Would you skip adjuvant RT in post prostatectomy patients?
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 patients would you still consider adjuvant RT?
Answer from: Radiation Oncologist at Academic Institution
I suspect that once the paper is published and we get a chance to review the data that we may begin to hold off on routine use of adjuvant RT for prostate cancer patients after radical prostatectomy with higher risk features. That said, it should be noted that the study did randomize to early salvag...
Comments
Radiation Oncologist at Virginia Commonwealth University Medical Center I agree with Dr. Sandler. We'll need to see the pa...
Radiation Oncologist at Cleveland Clinic Dr. Sandler makes an important point - while adjuv...
Radiation Oncologist at University of Miami Miller School of Medicine I agree with Dr. Sandler as well.
I am very...
Answer from: Radiation Oncologist at Community Practice
I have always leaned to early salvage RT, as opposed to direct post-op RT, because prostate bed RT is not always such a "benign" undertaking, and so I like to be convinced that it is absolutely necessary. This study does not change that opinion. That said, I do continue to be amazed at how frequentl...
Answer from: Radiation Oncologist at Academic Institution
Would just like to add in that RAVES presented at ASTRO 2019 had more classical, at least for US Rad Oncs, inclusion criteria and showed essentially the same findings as RADICALS: Early salvage, without ADT, seems equivalent to adjuvant. Others above have mentioned the caveats on actually doing 'ear...
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Radiation Oncologist at Varian Medical Systems/Allegheny health network Need to be careful with intervening at ultra sensi...
Radiation Oncologist at Vanderbilt-Ingram Cancer Center Agree and I would exercise caution with people who...
Answer from: Radiation Oncologist at Academic Institution
As many have pointed out one problem with Radicals-RT is the patient population they enrolled.
"Patients with post-op PSA≤0.2ng/ml and ≥1 risk factor (pT3/4, Gleason 7-10, positive margins or pre-op PSA≥10ng/ml) were randomized"
Who was going to expect benefit from adjuvant RT in a patien...
Answer from: Radiation Oncologist at Academic Institution
I agree with Dr. Sandler as well.
I am very interested to see the breakdown by Gleason score and further details in the manuscript of the Radicals trial. From the presentation, only 17%/16 % of pts had Gleason 8 or greater disease and >50% had 6 or 3+4=7. With a median f/u of...
Comments
Radiation Oncologist at Radiation Oncology Associates What this data doesn't prove is whether or not the...
Radiation Oncologist at University of Miami Miller School of Medicine I agree completely. It was meant to highligh...
Answer from: Radiation Oncologist at Community Practice
A non-rising low level PSA following radical prostatectomy may indicate surgical sparing of a portion of the seminal vesicles and thus would not benefit from radiation.
I agree with Dr. Sandler. We'll need to see the pa...
Dr. Sandler makes an important point - while adjuv...
I agree with Dr. Sandler as well. I am very...