Rationale for timing of adjuvant RT after surgery: breast and prostate
I'm seeing someone, Gleason 4+5=9, pre-tx PSA 8, pT3bN1, 9 months after radical prostatectomy whose post-op PSMA PET showed residual uptake in the pelvic nodes, no distant disease. He was started on ADT + zytiga and due to multiple issues (continence, logistical hurdles, etc) I'm only seeing him now. PSA is now undetectable.
So I understand that in breast and prostate, we typically have thresholds (which may vary between provider) for when we would consider adjuvant radiation. For breast, I...
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Source: Student Doctor Network - February 28, 2024 Category: Universities & Medical Training Authors: RadOncBeamer Tags: Radiation Oncology Source Type: forums
Lymphadenectomy in high-risk prostate cancer
Hey! I am asking for a friend here. He is planning a trial and would like to have some feedback on worldwide practice.
In your experience, do urologists perform lymphadenectomy in high-risk cN0 prostate cancer (provided the high-risk cancer was known before surgery - based on GS, PSA, cT3) when performing radical prostatectomy as primary treatment.
Thank you! (Source: Student Doctor Network)
Source: Student Doctor Network - October 16, 2022 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums
Salvage RT Prostate with Intestine In the Way
Had a young patient (56 yo) who had prostatectomy last year for Gleason 3+4 with low PSA in early ‘21. He had positive margin at the right base on path and had SVI bilaterally. PSA was negative after surgery for 5 measurements then rose to detectable but still low at .05 then .06 a couple months later. He had a PSMA which was negative and was referred to talk about early salvage. Fairly anxious patient who very much wanted RT. Urology sent him to a med onc too, bc of such low PSA they opted...
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Source: Student Doctor Network - July 20, 2022 Category: Universities & Medical Training Authors: Haybrant Tags: Radiation Oncology Source Type: forums
Lutetium Psma localized prostate cance
Anyone know the status of trials for lutetium Psma in localized prostate cancer either alone or neoadjuvant to surgery. Could really transform the specialty if it pans out. How about lutetium vs as?
Lutetium-PSMA Appears Safe in Locally Advanced High-Risk Prostate Cancer
Treatment with neoadjuvant lutetium prostate-specific membrane antigen followed by radical prostatectomy exhibited a favorable safety profile in patients with locally advanced high-risk prostate cancer.
www.onclive.com (Source: Student Doctor Network)
Source: Student Doctor Network - June 22, 2022 Category: Universities & Medical Training Authors: RickyScott Tags: Radiation Oncology Source Type: forums
PSA bounce after SBRT for bone metastasis
Interesting case.
Patient with metastatic prostate cancer (several bone mets after prostatectomy and adjuvant RT).
He started ADT over 3 years ago and got up-front 6 cycles of Docetaxel. PSA dropped to around 1.5 ng/ml, remained stable for almost 2 years and rose this winter to 2.5 ng/ml.
Whole-body MRI showed a viable lesion in the spine, the rest of the lesions seemed stable. We had done yearly wbMRI, so it was rather easy to pick up.
I SBRTed the lesion and measured the PSA immediately...
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Source: Student Doctor Network - May 24, 2022 Category: Universities & Medical Training Authors: Palex80 Tags: Radiation Oncology Source Type: forums
Adjuvant pelvic RT after N+ prostatectomy
What's the best evidence supporting adding XRT to hormones, when positive node(s) were found in the prostatectomy specimens? Thanks (Source: Student Doctor Network)
Source: Student Doctor Network - December 19, 2021 Category: Universities & Medical Training Authors: seper Tags: Radiation Oncology Source Type: forums
psma or axumin pet insurance /evicore denials.
So I've struck out multiple times on appeals for Axumin PET's on post prostatectomy cases.
Evicore (via BCBS) telling me their policy is PSA must be > 1.0....even though NCCN guidelines now say do it for 0.5. I've had young guys with negative margin cases where I'm worried about small bony mets (PSA like 0.6) but I literally cannot look with modern imaging because I'm hamstrung.
This is crazy to think that the standard of care imaging is not covered by insurance....but here we are...
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Source: Student Doctor Network - April 27, 2021 Category: Universities & Medical Training Authors: BobbyHeenan Tags: Radiation Oncology Source Type: forums
nodal relapse 9y after RP and PORT for prostatic carcinoma
75 years old patient, with controlled diabetes and hypertension, very fit.
he underwent in 2009, a radical prostatectomy followed 30 fractions of adjuvant 3D conformal radiation therapy to the prostatic bed only.
in 2018: PSA rise to 2.16
2019: PSA 2.16
Pet PSMA showed a 7 mm LN at the level of L4-5 secondary lesion, with no recurrence in the tumor bed, neither in bone or other LNs.
He was put on decapeptyl + casodex.
please vote the poll (Source: Student Doctor Network)
Source: Student Doctor Network - January 22, 2020 Category: Universities & Medical Training Authors: Kroll2013 Tags: Radiation Oncology Source Type: forums
