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Jun 5
We have reviewed ASTRO’s commentary on the PROTEUS trial and believe that it offers a largely one-sided interpretation of the data.
In several points, the commentary appears to misunderstand key methodological considerations and then they mischaracterize the study’s objectives, design, and findings.
To help readers recognized the value of PROTEUS for themselves, we will examine and respond to each of the main arguments presented in the commentary, point by point.
@declangmurphy @brookmans76 @piet_ost @seanmmcbride @TylerSbrt
@UrologyTimes @Uroweb @NEJM @EUplatinum
Jun 3
The #PROTEUS trial contributes important knowledge to the evolving evidence on high-risk #prostatecancer treatment options. ASTRO’s new summary document from @NehaVapiwala and @AmarUKishan is a member resource for discussions with your #multidisciplinary colleagues and patients.
ow.ly/2nBj50Z7kZj
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I think you are not correct
The available data, the TACT trial, did provide short-term disease control data, including PSA outcomes and 12-month biopsy results, as well as the adverse event reporting for TULSA.
What remains lacking are long-term oncologic outcomes and direct comparative studies with established treatment options.
Therefore, this is not appropriate when saying that there are no available data to backed this option, it would say that the available data are not yet sufficient.
pubmed.ncbi.nlm.nih.gov/3302…
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To stent or not to stent after uncomplicated URS: this is the question @wjurol
No stent:
37–45% less pain
55–82% less analgesia
65% less dysuria
81% less urgency
57% less hematuria
Equivalent SFR, complications & readmissions
link.springer.com/article/10…
What else to go no stent?
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Jun 14
What else?
To stent or not to stent… dilemma solved!
To stent or not to stent after uncomplicated URS: this is the question @wjurol
No stent:
37–45% less pain
55–82% less analgesia
65% less dysuria
81% less urgency
57% less hematuria
Equivalent SFR, complications & readmissions
link.springer.com/article/10…
What else to go no stent?
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What's a good solution to when academics blatantly lie to the public?
It's a major problem that I've never seen a *real* solution to.
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UK is a police state
Jun 15
JUST IN: UK Government clarifies adults will still be able to use social media by verifying their identities with digital IDs, facial recognition, passports and credit cards.
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**Verified.** The provocative claim ("devised in 1967 to predict 6-month survival among 18 deaths") is not supported by primary sources and appears overstated or mischaracterized.
Gleason's original 1966 system (Cancer Chemother Rep) identified 5 architectural patterns from a study of **~270 patients** at Minneapolis VA Hospital and correlated them with prognosis/survival. It was not based on a tiny set of 18 deaths.
The key 1974 J Urol paper (Gleason & Mellinger) expanded validation with a much larger cohort. Broader VACURG data reached thousands of cases.
Your correction is substantially accurate. The system was always about prognostic architectural patterns combined scoring, not a narrow short-term mortality count.
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This information is not entirely correct.
The Gleason scoring system was not originally developed survival outcome based on only 18 deaths.
In fact, in 1967, Gleason examined ~ 200 histological slides to identify 5 architectural patterns based on glandular structure, and subsequently correlated these patterns with short-term survival data to demonstrate their prognostic value.
Later, in 1974, this system underwent further validation and was expanded to include approximately 4,000 cases, providing additional evidence for its reliability and clinical utility.
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Provocative presentation by @VickersBiostats @UrologyMSK about #prostatecancer grading vs scoring. Past Present and Future. Gleason score was originally devised in 1967 to predict 6 month survival among 18 deaths! The ProQuant collaboration!
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Jun 15
⚡️ The FDA has approved adjuvant belzutifan pembrolizumab for clear cell RCC at intermediate-high risk of recurrence after nephrectomy.
LITESPARK-022 data: HR 0.72 (95% CI 0.59–0.87; p=0.0003) in DFS vs pembrolizumab alone. Median DFS not reached in either arm.
A meaningful step forward in a setting where we needed better options.
cancernetwork.com/view/fda-a…
#KidneyCancer
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Jun 13
“It (Phoenix criteria) was tuned to predict PCSM”
That’s a common misunderstand about Phoenix criteria among some RadioOnco.
The truth is Phoenix criteria was never tuned to serve as a surrogate endpoint for any long-term clinical outcomes, including PCSM.
Moreover, It is not validation as a surrogate endpoint following to rigorous standards (the high R² trial-level of ICECaP), ask @ChrisSweens1 to confirm.
Rather, Phoenix criteria was introduced to address major shortcomings of the original ASTRO definition of biochemical failure, particularly the high false positive rate (PSA bounce) and the problem of backdating, which distorted KM estimates and difference in reporting across studies.
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Jun 15
Does a smaller resectoscope change urethral stricture risk after prostate resection? A new study says yes — and it's a good case study in how to read evidence carefully. link.springer.com/article/10…
THE FINDING
First direct comparison of 22 versus 26 French continuous-flow sheaths in transurethral prostate resection. Strictures: 3.7% with the smaller sheath, 15.2% with the larger one. The smaller instrument also needed far less meatal dilation (15% versus 60%).
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Love this trial.
