Allen Edel

@drdavidpalma @SbrtSean @ChadTangMD Sorry for the estimate, you are right about the HR. Many pts are hopeful of cures from MDT, even w/o ADT! I point to the current lack of evidence and plead agnosticism; but if safe, why not? Pts rely on great researchers like you and @piet_ost to stand up for Levels of Evidence.

Seems like you have a very strong opinion here. No one is pretending anything. WOLVERINE is strong evidence, but phase III trials in prostate are completed and maturing. We'll wait for those. SABR-COMET was designed to give us a non-definitive comparison, so I'm not sure why the concern. But check out the SABR-COMET outcomes by histology, and BTW you can't just divide mortality numbers in the two arms to get HRs.

Top Ten Reasons the Prostate Specific Antigen (PSA) is Not a Perfect Test for Prostate Cancer: 1. Benign PSA Bounces Following Radiation Therapy for Localized Prostate Cancer

@Sofia_anna08 @SbrtSean Because ARTISTIC found no difference in outcomes between "early" salvage radiation (after waiting for PSA to reach 0.4) and adjuvant radiation. There is no value for uPSA. There are cases where adjuvant is preferred or even early salvage is unnecessary: prostatecancer.news/2021/10/except…

@TallAllen @SbrtSean Thank you for sharing your perspective. Could you please elaborate on why the UPSA test is considered unnecessary in the ARTISTIC context and how it contributes to anxiety among treated patients? @TallAllen

@drdavidpalma @SbrtSean @ChadTangMD I've read it. There is no Level 1 evidence that MDT has a survival benefit. Let's not pretend there is. BTW - here's my critique of your SABR-COMET trial: prostatecancer.news/2019/04/is-the…

@TallAllen @SbrtSean There's a large meta-analysis of RCTs led by @ChadTangMD that has shown impressive benefits of SBRT for prostate oligomets. It's called WOLVERINE. Improvements in rPFS, CRFS, and probably OS (p=0.051). ascopubs.org/doi/10.1200/JC…

@Raj_Singh_MD @SbrtSean No doubt! But any ADT vacation should be patient-driven after understanding the risks.

@TallAllen @SbrtSean In use of SBRT for oligometastatic mCSPC, I have found patients voice significant QOL benefits from the ADT free period per STOMP and ORIOLE that SBRT can provide

@alongi_filippo @SbrtSean My attitude toward MDT is: if safe, why not? I just do not kid myself that there is a proven survival benefit, or survival proof that ADT can be safely ignored after treating PSA.

@TallAllen @SbrtSean In a lot of posts(all written to quite minimise the value of SBRT?), I clearly understood that you do not believe in radiation oncology… Waiting for an endorsement for our daily work for our cancer patients as evidenced in several papers and guidelines!!

@bennyjohnson Your Dunning-Kruger Effect is showing! You know just enough about prostate cancer progression to get it wrong.

This is the Most Dangerous Cover-up in the History of the Presidency: Last summer, White House Physician Dr. Kevin O’Connor swore to the American people that Joe Biden was “completely fit for the Presidency” — no issues, nothing to see. Now we learn Biden has “advanced”prostate cancer. But wait… Advanced prostate cancer takes +10 years to develop to the stage where Biden’s diagnosis is. Prostate cancer is also *easy* to find. Simple blood test or prostate exam will give you near 100% accurate results. You’re telling me that the best doctors and testing on earth did not *find* Biden’s cancer in all these years of testing? Was every medical report a lie? For how long? Bullshit. This is the worst coverup in the history of the Presidency. Absolute scandal. They knew. They lied. They hid it. For power. People need to be held accountable for this. Evil.

@Philip_Goff Me: panpsychism 0%, biological consciousness 50%, consciousness emerges with complexity 75%, human-only conscious 50%, God super-conscious 99%, humans limited to spacetime and matter 100%, God exists beyond spacetime and matter 99%, IDK what God can do or why 100%

With respect to the philosophical views you defend, how likely are they to be true? Me: panpsychism 60%, some form of anti-physicalism 85%, God of limited power 75%, my heretical form of Christianity 50%, non-existence of all-powerful God 99%.

@AmarUKishan @CCR_AACR Thanks! I especially 🩷 your distinguishing acute, late and chronic. Any PROs forthcoming? Is it possible that the same miRNAs also make tumors more susceptible to SBRT-killing (lower α/β)?

Proud to share this work out in @CCR_AACR wherein we validity the ability of PROSTOX to predict late GU toxicity following SBRT. This test, based on SNPs in microRNAs, shows a robust AUC for late grade 2 or greater toxicity.

