SIU 2017: Routine Use of Adjuvant Radiation After Radical Prostatectomy for Positive Surgical Margin: Not for All!

Lisbon, Portugal (  Dr. Dall’era gave a very interesting talk elaborating why not all patients with positive surgical margins (PSM) after radical prostatectomy (RP) should receive adjuvant radiation therapy. He began his talk with several important arguments why adjuvant treatment is nor for all. First, not all men with PSM recur, not all PSM are the same, early salvage may be just as good, significant cost of adjuvant radiotherapy, and the argument that novel imaging and biomarkers will help identify men at risk, who should be treated.

SIU 2017:Use of Radiation for Positive Surgical Margins in Prostate Cancer – argument for adjuvant radiotherapy

Lisbon, Portugal ( Dr. Briganti presented his support for adjuvant radiation therapy for patients with positive surgical margins (PSM) after radical prostatectomy. He began his interesting discussion by pointing out the difficult choice surgeons must face between adjuvant radiotherapy and salvage radiotherapy, for patients after radical prostatectomy exhibiting adverse pathology.

SIU 2017: Prostate-Specific Membrane Antigen-Radioguided Surgery for Metastatic Lymph Nodes in Prostate Cancer

Lisbon, Portugal ( In this session, there were three well-respected Urologic Oncologists who were asked to talk about the single most important observation in the recent past. Each chose the area that they felt represented the most exciting discovery.

In this first Major Observation, Dr. Graefen discussed the role of PSMA (Prostate specific membrane antigen) guided surgery for metastatic lymph nodes in prostate cancer.

SIU 2017: Oligometastatic Bone Disease in Prostate Cancer Patients Treated on the TROG 03.04 RADAR Trial

Lisbon, Portugal ( In this session, there were three well-respected Urologic Oncologists who were asked to talk about the single most important observation in the recent past. Each chose the area that they felt represented the most exciting discovery. 

In this second Major Observation, Dr. Egawa discussed a paper by Sridharan et al, which focused on prostate cancer oligometastatic disease treated with radiotherapy as part of the TROG 03.04 RADAR study. In this study, patients with pT2aN0M0 intermediate localized disease OR pT2-4 any grade or PSA treated with radiotherapy. They randomized 2273 patients, and PCSM was the primary endpoint. There were 4 arms to the trial – two arms received ADT alone prior to RT, while 2 arms received ADT/Zoledronic acid. Two of the arms received no adjuvant therapy, while 1 arm received 12 months ADT and 1 arm received 12 months ADT/zoledronic acid.

SIU 2017: Artificial Intelligence (AI) Can More Efficiently Predict Prostate Cancer Compared with PSADT and PSAD

Lisbon, Portugal ( As all Urologists know, patients with fluctuating PSA’s can be very difficult to manage. Often times, there are preconceived notions of risk that influence our decision to biopsy, obtain genomic testing, or intervene. However, as with any other human based decision, inter operator variability is high – the same patient presented to two different urologists may result in different outcomes, as much as we would like to think guidelines should reduce variability.

SIU 2017: Management of Prostate Cancer in Men more than 80 Years of Age: Under or Over Treatment?

Lisbon, Portugal ( As the population ages, we are forced to address cancer in patients at much older ages than previously. While guidelines for prostate cancer suggest stopping screening at age 70-75, as patients’ life expectancy increases, we are finding and managing more men with prostate cancer over the age of 80. But, how do these men fare?

SIU 2017: Different Incidence of Prostate Cancer According to Metabolic Health Status: A Nationwide Cohort Study

Lisbon, Portugal ( While many prior papers have looked at the effect of obesity and BMI with prostate cancer incidence and prognosis, within the field of metabolic health, there is now an understanding that patients with normal weight can still have metabolic syndrome. These patients with “metabolically obese, normal weight” have a high visceral/subcutaneous fat ratio and other metabolic derangements associated with metabolic syndrome. Recent studies have also demonstrated that in Asian patients, diabetes and heart disease may be more prevalent even in the absence of obesity.

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