Debating prostate radiotherapy for metastatic hormone-sensitive #ProstateCancer. @TylerSbrt7 @UCSanDiego joins @l_ballas @CedarsSinai outlining his approach to radiation therapy for the primary tumor in metastatic hormone-sensitive prostate cancer. He summarizes three randomized trials that consistently show a progression-free survival benefit, particularly in patients with low-volume metastatic disease. #WatchNow on UroToday > bit.ly/4t9XGaq @APCCC_Lugano #APCCC26

The approval answers one question, but leaves another unanswered: which patients truly derive enough benefit to justify escalation beyond optimized BCG? The FDA approval of durvalumab plus BCG in high-risk NMIBC was driven by a meaningful improvement in disease-free survival (HR 0.68), mainly recurrence free survival. Checkpoint inhibitors are not benign therapies, carrying ~ 15% risk of serious treatment-related adverse events. At the same time, this trial also demonstrated that patients with BCG-naïve high-risk NMIBC have low rates of progression and bladder cancer mortality, when treated with BCG appropriately. For many patients, the balance between reducing recurrence and exposing them to potentially significant toxicity is not straightforward. That raises a practical question: who should actually receive treatment intensification?

My favorite slide from exciting #AUA26 crossfire discussion so far by @TylerSbrt on M1a PCA. Beware of indirect evidence. We have been burnt before.

US nonprofit hospitals spent $7.8 billion on management consultants from 2009 to 2023, but contracts were not associated with meaningful changes in finance, operations, or quality of care. 🧵 ja.ma/4d46zfq