Now that Meridian went bankrupt, there no support for this machine and the FDA canceled this treatment. Are you guys using the new Electra MRI Linac guided SBRT?
In SBRT cases, where the post treatment trend of PSA tests suggests that the treatment has NOT been successful, is there a routine, so to speak, protocol for how most Rad Oncs proceed to deal with such cases from that point forward?
Generally speaking, what kind of PSA reduction do you typically expect from SBRT 3 months post treatment, as an early indicator that the treatment has or hasnt worked? i am assuming no hormone therapy was involved.
Excellent, as in the stand alone lecture I saw of Dr Kishan on SBRT. I particularly liked the extra detail about the procedural requirements for MR Linac such as claustrophobia and urgency over a relatively long time period, though it is difficult to know what is tolerable until one is actually in that situation. However it is a corrective to all the benefits touted for the new Linac to see the downsides that might be lost in the noise to inform each person's decision.
🎯 Key points for quick navigation: 00:00:18 *🩺 Dr. Kishan is a radiation oncologist specializing in SBRT for prostate cancer at UCLA.* 00:00:44 *📚 SBRT stands for Stereotactic Body Radiotherapy, an advanced treatment condensing radiation for prostate cancer into as few as five sessions.* 00:02:05 *🧲 A new MRI-guided radiation device, ViewRay Meridian, allows continuous real-time imaging for precise prostate targeting during treatment.* 00:03:52 *🖼️ MRI-guided radiotherapy offers real-time imaging, tracking prostate movement four times per second, turning off if misaligned.* 00:07:16 *⏳ MRI-based treatment takes longer (45 mins) compared to traditional CT-based methods due to real-time prostate tracking.* 00:10:06 *💡 MRI-guided radiation uses smaller safety margins, potentially leading to less bladder exposure and reduced toxicity.* 00:12:53 *⚖️ An early analysis showed promising lower toxicity rates for MRI-guided treatment compared to traditional methods, leading to adjustments in study size.* 00:15:31 *🌀 The MRI machine allows for adaptive radiotherapy, adjusting treatment plans if organs move unexpectedly during a session.* 00:18:14 *🚀 High-risk prostate cancer patients are being effectively treated with SBRT as a standard option, supported by promising international trial results.* 00:20:50 *📋 SBRT for high-risk prostate cancer is gaining acceptance, supported by the NCCN guidelines and improving insurance coverage.* 00:23:12 *🧬 Innovations like the genetic test Decipher are increasingly used in the personalized assessment of prostate tumors.* 23:52 *🔍 Genetic profiling has improved prostate cancer risk assessment, differentiating between similar Gleason scores.* 24:45 *📑 Decipher, a prognostic genetic test, is now part of NCCN guidelines and covered by Medicare.* 25:00 *💬 Decipher results influence hormone therapy duration discussions for high-risk prostate cancer.* 26:10 *🧪 Clinical trials are investigating whether patients with a high Decipher score benefit from additional medications.* 26:51 *📊 Recent studies show certain high-risk prostate cancer patients benefit from adding Zytiga to ADT.* 27:18 *📉 High Gleason scores, high PSA, or tumor growth beyond the prostate identify patients for intensified hormone therapy.* 29:24 *🌍 The Stampede trial showed broad benefits for advanced prostate cancer patients using intensified therapy.* 30:47 *⚔️ Randomized trials in the UK are comparing SBRT and IMRT for high-risk prostate cancer.* 32:16 *📚 Levels of evidence guide treatment recommendations, with meta-analyses being highly regarded.* 34:52 *🧩 The global Markap project pools data from numerous trials to validate the use of hormone therapy.* 37:28 *🕵️♂️ Selection bias limits non-randomized studies, making randomized trials the gold standard.