@Dr_RaviMadan 💯 Some overestimate the detection capabilities of molecular imaging and MRI - patients and doctors.

Not sure why a need to do #PSMA after treatment if appropriate #PSA response outside a trial Seen this done a few times & it can lead to confusion, anxiety, unnecessary biopsies & a compulsion to change therapy w/out data I’d beware of unnecessary PSMA too #ProstateCancer

@CalaisJeremie @RO_GreenJournal @masatoshihotta @UCLA @Wes_Armstrong_ @CzerninJohannes @MSteinbergMD @AmarUKishan @andrea_farolfi @IdaSonni @UCLAHealth @UCLAJCCC I know of no kind of imaging that can detect "zombie" cancer cells (cells that have lethal ROS damage to their DNA but have not yet undergone mitotic catastrophe). There is no point to imaging before BCR.

Kinetics of PSMA PET signal after radiotherapy in 217 prostate cancer lesions: It takes multiple months for the uptake to decrease (> 6 months). Beware of "pseudo-progression" on PSMA PET performed shortly after RT. @RO_GreenJournal @masatoshihotta @UCLA sciencedirect.com/science/articl…

@NicholasZaorsky @NCCN @AJCCancer Stage T3 in AJCC 8th ed. is DRE-only:"Assigning the clinical T category (cT) is accomplished using information from the DRE of the prostate and should always reflect DRE findings only." Does STAMPEDE assign cT3 by DRE-only?

2025 prostate cancer staging from @NCCN and @AJCCancer 8th edition Major change in 2025 NCCN vs prior years: Very high risk disease is now per STAMPEDE criteria (not Hopkins)

@GertMeerleer @DrAndrewLoblaw You may want to review "levels of evidence."

@TallAllen @DrAndrewLoblaw Thank you for your nice Words. At latest ASCO-GU, Wolverine was presented. If this is not evidence enough, I love to keep suffering. I treated >1500 extracranial lesions: super safe, nearly no tox. Have a nice day.

Great study! Can we finally agree that RT + ADT is better than ADT or RT alone (for patients at high risk of recurrence). And yes I “lump” oligometastatic in with high risk ds

@SimonSchfe45703 Euthyphro says "the gods" (plural), indicating they are all following a higher-order order. Monotheism has a single source The Good - there is no higher-order order.

To say that there are no good replies to the euthyphro dilemma is just as ignorant as to say that a theistic metaethics is the only defensible way to secure robust moral realism.

@GertMeerleer @DrAndrewLoblaw Safety depends on individual anatomy and where the sites are. Once again, there is no Level 1 evidence. If you think evidence is "impressive," you are suffering from confirmation bias.

@TallAllen @DrAndrewLoblaw It is very safe, and evidence in metachronous disease is very impressive, once more. Have a nice day

@GertMeerleer @DrAndrewLoblaw Sorry Gert. MDT can be done in either case — but there is no Level 1 evidence for either. I’m not saying to not do it, I’m saying to do it if safe, but not to pretend that it is supported by good evidence.

@TallAllen @DrAndrewLoblaw Sorry Allen: You are mixing up things: offering MDT as SOC is only done in metachronous disease. NOT synchronous. Have a nice day

@TonyFelefly @GertMeerleer @DrAndrewLoblaw If safe, why not offer MDT? But that doesn't mean high-quality evidence supports it. RADIOSA only supports MDT w ADT. ≥75% agreement on an answer option was defined as consensus, while ≥90% agreement on an answer option was defined as strong consensus.

@TallAllen @GertMeerleer @DrAndrewLoblaw Just to be specific for the metachronous mHSPC as in RADIOSA population, Q83 is the relevant question, also No consensus, but for MDT with or without ADT, 82% were positive, which I think establishes a consensus (at least for the Europeans😅)

@GertMeerleer @DrAndrewLoblaw To be clear, I would never include N1M0 PCa as oligomets, only distant (M1) metastases. By lumping them together, you obscure any benefit. There is ZERO Level 1 evidence for MDT. You may want to review "levels of evidence:" pmc.ncbi.nlm.nih.gov/articles/PMC31…

@TallAllen @DrAndrewLoblaw It cures 25% of patients after a FU of 5 years. See milenkovic at all. The consensus about the oncological benefit is huge. It is even considered bad medicine not to offer it … Best wishes and good luck !

@GertMeerleer @DrAndrewLoblaw MDT is only palliative SOC, as far as we know. There is no consensus about its oncological benefit. We need more research to establish that.

@TallAllen @DrAndrewLoblaw Correct: MDT if PSMA abd conventional imaging show the same. In this case, MDT is SOC and will stay, patients are very happy with this and benefit is huge. Good luck