Articles to use against Proton radiotherapy for prostate cancer

[xrthopeful]

It's pretty clear that you guys are experts in radiation, not prostate cancer. I don't blame you, as that is the nature of your training and you have to treat patients with the full gamut of cancers. The idea of rad onc being the point of contact for new prostate cancer patients is honestly pretty horrifying though.

The incredibly embarrassing part is this guy actually believes this.


Urologists don't come close to knowing the Prostate data (surgery, ADT, chemo, radiation all included) as well as a well-trained Rad Onc

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[RadOncDoc21]

The incredibly embarrassing part is this guy actually believes this.


Urologists don't come close to knowing the Prostate data (surgery, ADT, chemo, radiation all included) as well as a well-trained Rad Onc

I think this will be a common theme throughout the field of medicine. I've seen plenty of patients recieve substandard care because of who they saw first versus what should have been done.

I think it's going to get worse with bundling of reimbursements.

 

[mpdoc2]

Yes of course.

These high risk patients are unlikely to be cured by radiation alone either. If you are spinning it as RP vs definitive therapy, you are just as unethical as the urologists you criticize. There is increasing evidence that multimodal therapy is the most beneficial for these patients, and that is part of the discussion I have with the patient. Certainly very high risk patients go into an RP with me expecting they will require radiation and ADT at some point postoperatively. A RP will certainly be more difficult and higher risk and may be impossible after XRT. It should be something the patient considers.

I think some of you are seriously misunderstanding the nomograms and/or what an RP is. High risk of EPE and/or SVI does not mean guaranteed positive margins or impossible surgical cure. The SV's are resected with the prostate during RP and we obtain negative margins on most patients with EPE. Even patients with node positive disease have about a 30% progression free survival with long term follow up after RP/LND. It's a great treatment, even with high risk disease.

Many urologists will feel less comfortable operating on patients with very high PSA, but that is not due to concerns about local control, but rather a high likelihood of distant metastatic disease.

One more point -- this is a very rare scenario. Most patients with prostate cancer present with very low-intermediate risk disease and are excellent candidates for AS, RP, or XRT. I offer all new patients referral to rad onc, but I am pretty well versed in XRT outcomes and side effects and can have a discussion about the options. IMO, the best candidates for primary XRT are older patients and poor surgical candidates with higher risk disease who are not candidates for AS, but it's obviously an option for any patients with localized disease.

It's pretty clear that you guys are experts in radiation, not prostate cancer. I don't blame you, as that is the nature of your training and you have to treat patients with the full gamut of cancers. The idea of rad onc being the point of contact for new prostate cancer patients is honestly pretty horrifying though.

You really should check out this website:

www.nccn.org

I know you probably didn't hear about NCCN during your training but you're breaking the Hippocratic oath and possibly committing negligent homicide the way you're practicing.

 

[RadOncDoc21]

It's pretty clear that you guys are experts in radiation, not prostate cancer.

You know we're Radiation ONCOLOGISTS right? That means we specialize in treating cancer. A urologist can take a prostate out (usually with positive margins) but doesn't make you an Oncologist.

 

[medgator]

The incredibly embarrassing part is this guy actually believes this.


Urologists don't come close to knowing the Prostate data (surgery, ADT, chemo, radiation all included) as well as a well-trained Rad Onc

Of course they don't. The RTOG has created more quality/randomized data in prostate cancer than any urology cooperative group afaik

 

[thecarbonionangle]

Yes of course.

These high risk patients are unlikely to be cured by radiation alone either. If you are spinning it as RP vs definitive therapy, you are just as unethical as the urologists you criticize. There is increasing evidence that multimodal therapy is the most beneficial for these patients, and that is part of the discussion I have with the patient. Certainly very high risk patients go into an RP with me expecting they will require radiation and ADT at some point postoperatively. A RP will certainly be more difficult and higher risk and may be impossible after XRT. It should be something the patient considers.

