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?

Would you offer adjuvant radiation? (Dose? Target?) vs Salvage? Would you add ADT? Would you add abiraterone? Would the number of lymph nodes involv...

If a patient is not a surgical candidate, what it the most appropriate treatment? 

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

How high would you try to boost those involved nodes if they are in a favorable location with respect to his rectum and small bowel? 

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. 

Per lutathera information, a patient who had previous treatment for describes an estimated radiation absorbed dose of 12.8 Gy to the bladder. Would yo...

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...

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...

Would you consider adding ADT? 

For the purpose of this question, please assume an initially undetectable post-prostatectomy PSA, no presence of positive margins, extracapsular exten...

Are there certain situations where a hydrogel spacer is most useful based on treatment modality (SBRT, protons, brachy, etc) or other factors?

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?

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...

Would you add abiraterone or enzalutamide?

If a patient who has undergone radical prostatectomy many years previously presents with biochemical failure and is found to have a nodule in the pros...

Would your management change if the prostate and lymph nodes were treated with radiation two years ago?

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

There is a recent publication that nicely summarizes the molecular/genetic tests for prostate cancer (https://www.ncbi.nlm.nih.gov/pubmed/26123120). W...

What dose constraint would you use for the neobladder? Small bowel constraint of 54Gy? Or would you recommend observation or ADT alone or low dose RT ...

How would a much higher risk cancer affect decision making? How would you treat him? 

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...

Will your recommendation change if there is suspicious/confirmed locally recurrent nodule in the prostate bed?

How long would you continue androgen deprivation after radiation? 

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...

Is there a benefit to one fractionation schedule v. the other?

Do we need to really worry about neutron contamination?

Abstract LBA5_PR ‘Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCA): survival results from S...

Is there a dose response relationship, as suggested in the phase I MSKCC dose escalation study presented at ASTRO 2017?

Based on the updated results of the PCS IV trial is 18 months of ADT the new standard of care for men with high-risk prostate cancer treated with...

Is there data to support this practice, which appears in the NCCN guidelines?

In the case of patients many years out from RP who have a slowly rising PSA, do you offer salvage RT while the PSA is still very low or follow the PSA...

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

With biopsy-proven, negative systemic restaging disease, what dose and fractionation is appropriate if treating with IMRT? Should ADT generally b...

Would you consider this an indication to treat lymph nodes, if you would typically not do so?

Is there an upper limit to offer definitive RT? Is it possible to have a PSA of 100-500 and still have only local disease?

Should the workup change with the PSA level (for example, >2 vs <2 ng/ml post-op PSA)?  Is there a PSA level for which salvage radiotherapy...

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...

If so, what criteria do you use to guide your decision?

In the recent 10 year update of the ARO (adjuvant pelvic RT versus observation) trial, their definition of PSA failure was 2 successive rise...

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

Would a specific Gleason score, age, pathological feature, or PSA be an indication for covering the pelvic nodes? Would giving concurrent ADT affect y...

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

Does PSADT play a factor in your decision-making? If so, how specifically?  I've tended to wait until the PSA is 10-15, re-image, and then begin...

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

In situations where there is a significant risk of either local or nodal persistence/recurrence post prostatectomy with a rising PSA, or nodal involve...

 In a patient with node positive disease, treated definitively with radiation, should continuous or intermittent ADT be administered? If a patien...

Guidelines dont seem to account for this possibility. Could it just be normal prostate tissue growing back that is leading to PSA, why just assume it ...

Do you offer RT if the patient is well controlled on medications?

In starting prostate SBRT at an instutution, what are issues with the treatment that one should pay special attention to?

On what other factors should be considered in making a treatment recommendation for salvage radiation therapy?

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

With ultra-sensitive PSA, it's unclear to me whether a doubling from 0.01 to 0.02 or 0.02 to 0.04 is significant. Is there a certain value that you wo...

If a patient is deemed high risk enough to require hormones with RT in the salvage setting, how long would you maintain them on ADT? Would you extrapo...

Would you favor only offering salvage therapy if the PSA rises?

When counseling patients with organ-confined prostate cancer, what rates of impotence, incontinence, rectal toxicity, and urethral stricture shou...

The optimal timing of post-prostatectomy RT in high-risk patients is debatable and currently the question of prospective randomized trials; however, g...

Fore example for a T3N0 rectal cancer on EUS?

In this case, the patient is currently on maintenance BCG.

If so, what selection criteria do you use for such patients?

Do you use a particular cut-off? For example, someone in their 40's?

If so, what dose?

The patient has a positive bone scan (2 lesions), grade 4+5=9/10 prostate, and cancer cannot urinate without a catheter.

 

More specifically, which cardiac risk factors do you look for? Diabetes? Previous MI? Dyslipidemia? Peripheral vascular disease? CHF?

In general how do you counsel patients with high risk prostate cancer when choosing radiation verse prostatectomy? What numbers do you quote for ...

This is a patient who would have been an appropriate candidate for radiation upfront, but was managed with androgen deprivation therapy instead. On th...

Sometimes the scans don’t line up well because of differences in rectal and bladder fullness- any tips to optimize the fusion?

I ask this because I am seeing more and more patients who have had surgery despite presenting with high risk disease.

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?

And should special precautions be taken (such as dose reduction, prophylactic symptom management, etc)?

Would you treat this as high risk?