Prostate Cancer   

Is prior Ra-223 a contraindication for treatment? 

Patient has ED unresponsive to cialis/viagra; would you recommend testosterone replacement therapy?

Do you have a preference for bicalutamide? Can abiraterone be used instead?  

At what PSA would you become suspicious for biochemical recurrence and pursue restaging? Is there a threshold value? What imaging modality would you ...

Would you use it for initial staging or at time of biochemical recurrence?

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...

The trial inclusion criteria was essentially "docetaxel candidate per the treating oncologist"

Is there a concern regarding rarer side effect emergence (cardiac, bone, muscle, cognitive) of long term exposure to "maximal" androgen deprivation? I...

When do you order PSMA PET? Will you preferably order Locametz (gallium Ga 68 gozetotide) PET? 

Would you consider boosting the nodes?  What dose?  Would this change your recommendation for length of ADT?  

Would you consider chemotherapy, androgen blockade or triple therapy (chemo and AR targeting)?

Would the results of PEACE-1 trial justify this?

Are there clinical features (post-op PSA, Decipher score, pN+, pT3, etc) that would inform your decision?

Do you worry about false negatives on PET, CT, MRI if ADT is started before the scan? Scheduling scans can sometimes book 2-4 weeks out. 

Would you treat with PARP inhibitor or Check-Point Inhibitor?

Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as ca...

PSA rose from 25 to 30 ng/mL over 6 months on darolutamide for M0 CRPC, prompting scans which showed oligometastatic disease to bone, not amenable to ...

Or would you restrict such treatment to patients with known pathogenic germline BRCA mutations?

Given ductal histology, is docetaxel preferred over NHT?

Are there other high or very high risk features that would also contribute to your decision making?

GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease.  Prostate MRI pending. 

Patient previously had prostatectomy and salvage RT

Would you recommend surgery first or neoadjuvant therapy such as concurrent cisplatin/RT or another regimen?

Did you change your practice given the SRE results in the control arm of EORTC 1333 at ASCO 2021? When using bisphosphonates or denosumab, what dosin...

Do prior treatments for mHSPC change your thinking on whether or not to use sipuleucel-T?

No targetable mutations detected

In addition to ADT, would you treat with abiraterone, enzalutamide or docetaxel? Or other treatment - platinum/taxane?

Gleason 4+3=7 and PSA 4

Are there other adverse features aside from seminal vesicle invasion, positive margins, or extraprostatic extension that you consider?

Does post docetaxel PSA influence your decision?

Specifically, would you offer salvage radiation to a patient who underwent a prostatectomy with PLND and had a post-op PSA of 12 with pathology reveal...

What line would you give pembrolizumab?

Would you add abiraterone or enzalutamide?

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

What clinical scenario(s) do you find results to be the most beneficial?

Does the specimen (blood vs tissue) used to detect mutation affect your consideration?

Are there particular populations in whom you would add an AR targeted agent after docetaxel?

Assuming patient received appropriate local therapy for brain metastases, which agent would you use?

HERO study - https://clinicaltrials.gov/ct2/show/NCT03085095

Given that ADT + abiraterone and ADT + docetaxel have not been directly compared.

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? 

Assuming patient is not a surgical candidate and wishes to pursue definitive radiotherapy, what duration of ADT would you give?

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...

Do you offer EPO and TPO support? Do you modify your systemic therapy up front or after subsequent cycles?

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...

In this case, Gleason 5+5 in all cores, clinical T4.

How long would you continue androgen deprivation after radiation? 

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

Per the ALSYMPCA study, they excluded patients with > 3cm lymphadenopathy. Patient is currently on enzalutamide and leuprolide and refuses docetaxe...

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...

Assuming there was an initial period of response to the mCRPC treatment.

Or would you proceed with cabazitaxel or other therapy? Initial chemo-hormonal therapy was ADT + Docetaxel x6 cycles. Docetaxel rechallenge at time o...

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...

Should it be started at the initial diagnosis of bone mets?

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...

If yes, what factors push you to test for AR-V7 or would you test all patients in this clinical scenario?

Would you initiate abiraterone or enzalutamide for the rising PSA or wait until the patient is symptomatic or has a new site of metastasis?

In patients with new bone pain and without any evidence of bone metastases receiving GnRH agonists, how do you manage pain symptoms?

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...

Do other factors (i.e. Gleason score, pretreatment PSA, or pT stage) affect your decision? 

Given recent advancements in the understanding of biological differences in prostate cancer patients of African vs. other ancestry, does your manageme...

Are there specific subsets for whom these results should change management?

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...

What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...