Radiotherapy makes it into Medscape's Top 8 Clinical Trials of 2019

[SneakyBooger]

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[RadOncDoc21]

Damn urologists!

 

[Chartreuse Wombat]

The utilization of adjuvant RT was minimal prior to this report and will remain so. The sky is not falling.

 

[BruiservonWillebrand]

The utilization of adjuvant RT was minimal prior to this report and will remain so. The sky is not falling.

The sky is not falling in this particular indication. Active surveillance and 5 fraction treatments however...

 

[PhotonBomb]

The sky is not falling in this particular indication. Active surveillance and 5 fraction treatments however...

Both great for patients.

Credit to Urologists for taking the lead in active surveillance. Probably
The only oncologically sound thing they do

 

[BruiservonWillebrand]

Both great for patients.

Credit to Urologists for taking the lead in active surveillance. Probably
The only oncologically sound thing they do

I am not denying they are great for patients, they are "disruptors" as Chartreuse Wombat said in another thread.

 

[scarbrtj]

The utilization of adjuvant RT was minimal prior to this report and will remain so. The sky is not falling.

In the new 'The Irishman" movie, Joe Pesci tells a little girl "Why did God make the sky so high? So the little birdies wouldn't bump their heads!" Lots of little birdies bumping their heads 'round here nowadays...

 

[Neuronix]

Credit to Urologists for taking the lead in active surveillance. Probably the only oncologically sound thing they do

My experience has been that since the low risk disease is drying up there are more resections on high risk disease.

In the new 'The Irishman" movie, Joe Pesci tells a little girl "Why did God make the sky so high? So the little birdies wouldn't bump their heads!" Lots of little birdies bumping their heads 'round here nowadays...

 

[PhotonBomb]

In the new 'The Irishman" movie, Joe Pesci tells a little girl "Why did God make the sky so high? So the little birdies wouldn't bump their heads!" Lots of little birdies bumping their heads 'round here nowadays...

fantastic movie.

 

[scarbrtj]

View attachment 289615

Hey Boogs:
Radiotherapy makes it into Medscape's Top 8 Clinical Trials of 2019
Skipping Radiotherapy makes it into Medscape's Top 8 Clinical Trials of 2019

 

[seper]

what's the standard-of-care PSA level to trigger salvage RT?

 

[scarbrtj]

what's the standard-of-care PSA level to trigger salvage RT?

When it gets higher than the patient's hematocrit. #ImARealDoctor

 

[evilbooyaa]

what's the standard-of-care PSA level to trigger salvage RT?

0.1 for some, should be 0.2 as an absolute standard. Of course this is frequently not the case.

 

[medgator]

what's the standard-of-care PSA level to trigger salvage RT?

IIRC a level of 2 excludes people from trials so I would hope it should be lower than that

 

[DoctwoB]

what's the standard-of-care PSA level to trigger salvage RT?

0.5 is the traditional standard. 0.2 is the new gold standard. All studies say lower is better. In practice I’ll refer as soon as it’s detectable and confirmed unless I’m trying to wait out a very low level to allow for recovery from surgery e.g it’s 0.02 and rising slowly and the patient is 3 months post op. If there is a psa persistence after surgery I’ll make sure it’s rising to rule out benign prostatictissue and then refer.

This will all change within 5 years though. It will go biochemical recurrence—psma scan—XRT to pelvic nodes (30-40% of time), prostate fossa and pelvic nodes (10%) or SBRT to oligometastatic lesions (most of remainder). This is based on UCSF and UCLA data for patterns of recurrence on psma after surgery.

 

[PhotonBomb]

0.5 is the traditional standard. 0.2 is the new gold standard. All studies say lower is better. In practice I’ll refer as soon as it’s detectable and confirmed unless I’m trying to wait out a very low level to allow for recovery from surgery e.g it’s 0.02 and rising slowly and the patient is 3 months post op. If there is a psa persistence after surgery I’ll make sure it’s rising to rule out benign prostatictissue and then refer.

This will all change within 5 years though. It will go biochemical recurrence—psma scan—XRT to pelvic nodes (30-40% of time), prostate fossa and pelvic nodes (10%) or SBRT to oligometastatic lesions (most of remainder). This is based on UCSF and UCLA data for patterns of recurrence on psma after surgery.

nice. we need more urologists who are referring for the undetectable -->0.03 --> 0.05 --> 0..08s

where I trained they had all been educated as such and it was nice.

 

[Mandelin Rain]

I treat anything that was undetectable and is now detectable, or is persistently detectable after RP (even 0.03, or something similarly low) with any adjuvant indication.

If it's barely detectable and otherwise low risk, I may just wait it out to see if it rises.