Abhishek ("Shake") Kumar, MD MAS

🧵 Tweetorial: 1/ MRI is now central to prostate cancer workup — but does what we see on MRI predict outcomes? In a national cohort of 2,275 veterans, we found that MRI-detected EPE is common & highly prognostic.

What comes after QUANTEC, HyTEC, and PENTEC? Could it be ReTEC? Read our new proof-of-concept paper! @ASTRO_org @ESTRO_RT @JimmGrimm1 @SahgalArjun @KristinRedmond2 @JohnRAdler @MichaelTMilano aapm.onlinelibrary.wiley.com/doi/10.1002/ac…

Good luck to everyone taking @ABR_Radiology #RadOnc oral board exam this week! Made this to help prepare, and sharing in case others find it useful @ACRORadOnc @ARRO_org @ACROresident @S_W_R_O

A very long but hopefully fairly thorough review of all 8 disease sites that are tested on oral boards! Good luck to everyone this week! ❤️ youtu.be/goLEoX05UCY?si…

SBRT for high-risk PCa: 2026 update from the SHARP consortium out in @EurUrolOncol authors.elsevier.com/a/1mvz49Cfw07F…. Excellent BCRFS and DMFS outcomes. Non-randomized, but dose escalation to 40 Gy with at least 12 mos of ADT performs extremely well.

Incredibly thankful for @joshuapalmermd's mentorship and also many institutions' participation (@SahgalArjun) in this meta-analysis showing roughly 20-30% improvements in 3- and 5-year PFS with dose escalation for high-risk meningiomas meriting further examination prospectively

Breast Cancer Recurrence Remains Low Even After 10 Years With Radiotherapy Tailored to Patient’s Individual Risk - The ASCO Post ascopost.com/news/march-202…

Need to observe RPT cases for AU status? ASTRO's AU Training Centers provide in person observation of supervised administrations at APEx accredited sites, with documented cases and preceptor attestation. Supported by an educational grant from Novartis Pharmaceuticals Corporation. Learn more & apply now: astro.org/AUTrainingCent…

Patients With Lung Cancer May Safely Receive Adequate SBRT Dosage in One Treatment - The ASCO Post ascopost.com/news/april-202…

Thank you for the kind words @SameerKeoleMD and to everyone else who has taken time to download and share the app! I’ve gotten some great feedback already and will have an updated version with minor fixes and improvements out very soon.

@DrRishabhOnco We had a similar study with very similar findings in the VA population: x.com/ShakeKumarMD/s…

Agrotis et al. JAMA Oncology 2026 👉 doi.org/10.1001/jamaon…

MRI before prostatectomy isn’t just staging… it’s prognostic. New meta-analysis in JAMA Oncology shows MRI predicts outcomes independently. 🧵 📌 Study: Pretreatment MRI as prognostic factor after radical prostatectomy 📊 40 studies | 24,941 patients 👨‍⚕️ Population Men undergoing radical prostatectomy with pre-treatment MRI ⚔️ Key MRI features → Strong outcome predictors 🔴 Extraprostatic extension (mrT3a) •BCR: HR 2.16 •Metastasis: HR 3.18 •Cancer-specific mortality: HR 10.9 (!!) 🔴 Seminal vesicle invasion (mrT3b) •BCR: HR 2.74 •Metastasis: HR 5.58 📊 Quantitative MRI also matters •PI-RADS 4–5 → HR ~2.1 •Tumor ≥20 mm → HR ~2.35 •Low ADC → HR ~2.4 💡 Key insight MRI adds independent prognostic value beyond PSA, Gleason, and pathology 👉 Not just imaging 👉 A biologic risk signal before surgery ⚠️ Practice-changing angle MRI T-staging may be stronger than DRE-based clinical staging → Enables better pre-op risk stratification → Potential for treatment intensification / de-escalation 🎯 Takeaway If you’re still using MRI only for staging… You’re underusing it MRI = prognosis + decision-making tool 🔖 Save this for clinic discussions 📖 Full paper in comment ⬇️ #OncoTwitter #MedTwitter #ProstateCancer #UroOncology @OncoAlert @myesmo @esmo_open @asco

