Nat Lester-Coll, MD

Wanted to highlight our AASUR trial. Was an awesome multi-institutional collaboration. Especially grateful to @ThePCCTC and @UMichRadOnc team (@DrSpratticus, Jason Hearn, et al were our 2nd leading accruers). But a true team effort. And many thanks to @JNJInnovMed and @PCFnews for funding. TL;DR: in VHR localized PCa, a short course (6mo), ADT/ARPI regimen combined with 40/5 prostate-only SBRT had favorable toxicity profile, rapid T return, and, despite not meeting superiority threshold, BCR rates that looked similar to long course ADT historical controls. These patients were not DECIPHER-selected or PSMA PET staged. It may be that scADT/ARPI+RT would provide equivalent results in the vast majority of RT-treated VHR, localized dz. Obviously this would require confirmation in an appropriately sized NI trial. #radonc #pcsm

#GU26 and #fengsymposium was a blast to see progress. Hoping it eventually moves away from San Fran 😁. Another red eye on the books back home. My observations from PCa sessions: - the field continues to push for over tx and many fail to recognize high risk dz is not high risk anymore for most patients. Enzarad negative, Rtog 0924 neg, ascend-RT neg for MFS/OS, peace2 neg. RT+ADT plenty for most. Many need even less. Select trials paving the way. - for mHSPC not all patients need doublet let alone triplet; age matters - continuous ADT can often be more harmful than helpful now with MDT -most BCR patients post RP do not need ADT—> get biomarker testing to help -many have jumped on bandwagon that OS too hard to improve and settling for early non-surrogate endpoints; peace3 should remind us it’s possible -sequential PARPi /Abi often just as good as combination -early germline/somatic testing for all high risk disease remains without data to support it; even testing in mHSPC unclear benefit as can give PARPi in mCRPC setting (earlier not better than later). -actinium RLT promising but toxicity remains concern -neoadj before RP remains largely ineffective, adds costs and toxicity and most still need postop tx.

🚨🚨Multiple Brain Mets Randomized Trial🚨 · Significantly less symptom burden with SRS compared to HA-WBRT · Better ADL, cognition & KPS after SRS · SRS Standard of Care 5-20 brain mets jamanetwork.com/journals/jama/…

Full free-text link to the ASTRO GU Resource Panel's response to the IRRADIATE publication @RicBertolo @EurUrolOncol authors.elsevier.com/a/1mdSX9Cfw07F… @NehaVapiwala @ASTRO_org

Frustrating @UHC @Optum #priorauth Peer-to-peer requested during my admin time multiple days this week, but “no doctor available”? Now expedited to a random unscheduled call today-Monday. We’re not available 24/7. Figure out how to schedule properly…unnecessary delays & waste!

Hot off the presses, ReCOG consensus statement endorsed by multiple Rad Onc societies now in @TheLancetOncol. Major step forward for advancing reirradiation. Congrats to authors, in particular @DrKCParadis, @ChuckMayoPhD, @elizapowerpuff. @UMichRadOnc. sciencedirect.com/science/articl…

Extremely excited to share our latest article published @TheLancetOncol a few hours ago: authors.elsevier.com/a/1mYT65EIIgTS…. The WOLVERINE individual patient meta-analysis was an international collaboration and part of X-MET collaboration. Goal was to evaluate MDT in oligomet prostate ca.

Credit @RicBertolo for spotlighting degree of burden in these affected pts. For accurate risks (i.e., true incidence rates of complications)? Need to push for pop-based multidisciplinary studies. We should collaborate for clarity.

3) Concerning too: conversation devolved into defensiveness, straying from science. We must rise above narrative-pushing to seek truth in order to best inform our patients.

This paper is getting a lot of attention. My concerns: 1) Selection bias: ONLY symptomatic pts enrolled, so 43% grade 3+ stat from biased 321-sample. No denominator = no true incidence. Tautological & misleading

To the #Brown community, I am holding you all close in my thoughts. Lean on each other. Grieve together. I know how strong, resilient, and fiercely devoted you are. Home endures through us. #BrownStrong

No one should fear studying could be their last moment. It is a loss of innocence we cannot undo. Fueled by a cycle we have let continue, with the gun lobby blocking reforms that save lives.

@BrownUniversity is more than a university to me. It is family. I grew up exploring those streets and feeling at home on the quads. I met my wife there. Took physics classes in Barus & Holley. My sister went there. My parents are professors.

Another important MARCAP analysis led by @NicholasZaorsky @DrSpratticus looking at the varying benefit of prolonging ADT based on risk group, leveraging individual patient data from multiple trials. 12 months seems to be very reasonable for many contemporary high risk patients