🤔Qs
1️⃣ If willing to accept 10% non-inf margin, could we just not biopsy the PI-RADS 2? Only 10-12% had csPCa on biopsy. Most of those not immediately threatening
@NikiSushentsev @LondonProstate1 @DrSpratticus @wandering_gu @mleapman
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Jun 10
Thrilled to share #PRIMARY2 Trial Results. This is the first randomised trial to show that adding [⁶⁸Ga]Ga-PSMA-11 PET-CT to MRI can safely halve the number of men needing a prostate biopsy.
Hot off the press in @TheLancetOncol 🎉
In 660 men across Australian sites with PI-RADS 2-3 but high clinical risk, PSMA-PET:
- Avoided biopsy in nearly half (49%)
- Was non-inferior for detecting clinically significant cancer (12% vs 16%)
- Halved the overdiagnosis of insignificant cancer (32% to 14%)
Fewer biopsies, less overdiagnosis, whilst not missing clinically significant prostate cancer: a real step forward for the diagnostic pathway.
Enormous congratulations to @ButeauJames @PeterMacCC , who led this as the centrepiece of his PhD and presented it as a plenary at #EAU26 in London. And to my brilliant co-lead @drlouiseemmett - this was a true partnership across our two centres.
Thank you to the UROLOGISTS @DrDanielMoon @declangmurphy (& many others), nuclear medicine physicians, technologists, radiopharmaceutical scientists across every site, and to @AnnetteVDHeyden and the @pros_tic who held it all together.
We are grateful to our funders: @PCF_Science, @nhmrc, St Vincent's Curran Foundation, Peter MacCallum Cancer Foundation, and @ANZUPtrials
Most of all, thank you to the 660 men who took part.
Open Access article: thelancet.com/journals/lanon…
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Jun 14
In the strategy combining MRI and PSMA PET/CT, the key issue is not merely the number of biopsies avoided, but the trade-off underlying that decision.
PRIMARY 2 was designed as a non-inferiority trial and, from its settling, the adding PSMA PET/CT in a high risk patients with PIRAD 2-3, aimed at avoiding biopsies could detect fewer cases csPCa, less than 10%, a prespecific non-inferirority margin.
That’s the trade-off in PRIMARY2 setting.
And in a population (high risk PIRAD 2-3) with a relatively low prevalence of csPCa, a 10% non-inferiority margin may be perceived as a substantial concession in cancer detection.
I also agree with @DrSpratticus perspective that these findings should be viewed as preliminary. Given the absence of long term oncologic outcomes, caution is warranted before broadly implementing this strategy into routine clinical practice.
In @DrSpratticus editorial accompanying the PRIMARY2, there is a very effective metaphor that prompts us to pause before claiming that these data can already be considered a paradigm shift. A longer follow-up is needed for patients managed through the PSMA PET–based path. #radonc
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In @DrSpratticus editorial accompanying the PRIMARY2, there is a very effective metaphor that prompts us to pause before claiming that these data can already be considered a paradigm shift. A longer follow-up is needed for patients managed through the PSMA PET–based path. #radonc
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For most of its history western philosophy was dominated by metaphysics, the attempt to know the necessary features of the world simply by thinking. | iai.tv/articles/the-return-o…
Then came Kant, who showed that reason alone can’t gain knowledge of the world without the help of experience.
Hegel’s philosophy is seen by many as ignoring the lessons of Kant’s critique of metaphysics and regressing to a pre-Kantian style of philosophy. But a more careful reading of Hegel shows that he was not in fact ignoring Kant’s lesson, but following his argument: even if pure reason can’t know the world, it can know itself.
And in discovering the nature of thought, Hegel argued, one also discovers the nature of anything that can be thought, that is, reality. Thus, writes Robert Pippin, Hegel was able to change the fate of metaphysics.
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A bit rough around the edges, but it effectively conveys the importance of the PRIMARY2 study in press on #radonc @TheLancetOncol @NotebookLM
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Jun 14
“No great discovery was ever made without a bold guess.”
― Isaac Newton
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Jun 13
Now that adjuvant pembro plus Belzutifan is approved by @usfda
How will you decide who needs 1 drug vs 2 drugs in adjuvant RCC
pT3 NO clear cell RCC , Fit pt .
What will you u give in adjuvant .
Do vote below and opine 🙂 @OncBrothers @yekeduz_emre @dr_yakupergun @DrChoueiri
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Pembro Belzutifan
44%
Pembrolizumab alone
12%
Observation
6%
I don't know
34 votes • Final results
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Jun 13
What does RT look like in 10 years? What an inspiring talk @Xristodouleas @iartistanbul
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Jun 13
On this day 150 years ago William Sealy Gosset was born. He spent his whole career as a brewer at Guinness, working on a problem the textbooks ignored: how to draw conclusions from tiny samples, like four plots of barley or a handful of hops. The statistics of the day assumed large samples so Gosset invented the statistics of small ones.
Guinness barred its employees from publishing after one of them leaked trade secrets, and did not want competitors knowing it used science to brew beer so when Gosset published his method in 1908 he signed it with a pseudonym: Student.
Every clinical trial, lab experiment and A/B test that runs a t-test today is using the work of Student. The most famous name in statistics is a fake one.
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