Robert Pfeffer

Fair point about ARPI! I don't fully agree. To be clear, I am talking here about low-volume mHSPC. Few points: 1- I wouldn't say PEACE-1 showed no OS benefit. It doesn't prove a benefit, neither does it disprove one. HR for SOC+Abi +/-RT was 0.77 (Curves below). There is certainly a trend. I think we need a higher N for the ARPI subgroup. There was however a signicant improvement in CRFS. 2- In a NMA (@soum_roy_radonc) with Bayesian pairwise comparison, the best treatment was SOC+ARPI+RT, and was associated with reduced mortality wrt SOC+ARPI europeanurology.com/article/S0302-… 3- STOPCAP meta-analysis (including PEACE-1 data) showed an OS HR of 0.92 (0.84-1.0) for RT for all-comers, low and high-volume (Forest plot below). For low-volume, OS HR was 0.79 (0.67-0.93). annalsofoncology.org/article/S0923-… urotoday.com/conference-hig… So based on the above, I think it's safe to say that RT to the primary is beneficial for low-volume mHSPC treated with ADT +/- ARPI. PEACE-1 cannot rule out an OS benefit for the ADT+ARPI subgroup, mainly due to small N and Frequentist design. It does however prove a CRFS benefit. On another hand, a Bayesian comparison (NMA above) showed that these patients most likely benefit from RT. In light of these, I think it's hard to NOT recommend RT even with ARPI. Wondering what is the current practice at your institution. Also curious to know what other Rad-Onc colleagues think about this @pcaparker @soum_roy_radonc @drspratticus @tylersbrt @seanmmcbride @sbrtsean @alison_tree @vedangmurthy @piet_ost @paulsargos @jryckman3 @5_utr @adib_elio @protonstorey @docpriyamvada @_shankarsiva @albertobossial @amarukishan

Someone suggested I make a table summarizing the video. Here it is!

@NicholasZaorsky @ASTRO_org @YouTube That's awesome - 👏👏👏!

@satyanadella Hoping this brings up MSFT share prices

We’re the first cloud to bring up an NVIDIA Vera Rubin NVL72 system for validation, another big step in building the next generation of AI infrastructure with NVIDIA.

RFK Jr is trying to get 14 peptides, without data on safety or efficacy, licensed and approved by FDA. His favorite is BPC-157. "Only three small human studies of BPC-157 exist, for instance, the largest of which is a telephone survey of 16 people who received an injection of the drug for knee pain, and which was published in a third-tier journal, Alternative Therapies." economist.com/science-and-te…

Radioterapia en cáncer de vejiga. Si el tratamiento neoadyuvante consigue >50% de RCp y la cistectomía no mejora la supervivencia frente al tratamiento conservador... ¿Quién no va a querer conservar la vejiga?

On portal venous phase CT, the uterus enhances more than the cervix. This differential enhancement is common and physiological. Yet it is often mistaken for cervical pathology. The relatively lower attenuation of the cervix is often overcalled a cervicitis or a cervical mass. Understanding normal enhancement patterns helps avoid these errors and keeps us from creating pathology where none exists. —Pearls, Pitfalls, and Wisdom from my reporting list

Kinetics of prostate volume reduction under hormonal treatment: Timing and impact on external beam radiotherapy - A PRISMA-Compliant systematic review - PubMed pubmed.ncbi.nlm.nih.gov/41756145/

Congressional advisers call to rein in Medicare Advantage spending amid industry pressure I’ll summarize for you. EVERY SINGLE FAMILY IN THE USA IS PAYING $800 A YEAR to the big insurance companies because taxpayers pay them more than it costs to support Trad Medicare That’s insane. And it doesn’t even include the increased premiums trad medicare plan holders have to spend. Medicare Advantage was meant to cost LESS than trad Medicare. Yet here we are Support the Break Up Big Medicine bill from @HawleyMO and @SenWarren If your representative is up for election in Nov and they don’t support this bill. Don’t vote for them. They support higher healthcare costs. To reduce healthcare costs, this bill is the most direct path statnews.com/2026/03/12/med… via @statnews

Not sure who needs to hear this, but it is reasonable to ask whether a treatment being offered for cancer is actually approved for treating cancer. #OncTwitter

