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BackTable / Urology / Podcast / Episode #113

Radiotherapy for High Risk Prostate Cancer

with Dr. Daniel Spratt

This week on the BackTable Urology Podcast, Dr. Bagrodia talks with Dr. Daniel Spratt, professor and chairman of radiation oncology at Case Western University in Cleveland, about the workup and treatment of high risk prostate cancer.

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Radiotherapy for High Risk Prostate Cancer with Dr. Daniel Spratt on the BackTable Urology Podcast)
Ep 113 Radiotherapy for High Risk Prostate Cancer with Dr. Daniel Spratt
00:00 / 01:04

BackTable, LLC (Producer). (2023, August 23). Ep. 113 – Radiotherapy for High Risk Prostate Cancer [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Daniel Spratt discusses Radiotherapy for High Risk Prostate Cancer on the BackTable 113 Podcast

Dr. Daniel Spratt

Dr. Daniel Spratt is the chair of radiation oncology at University Hospitals (UH) Cleveland Medical Center Seidman Cancer Center and a professor with Case Western Reserve University in Cleveland, Ohio.

Dr. Aditya Bagrodia discusses Radiotherapy for High Risk Prostate Cancer on the BackTable 113 Podcast

Dr. Aditya Bagrodia

Dr. Aditya Bagrodia is an associate professor of urology and genitourinary oncology team leader at UC San Diego Health in California and adjunct professor of urology at UT Southwestern.

Synopsis

First, Dr. Spratt defines high risk prostate cancer and discusses how to evaluate non-specific PSMA PET findings. He notes the importance of standardized systems to avoid over-calling such findings and discusses the role of CT scans and MRI scans when necessary. Finally, the doctors emphasize the importance of synthesizing PSMA PET findings into their decision-making. Next, the doctors discuss the use of germline and genomic testing, specifically Decipher testing, to characterize the tumor. Germline testing can determine eligibility for neoadjuvant PARP inhibitor trials, and biomarkers have the potential to improve radiation therapy outcomes. Although they quickly summarize the NCCN guidelines, they also emphasize the importance of patient counseling to determine the right treatment plan.

Then, the doctors move on to discuss the different radiation treatments available for treating high-risk prostate cancer, such as conventional fractionation, brachytherapy, and ultrahypofractionated radiotherapy. They also explain the use of protons in treating high-risk prostate cancer, which is difficult because of the lack of high-level evidence and financial benefit when using protons compared to conventional radiation treatments.

Finally, they wrap up the episode by explaining the correlation between early PSA responses and the success of radiation therapy. Surgery and radiation are often used together in treating most cancers, and how combining both can cut down the chances of PSA recurrence.

Resources

Veracyte Decipher:
https://decipherbio.com/

Transcript Preview

[Dr. Aditya Bagrodia]
Today, we're going to round things out with high-risk prostate cancer. Absolutely a pleasure. I thought it might just be helpful to get some basic definitions in there. High-risk, very high-risk when patients are coming to you. Who are we talking about here?

[Dr. Daniel Spratt]
I would say defining high-risk is a little easier as a larger bucket. We're talking to high grades of Gleason 8 to 10, or Grade group 4 or 5, PSAs over 20. Now, it's probably more in the MRI realm, but clinical T3, rarely we see these T4 patients. I think the value of very high-risk, and the definition used in NCCN is highly debatable. That's from a retrospective study, I think out of Hopkins that I don't think has a lot of clinical implications, and most of the guidelines say you treat them the same. There's been some newer definitions. People call the STAMPEDE very high-risk, which is PSAs over 40, high-grade T3, having two or more of those features, which may have some actual clinical implications.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

High-Risk Prostate Cancer: Diagnosis & Treatment Strategies

High-Risk Prostate Cancer: Diagnosis & Treatment Strategies

Radiation Therapy for High-Risk Prostate Cancer: Which Modality is Best?

Radiation Therapy for High-Risk Prostate Cancer: Which Modality is Best?

Topics

Prostate Cancer Condition Overview
Radiation Therapy Procedure Prep
Learn about Urologic Oncology on BackTable Urology

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