BackTable / Urology / Podcast / Episode #41

Radiotherapy for Unfavorable Intermediate Prostate Cancer

with Dr. Neil Desai

Dr. Neil Desai, a radiation oncologist with UT Southwestern, shares his perspectives on radiation therapy indications, algorithms, side effects, and prognoses for unfavorable intermediate risk prostate cancer patients.

Sponsored by:

Laurel Road for Doctors
Radiotherapy for Unfavorable Intermediate Prostate Cancer with Dr. Neil Desai on the BackTable Urology Podcast)
Ep 41 Radiotherapy for Unfavorable Intermediate Prostate Cancer with Dr. Neil Desai
00:00 / 01:04

BackTable, LLC (Producer). (2022, June 1). Ep. 41 – Radiotherapy for Unfavorable Intermediate Prostate Cancer [Audio podcast]. Retrieved from https://www.backtable.com

Earn CME

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs.
Follow the button below to get started with CMEfy.

BackTable CMEfy button

Stay Up To Date

Follow:

Subscribe:

Sign Up:

Podcast Contributors

Dr. Neil Desai discusses Radiotherapy for Unfavorable Intermediate Prostate Cancer on the BackTable 41 Podcast

Dr. Neil Desai

Dr. Neil Desai is a radiation oncologist with UT Southwestern in Dallas, Texas.

Dr. Aditya Bagrodia discusses Radiotherapy for Unfavorable Intermediate Prostate Cancer on the BackTable 41 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.

Show Notes

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. Neil Desai, a radiation oncologist from UT Southwestern, about radiation therapy indications, algorithms, side effects, and prognoses for unfavorable intermediate risk prostate cancer patients.

Intermediate risk prostate cancer is defined by a Gleason grading score of 7 or more and a PSA level above 10 ng/mL but below 20 ng/mL. Radiation therapy is a common unimodal or multimodal therapy in these prostate cancer patients. Dr. Desi recommends additional imaging via MRI to stage the cancer before starting treatment. Additionally, bone scans and colonoscopies may be beneficial in order to find metastases and colon cancer, respectively, that can also be treated with radiation therapy (RT).

A thorough patient history is important to obtain before choosing a radiation therapy option. Dr. Desai divides his history into 2 different categories-–patient-specific factors and disease-specific factors. For patient-specific factors, baseline urinary symptoms, metabolic disorders, hormonal disorders, patient preferences, and baseline sexual potency are important. Contraindications under this category include connective tissue disorders, ulcerative colitis, and Crohn’s disease. Prostate anatomy, such as large median lobes, also need to be assessed. Dr. Desai emphasizes that many of these contraindications do not totally rule out the possibility of radiation therapy, but just warrant careful consideration of the intensity of radiation used on the patient. Next, he discusses disease-specific factors, such as the efficacy of androgen deprivation therapy (ADT). The majority of prostate cancer patients are started on ADT for 4-6 months first, and then begin RT. Dr. Desai notes that delayed castration resolution times are possible in older patients, so a baseline testosterone level must be started before ADT has begun in order to assess its efficacy. Also, he allows his patients to start on ADT for one month before RT to give them an opportunity to adapt to the side effects of one therapy at a time. Then, he and Dr. Bagrodia discuss the exciting new field of second-generation ADT.

Next, Dr. Desai summarizes his explanation of RT to his patients. He starts by delineating the differences between internal and external RT, which exist on a continuum. Based on which RT option the patient chooses, the acuity and duration of lower urinary tract symptoms (LUTS) will vary. The RT option he most commonly recommends to patients without contraindications is brachytherapy with an external beam, which results in less cancer recurrence but more LUTS. However, he acknowledges that brachytherapy may not be offered in all centers, may have reduced efficacy in big prostates, and may be an unfavorable choice in patients with severe LUTS. In these cases, conventional fractionation, hypofractionation, or ultra hypofractionation are better options. Furthermore, Dr. Desai dives into more technical aspects of RT, such as the importance of a full bladder as a form of protection from external beam RT and the superiority of photon-based RT over proton-based RT. Additionally, he recommends measuring PSA levels after 3 months post-RT to minimize the chance of picking up noise. He mentions that physicians should address the “PSA bounce”, a fluctuation of PSA level post-RT followed by a transient resolve, with their RT patients because it may be a source of patient anxiety.

Finally, Dr. Desai highlights the importance of the collaboration between urologists and radiation oncologists. The patient should be made aware that both specialties are in communication and feel comfortable discussing treatment options with both sides. Dr. Desai will usually advise his patients to meet with their urologists before making a final decision on their radiation therapy. Also, it is important for both sides to coordinate any new tests and check in periodically with patients.

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.

Earn CME When You Listen to BackTable CMEfy

Up Next

Practical PSA Screening for PCPs and Urologists with Dr. Scott Eggener on the BackTable Urology Podcast)
Diagnosis and Management of Upper Tract Urothelial Carcinoma with Dr. Shahrokh Shariat on the BackTable Urology Podcast)
Management of Penile Cancer with Dr. Philippe Spiess on the BackTable Urology Podcast)
Holistic & Integrative Approaches to Prostate Cancer with Dr. Geo Espinosa on the BackTable Urology Podcast)
Management of Localized Prostate Cancer with Dr. Jeff Cadeddu on the BackTable Urology Podcast)
Minimally Invasive Focal Therapy for Prostate Cancer with Dr. Amit Patel and Dr. Ranko Miocinovic on the BackTable Urology Podcast)

Articles

Topics

Get in touch!

We want to hear from you. Let us know if you’re interested in partnering with BackTable as a Podcast guest, a sponsor, or as a member of the BackTable Team.

Select which show(s) you would like to subscribe to:

Thanks! Message sent.