I think some of you are seriously misunderstanding the nomograms and/or what an RP is. High risk of EPE and/or SVI does not mean guaranteed positive margins or impossible surgical cure. The SV's are resected with the prostate during RP and we obtain negative margins on most patients with EPE. Even patients with node positive disease have about a 30% progression free survival with long term follow up after RP/LND. It's a great treatment, even with high risk disease.

Many urologists will feel less comfortable operating on patients with very high PSA, but that is not due to concerns about local control, but rather a high likelihood of distant metastatic disease.

One more point -- this is a very rare scenario. Most patients with prostate cancer present with very low-intermediate risk disease and are excellent candidates for AS, RP, or XRT. I offer all new patients referral to rad onc, but I am pretty well versed in XRT outcomes and side effects and can have a discussion about the options. IMO, the best candidates for primary XRT are older patients and poor surgical candidates with higher risk disease who are not candidates for AS, but it's obviously an option for any patients with localized disease.

It's pretty clear that you guys are experts in radiation, not prostate cancer. I don't blame you, as that is the nature of your training and you have to treat patients with the full gamut of cancers. The idea of rad onc being the point of contact for new prostate cancer patients is honestly pretty horrifying though.

Wow brotha! that is quite a response, mate. Such as "well versed" individual in the topic of prostate cancer, as yourself, should be familiar with the data others have posted, and NCCN guidelines. You come here to correct our "misunderstanding", but made some very questionable dodgy statements which do not stand up to the data. You do realize it takes 5 years to become a radiation ONCOLOGIST, right? we aren't "radiation doctors" or monkeys. This means we take oral and clinical boards in ONCOLOGY. In fact, we have more ONCOLOGY training than medical oncologists. you know, the so called, "cancer doctors". Are they experts of chemotherapy and not oncology?

I'ts pretty clear that you are an expert in cutting. The prostate has cancer. I must take out prostate. Take prostate out. bad thing out. I don't blame you, as it is the nature of your training. The idea of urology being the point of contact for new prostate cancer patients is honestly pretty horrifying though.....if your view represents the general understanding of prostate cancer in your specialty. It will behoove you and your patients for you to really get educated. Otherwise you are going truly hurt some people.

P.s. what are your thoughts on wearing a toupee?

 

[seper]

One guy from my medschool class, who became a urologist, was making some $ by reselling stethoscopes to his classmates.

 

[medgator]

http://ascopubs.org/doi/abs/10.1200/JCO.2017.74.0720

http://ascopubs.org/doi/full/10.1200/JCO.2017.76.5479

The use of proton therapy has been a topic of debate for years. In the article that accompanies this editorial, Liao and colleagues1 report the first randomized study to assess the value of proton therapy compared with photon intensity-modulated radiotherapy (IMRT) in non–small-cell lung cancer (NSCLC). Completion of this study is not trivial because the evaluation of the benefit of a new technology rarely has been done during the century-long history of radiation oncology practice.

Personally, as a radiation oncologist, I would not recommend proton therapy for NSCLC outside a clinical trial setting until a clinical benefit is demonstrated in a prospective randomized study.

Is there a future for proton therapy? The results from Liao and colleagues1 suggest a dismal future in locally advanced NSCLC because the PSPT arm with significantly less lung volume receiving lower doses as well as significantly better dosimetry to the heart and esophagus did not lead to less lung toxicity or better survival (numerically higher rates of lung toxicity and shorter median survival instead). Although negative results from a phase II study in NSCLC cannot exclude the potential benefit of proton therapy in other clinical situations, such as for pediatric patients, and the cost of proton therapy will be significantly reduced by newer technological changes, this trial should at least cause some pause in hospitals that are building these facilities for competitive reasons and not for cost-effectiveness reasons. We should also learn from the experience of the Scripps Proton Therapy Center in San Diego, California, a center that cost $165 million that started operations in 2011 and then filed for bankruptcy on March 1, 2017.