* 40:19 *🗃️ Large databases lack detailed treatment data, offering limited insights compared to clinical trials.* 43:09 *🌟 Markap found robust benefits in adding hormone therapy to radiation for prostate cancer.* 46:22 *🔄 Prolonging hormone therapy post-radiation is beneficial; pre-radiation prolongation shows no advantage.* 48:28 *📊 A recent U.S. trial, RTOG0815, compared high-dose radiation alone to radiation plus hormone therapy, showing benefits across different patient groups, with further analysis pending.* 49:21 *🕒 Pre-treatment hormone therapy can be used for logistical reasons or to aid recovery in prostate cancer patients without increasing cancer progression risk.* 51:30 *🗺️ PSMA PET scans may replace traditional bone scans and CTs for detecting metastases, but current risk assessment and staging systems are based on older imaging methods.* 56:48 *⚖️ There's concern about over-staging patients with PSMA scans, which might affect treatment decisions, requiring careful consideration of the evidence.* 01:00:23 *📈 A trial showed a benefit for Axumin scans in the post-operative setting, although more data is needed to confirm PSMA scan utility.* 01:01:17 *💊 Medications like anti-cholinergics can be used during SBRT to manage urinary urgency, though they come with potential side effects.* Made with HARPA AI
Physicians need to be up front regarding financial disclosures and potential conflicts. These are not stated in the video. Admittedly, I may have missed them. Dr Kishan has received compensation from the manufacturer of the MRI machine used in the study. I am not disparaging Dr Kishan's skills or expertise. Yet it is well known that financial payments can introduce bias into medical studies.
Thanks for your comment. Of course, everyone should be "up front" about disclosures. As you see, this is a patient focused presentation in the most informal of manner, as if you are sitting in the doctor's office and having a conversation.
He did so in the MIRAGE study/trial conducted at UCLA (a Harvard MD, summa cum laude); for those who may have an interest in the machinery and options thereoff : www.ncbi.nlm.nih.gov/pmc/articles/PMC9409689/ @@backbonz
Now that Meridian went bankrupt, there no support for this machine and the FDA canceled this treatment. Are you guys using the new Electra MRI Linac guided SBRT?
In SBRT cases, where the post treatment trend of PSA tests suggests that the treatment has NOT been successful, is there a routine, so to speak, protocol for how most Rad Oncs proceed to deal with such cases from that point forward?
Generally speaking, what kind of PSA reduction do you typically expect from SBRT 3 months post treatment, as an early indicator that the treatment has or hasnt worked? i am assuming no hormone therapy was involved.
I think the general rule [without ADT] is that PSA decreases over a much longer period up to 2 years before reaching nadir.
Excellent, as in the stand alone lecture I saw of Dr Kishan on SBRT. I particularly liked the extra detail about the procedural requirements for MR Linac such as claustrophobia and urgency over a relatively long time period, though it is difficult to know what is tolerable until one is actually in that situation. However it is a corrective to all the benefits touted for the new Linac to see the downsides that might be lost in the noise to inform each person's decision.
Two rock stars! Thank you!!
Thanks for sharing your appreciation
Why isnt SBRT bein offered by at least most, if not all, Proton Therapy Centers and when might it be in the future?.
Alan could adress this more, but my understanding is that SBRT for proton therapy is undergoing trials at present.
@@jonkahrs4749 I only know of one facility ...Emory in Atlanta...which is offering SBRT using Proton Therapy at this time.
