Please select the option that best describes you:
What criteria do you use in deciding whether or not to treat the pelvis in prostate cancer?
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?
This question is part of our collaboration with ASTRO 2025 to highlight impactful trial data from this year's meeting. This question is inspired by the Clinical Trials Session Presentation "Androgen Deprivation Therapy (ADT) and High Dose Definitive Radiotherapy (RT) +/- Whole Pelvic RT in Patients with Unfavorable Intermediate or Favorable High-Risk Prostate Cancer: Early Results of a Phase III Randomized Controlled Trial" by Dr. Mack Roach.
Answer from: Radiation Oncologist at Community Practice
The literature is compelling (as summarized by Dr. @Spratt) that for many high-risk patients, and likely all unfavorable intermediate-risk patients, WPRT is unnecessary.That said, I will gripe that stating "The end of elective nodal RT in localized prostate cancer" is overselling things a little bit...
Answer from: Radiation Oncologist at Community Practice
There may be no issue in radiation oncology more controversial than elective nodal irradiation (ENI) in prostate cancer. If we knew, we wouldn’t currently have 0924 open, which is the largest study ever attempted by the RTOG, this time powered for 10-year OS (target accrual = 2,580). Since we ...
Answer from: Radiation Oncologist at Community Practice
It’s interesting that in PEACE V, elective nodal volume treatment in nodal recurrence did improve regional recurrence as well as metastasis-free survival compared to INRT. So it may be a function of what the risk of microscopic disease in the pelvis is. PEACE2 for very high risk done in the mo...
Answer from: Radiation Oncologist at Community Practice
I always let the patient decide.I review the accuracy of an MRI, CT, and PET for detecting lymph nodes.I then review the idea behind the MSKCC nomogram followed by the low pelvic failure rates despite a high prediction rate Zumsteg et al., PMID 26165583.We then cover the ability to salvage pelvic fa...
This response is very well written.
Would you feel as strongly about omitting ENI in u...