Your iPhone battery isn't 'old.' It’s being hijacked by 14 hidden scripts. I checked my background activity at 2 AM. Despite 'Low Power Mode,' 3 apps were pinging servers in 4 different countries. It’s called 'Zombie-Syncing,' and it’s why your phone dies at 20%. Here is how to reclaim your hardware for good:

@DrYukselUrun @I_Migowski @JNCI_Now @APCCC_Lugano @OncoAlert @ONCOassist @OncBrothers Hi way ahead ! we have published national guidelines a few weeks ago @RCRadiologists

@DrSpratticus @jeshoag This editorial in the IJROBP is excellent.

Encourage everyone to read our editorial by our incredible urologic oncologist @jeshoag on the pervasive “focal fallacy”. redjournal.org/article/S0360-… Wish there were more urologists out there willing to push for evidence for our patients and accept the evidence where it is and run the real trials. We did this for protons and showed no benefit. We did this for brachy vs combo brachy and combo added costs and toxicity. Do it for patients.

Have you ever wondered whether you need to hold systemic during RT due to concern for additive toxicity? See this 10 min video. Categorized by systemic type (cytoxic chemo, IO, TKI, BRAF, etc) & RT regimen (SBRT/conventional/palliative) Slides🧵& full video below. 1/8

Hence why people don’t trust science or MDs anymore. We have a doctor you posted likely paid saying they violated national guidelines for what payers deem experimental, we have biomedical news agencies funded by industry saying these devices are amazing for things they are not approved for, we have major medical meetings promoting these devices, we even have @nytimes articles saying how great these devices are. Yet reality is there is not a single well done multi center randomized trial with reasonable endpoints and good followup showing it is better than AS or RT. To be clear, none of this is targeting the Vanquish system. It is the whole field of ablative devices being used for cancer without being approved for cancer.

🚨 This paper followed 58,000 DLBCL patients for up to 25 years. 17% died from non-lymphoma causes — infection, leukemia, heart disease, solid tumors. Many were cured of their lymphoma. They were killed by the treatment. We need to talk about this. 🧵

@TheGreatScrolls @PhysInHistory This photo is the quintessence of coolness.

@PhysInHistory Dirac and Pauli are standing pretty close in the middle row of that famous Solvay photo. Hard to imagine the room without picturing this exchange happening somewhere off to the side.

Remark made by Wolfgang Pauli during 5th Solvay Conference in 1927 during a discussion about the religious views of various physicists ✍️

90% of students “read” research papers and still can’t explain them….This is the method I use anytime I lead a Journal Club. I can tell in 30 seconds if you actually understood a research paper…. Most people don’t…. They “read” it… Then they can’t explain the question, the method, or the point. Here’s the reading method researchers are trained to use: The Three-Pass Method. ⸻ ★ PASS 1 (5–10 minutes) Get the map, not the details Read only: → Title → Abstract + intro → Section headings → Conclusion → References (quick glance) By the end, you should be able to say: ↳ What kind of paper is this ↳ What problem is it solving ↳ What are the main contributions ↳ Do the assumptions seem reasonable ↳ Is it worth your time If the answer is “no,” stop here. That’s not quitting. That’s focus. ⸻ ★ PASS 2 (up to 1 hour) Understand the argument Now read with a pen. Your job is to track: → What claim are they making → What evidence supports it → What figures/graphs prove it Study the visuals like your reputation depends on it: ↳ Are axes labeled ↳ Are error bars shown ↳ Do the results actually justify the conclusion At the end of pass 2, you should be able to explain the paper out loud to a friend. No notes. If you can’t, you don’t own it yet. ⸻ ★ PASS 3 (the “real researcher” pass) Rebuild the paper in your head This is the move that separates “I read it” from “I understand it.” Try to recreate the work mentally: → Why this method and not another → What assumptions are hiding in plain sight → What would break if one assumption fails → What would you change if you ran the study By the end, you should be able to reconstruct the whole paper from memory, including strengths and weak spots. ⸻ 💬 What trips you up the most when reading papers? ♻️ Repost if you know someone drowning in PDFs.

During a job interview, if they ask: "Why is there a gap in your resume?" USE THE GOLDEN RESPONSE: