John Rewcastle, PhD

Any KM curve showing biopsy results from AS or focal therapy should include, on the same graph a freedom from biopsy KM curve! It’s hard to interpret without knowing the denominator. #eau26 #prostatecancer

@DongNguyeb @MrJosephNorris @DrSpratticus Regarding point 1: it is not off label. Period.

@DrSpratticus seems to hopeless to make any valid argument against FT other than repeatedly spreading misleading interpretations. First, most devices used for FT have received FDA clearance through the 510(k) pathway for tissue ablation. This clearance means the device can be marketed and used safely from a technical device standpoint, but it does not represent an evaluation of clinical efficacy for a specific disease. Therefore, using FT to treat prostate cancer is an off-label use, which is entirely permissible in clinical practice when you have a reasonable medical rationale and appropriate informed consent. Second, it is true that guidelines such as EAU and NCCN currently recommend that FT be performed within a clinical trial or prospective registry, largely because long-term oncologic evidence is still evolving. However, this does not mean that educational masterclasses are not allowed to teach how to do FT . A masterclass is simply an educational activity, training in technique, sharing experience, and discussing clinical cases. It is not the same as clinical practice and therefore falls outside the scope of guideline recommendations. Finally, if FT truly proves ineffective, long-term follow-up data will ultimately demonstrate that. Science advances through evidence over time. Repeatedly presenting exaggerated or misleading claims does not contribute to a constructive scientific discussion.

Curious what a Masterclass in a non-FDA approved, non-guideline supported treatment looks like?🤷‍♂️ EAU says to not do unless on prospective study, NCCN says the same. Is it how to manage the toxicity and recurrence for the patients I am sure are all enrolled on trials who are being treated? Share more what is going on in London 🙏

@fgomsan PRO = patient reported outcomes: IPSS, IIEF, EPIC-26 and the like. What was this gentleman’s PRO function before and after Tx?

@rewcastle_john I am afraid I do not understand the question

🔬 Case report: 76-year-old patient, 180g trilobar prostate, failed previous TURP. The en-bloc HoLEP with early apical release and sphincter's mucosal preservation achieved: ✅ Complete enucleation in a single piece ✅ Immediate postoperative continence ✅ 12-month IPSS: 28→3 23-year experience operating in many countries confirms: size doesn't limit the technique. What's your approach to giant prostates? 🤔 #HoLEP #BPH #Urology #MinimallyInvasive #ProstateSurgery

@jimhumd These options all seem heavy handed in light of ProtecT. There are a few certainties w/ PCa. One is that favourable intermediate rest disease can absolutely safely be watch for a year. Watch it - change your treatment decision basis being a photograph to a movie!

GG2 1/14 cores with PSA 8.3, prostate volume 40 mL. 20% pattern 4. Incidental 1.7 cm left lower pole anterior tumor. 1/2

Aquablation demonstrated noninferior short-term LUTS relief and similar safety compared to LEP, with superior ejaculation preservation and avoidance of SUI in short-term follow-up. #BPH #Aquablation #menshealth pubmed.ncbi.nlm.nih.gov/41638951/

FDA is now open to Bayesian statistical approaches. A leap forward! Bayesian statistics can help: ✅ Clinical trial design ✅ Finding the optimal dose ✅ Extrapolation to children ✅ Leveraging phase 2 results in phase 3

Dr. Inderbir Gill, @USC_Urology discusses how the WATER IV Prostate Cancer trial came about - which compares #Aquablation to Radical Prostatectomy. @PROCEPTRobotics prostatehealthpodcast.com/110

@DrRishabhOnco I disagree that ProtecT is a low-risk study. A third of the patients were intermediate risk at diagnosis, but it was before MRI. If you diagnosed the ProtecT population today with MRI guided biopsy half would be intermediate-risk.