Less Isn't Simple: Insights From Postmastectomy Radiotherapy Deintensification Trials | Journal of Clinical Oncology ascopubs.org/doi/10.1200/JC…

Great story from Coach K on running into a former camper and the lesson this man carried with him. Coach K asked all the kids at the camp... "Who do you talk to the most?" “Yourself… so when you talk to yourself, why not be yourself's best friend?” A lot of performers are entertaining an internal voice that’s critical, impatient, and unforgiving. We say things to ourselves we’d never say to a teammate and then we expect confidence, consistency, and composure to follow. You're in a lifelong conversation with yourself. Make it one worth having. 📹: Sons and Daughters Podcast

[177Lu]-PSMA-617-PSMA-617 in oligometastatic hormone sensitive prostate cancer (BULLSEYE): an open-label, randomised, phase 2 study - The Lancet Oncology thelancet.com/journals/lanon…

More than 1 in 2 cancer patients could receive a DIFFERENT treatment just based on who reviews their case. In a retrospective study at Stanford (n=657) 🚨53.8% had a treatment change (34% minor, 20% major) 77% stage III–IV (III 19.8%, IV 57.1%) 🚨Interestingly, stage II had the highest rate of change (64%) vs ~45% in I/III 24.7% international pts Evaluated by subspecialty experts, most commonly MedOnc (67.6%) Not because the first plan was wrong but because oncology is complex, variable, and evolving This may help explain why outcomes differ. However, this likely reflects selection bias, with younger, more proactive users, often women with breast cancer. 🤔Bottom line: a second opinion can change your treatment, your outcome and your costs. ascopubs.org/doi/pdf/10.120… @OncoAlert

@TylerSbrt7 @davidjeinstein @DrVMuralidhar @BIDMCUrology Great discussion. Agreed that MRI-EPE likely strongly correlated w/ crib/higher grade. Possibly PIRADS also correlated? Wish we had path specimen for our VA patients to be able to review but we do not. We could look at path reports for mention of crib+ but this would be biased.

@davidjeinstein @DrVMuralidhar @ShakeKumarMD @BIDMCUrology My working hypothesis (for GG1/2): -Bad on MRI:⬆️prob of crib+ -But PPV def not 💯 -If crib NOT present, very little metastatic risk per ProtecT RP analysis above and Nguyen et al paper: onlinelibrary.wiley.com/doi/abs/10.111… — even if rT3

I’ve been worried about overtx w extending ADT based solely on MRI T3, especially grade 1

@TylerSbrt7 @davidjeinstein Best paper I’ve seen on this question so far @ShakeKumarMD acsjournals.onlinelibrary.wiley.com/doi/10.1002/cn…

Huge congrats to Dr Saad Ashraf on his @FrontOncology case report! 👏 This unique case of OPD highlights 8 courses of SABR for 17 metastases over 5 years, delaying systemic therapy changes 8x to prioritize patient QOL in a HER2+ breast cancer. Read: frontiersin.org/journals/oncol…

For rad oncs taking oral boards soon, here is a video I made a year ago to help prep for the GI section. Good luck🍀! m.youtube.com/watch?v=G157j6…

@DrSpratticus @alison_tree @TylerSbrt7 @jryckman3 @DrVMuralidhar @VladGalatan @cpeedell @SeibertLab @IJROBP @RO_GreenJournal @ARRO_org @ASTRO_org @ESTRO_org @subatomicdoc @PBlanchardMD @DrAndrewLoblaw @SbrtSean @NehaVapiwala @piet_ost @seanmmcbride Two phase III trials will complete recruitment soon. Both compare 60-62 Gy in 20fx vs 5 fx GTV boost to 40-42 Gy (HypoFocalSBRT) and up to 50 Gy (FLAME group) in unf interm and high risk pat. In the HypoFocal trial, PSMA PET was mandatory in addition to MR

@5_utr @yuanjamesrao @adornisch_MD @UCSDCancer It is not a biologically interesting question. But it matters to the patients, so it matters to me. Patients on the bladder empty arm are volunteering to give testimonials—they love it. Some patients in f/u from pre-trial era are donating to the cause.