few answers outside of the limited RCTs we have and are in the works. Dr. @Dr. First Last has a nice outline of the evidence.
To highlight some of the critiques and challenges:
- The median follow-up of 6 years is particularly challenging for comparisons between arms with and wi...
There are two very good answers to this question, so I will not provide a lengthy answer. I just wanted to add that radiotherapy for prostate cancer was significantly different in 2004 than in 2015. In 2004, IMRT and dose-escalation were very uncommon and only performed at a few innovative academic ...
At ASTRO 2025, we presented a retrospective analysis using the United States Veterans Affairs Corporate Data Warehouse to compare outcomes between a radiotherapy-based approach and radical prostatectomy in patients with high-risk localized prostate cancer treated within a similar access system. The ...
The SEER analysis mentioned (Di Bello et al., PMID 39827002) is limited to prostate cancer incidentally discovered in TURP specimens (cT1a-b only). From this standpoint, it can't be compared directly to Roy et al., PMID 40683825, which would seem to represent the best available data at the present t...
The SHARP trial will change the above conversation. I have created tables for every NCCN risk category (which I will need to update) and CAPRA score regarding the PSA control (5 y & 8-10 y) for 8 different treatment options that I show my patients. I have also created toxicity tables with and withou...
It hasn’t changed my practice. I still refer patients for a surgical opinion, but I don’t use the whole 'you can’t do surgery after rads' argument if I think they need surgery. This is not a true scenario, as if their lymph nodes are at high risk of being involved, I treat the pelvis, and a recurren...