🎯 Key points for quick navigation:
00:00:18 *🩺 Dr. Kishan is a radiation oncologist specializing in SBRT for prostate cancer at UCLA.*
00:00:44 *📚 SBRT stands for Stereotactic Body Radiotherapy, an advanced treatment condensing radiation for prostate cancer into as few as five sessions.*
00:02:05 *🧲 A new MRI-guided radiation device, ViewRay Meridian, allows continuous real-time imaging for precise prostate targeting during treatment.*
00:03:52 *🖼️ MRI-guided radiotherapy offers real-time imaging, tracking prostate movement four times per second, turning off if misaligned.*
00:07:16 *⏳ MRI-based treatment takes longer (45 mins) compared to traditional CT-based methods due to real-time prostate tracking.*
00:10:06 *💡 MRI-guided radiation uses smaller safety margins, potentially leading to less bladder exposure and reduced toxicity.*
00:12:53 *⚖️ An early analysis showed promising lower toxicity rates for MRI-guided treatment compared to traditional methods, leading to adjustments in study size.*
00:15:31 *🌀 The MRI machine allows for adaptive radiotherapy, adjusting treatment plans if organs move unexpectedly during a session.*
00:18:14 *🚀 High-risk prostate cancer patients are being effectively treated with SBRT as a standard option, supported by promising international trial results.*
00:20:50 *📋 SBRT for high-risk prostate cancer is gaining acceptance, supported by the NCCN guidelines and improving insurance coverage.*
00:23:12 *🧬 Innovations like the genetic test Decipher are increasingly used in the personalized assessment of prostate tumors.*
23:52 *🔍 Genetic profiling has improved prostate cancer risk assessment, differentiating between similar Gleason scores.*
24:45 *📑 Decipher, a prognostic genetic test, is now part of NCCN guidelines and covered by Medicare.*
25:00 *💬 Decipher results influence hormone therapy duration discussions for high-risk prostate cancer.*
26:10 *🧪 Clinical trials are investigating whether patients with a high Decipher score benefit from additional medications.*
26:51 *📊 Recent studies show certain high-risk prostate cancer patients benefit from adding Zytiga to ADT.*
27:18 *📉 High Gleason scores, high PSA, or tumor growth beyond the prostate identify patients for intensified hormone therapy.*
29:24 *🌍 The Stampede trial showed broad benefits for advanced prostate cancer patients using intensified therapy.*
30:47 *⚔️ Randomized trials in the UK are comparing SBRT and IMRT for high-risk prostate cancer.*
32:16 *📚 Levels of evidence guide treatment recommendations, with meta-analyses being highly regarded.*
34:52 *🧩 The global Markap project pools data from numerous trials to validate the use of hormone therapy.*
37:28 *🕵️♂️ Selection bias limits non-randomized studies, making randomized trials the gold standard.*
40:19 *🗃️ Large databases lack detailed treatment data, offering limited insights compared to clinical trials.*
43:09 *🌟 Markap found robust benefits in adding hormone therapy to radiation for prostate cancer.*
46:22 *🔄 Prolonging hormone therapy post-radiation is beneficial; pre-radiation prolongation shows no advantage.*
48:28 *📊 A recent U.S. trial, RTOG0815, compared high-dose radiation alone to radiation plus hormone therapy, showing benefits across different patient groups, with further analysis pending.*
49:21 *🕒 Pre-treatment hormone therapy can be used for logistical reasons or to aid recovery in prostate cancer patients without increasing cancer progression risk.*
51:30 *🗺️ PSMA PET scans may replace traditional bone scans and CTs for detecting metastases, but current risk assessment and staging systems are based on older imaging methods.*
56:48 *⚖️ There's concern about over-staging patients with PSMA scans, which might affect treatment decisions, requiring careful consideration of the evidence.*
01:00:23 *📈 A trial showed a benefit for Axumin scans in the post-operative setting, although more data is needed to confirm PSMA scan utility.*
01:01:17 *💊 Medications like anti-cholinergics can be used during SBRT to manage urinary urgency, though they come with potential side effects.*
Made with HARPA AI
How does Decipher compare with Prolaris in assisting your evaluation of the aggressiveness of prostate cancer?
Physicians need to be up front regarding financial disclosures and potential conflicts. These are not stated in the video. Admittedly, I may have missed them. Dr Kishan has received compensation from the manufacturer of the MRI machine used in the study. I am not disparaging Dr Kishan's skills or expertise. Yet it is well known that financial payments can introduce bias into medical studies.
Thanks for your comment. Of course, everyone should be "up front" about disclosures. As you see, this is a patient focused presentation in the most informal of manner, as if you are sitting in the doctor's office and having a conversation.
In any professional presentation (to a society meeting, in a study, etc. )he would list it under his disclosures.
He did so in the MIRAGE study/trial conducted at UCLA (a Harvard MD, summa cum laude); for those who may have an interest in the machinery and options thereoff : www.ncbi.nlm.nih.gov/pmc/articles/PMC9409689/ @@backbonz