🚨 Prostate cancer care has changed fast. Here’s the 2025 snapshot. The new Lancet Seminar lays out how prostate cancer management has transformed across the disease spectrum 🌍🧬 🔍 Early disease Active surveillance is the default for low-risk tumors, avoiding overtreatment while maintaining excellent outcomes. MRI-first pathways improve detection of clinically significant cancer. ⚖️ Localized to high-risk Surgery and modern radiotherapy offer equivalent cancer control. Hypofractionation and SBRT shorten treatment without compromising efficacy. High-risk disease needs multimodality care. 🚀 Metastatic hormone-sensitive ADT alone is no longer enough. Doublet or triplet therapy with ARPIs ± docetaxel is now standard, with prostate RT benefiting low-volume disease. 🎯 mCRPC era Treatment is biology-driven: PARP inhibitors for HRR alterations, Lu-177 PSMA radioligand therapy after ARPI and taxanes, cabazitaxel preferred over ARPI sequencing. 🧠 Big takeaway Sequencing, patient selection, toxicity, and shared decision-making matter as much as drug choice. 📖 Valérie Fonteyne et al. Lancet 2025 A must-read, practice-defining review for every GU oncologist 🔖 #OncoTwitter #MedTwitter #ProstateCancer #GUOncology @TheLancet @myESMO @OncoAlert @ASCO

Just out in @TheLancet: an overview on current approaches to diagnosis and management of prostate cancer. sciencedirect.com/science/articl…

👀 Important work on under appreciation of GG1 cancer in the MRI era by @ShuWangMD @EvanSuzman @nyphospital @UTSWMedCenter @WeillCornell: Trends of upgrading and upstaging of grade group 1 prostate ... : Current Urology journals.lww.com/cur/fulltext/9…

@Prince_Fynnz WTF is this? Image is so incorrect it would be laughable if not intended to educate men on cancer. Facts are wrong throughout: Prostate is not surrounded by the urethra, iCT is not used for prostate cancer screening. It’s not the number one cancer killer in men…

PROSTATE CANCER: WHAT EVERY MAN SHOULD KNOW Prostate cancer is the second most common cancer in men. Why is it so common? When should you be concerned? Let’s learn everything about prostate cancer, and how to reduce your risk of developing it. Check Thread 👇

@JoelHillelsohn Successful?

Same day discharge planned

200 gram aqua no traction case # 325. I love this procedure. #aquablation

Talking about Biden’s #prostatecancer in terms of Gleason scores rather than @IntSocUropath grade groups is a step backwards and an unfortunate missed opportunity for patient education.

First human bladder transplant performed at UCLA performed with USC Urology’s Dr. Inderbir Gill ✌️#bladdertransplant #uclaurology #uscurology #urosome uclahealth.org/news/release/f…

@IP_London @LondonProstate1 @AJWLight @Archana_GK1 @cut_tt_chase Fantastic picture!

That’s a wrap on #AUA25 for Team IP! See you in Washington DC for #AUA26! 🇺🇸

@apkenigsberg @FocalSociety @FocalOneHIFU @ProfoundMedical Agree but it leaves it in guideline purgatory. 25% is understandable but statistically a non-starter. The analysis shouldn’t be termed ITT because it was not. I don’t like treatment free survivals either because the treatments are fundamentally different in the different arms.

@rewcastle_john @FocalSociety @FocalOneHIFU @ProfoundMedical Not sure a perfect focal vs prostatectomy trial is possible anymore, given there’s reasonably broad access to focal modalities off trial. In that context 25% crossover isn’t bad. What would you propose as reasonable endpoint? Salvage treatment-free survival?

Tremendous podium by Dr. Eduard Baco—FARP trial with first RCT evidence that focal HIFU/TULSA non-inferior to prostatectomy! Paradigm shifting work and an incredible effort. Certainly seems like focal therapy ready for prime time. @FocalSociety @FocalOneHIFU @ProfoundMedical

@apkenigsberg @FocalSociety @FocalOneHIFU @ProfoundMedical I have immense respect for this effort and congratulate Eduard. Unfortunately, interpretation is precluded by (1) randomization broken by crossover (25% in RP arm) and (2) asymmetric primary endpoints. Simply can’t have different primary endpoints for the two arms.