Even 20 years into radiology and medical education, the doubt still surfaces. Imposter syndrome never left me. The difference now is knowing that no one has it all figured out. If you’re willing to learn and adapt with humility, you belong in medicine.

Clearly you did not read the manuscript and have minimal grasp of radiation biology. They used low dose SBRT, which did have improved QOL/reduced toxicity in select domains, but will not show superiority with those doses which are not standard today. Most people who use that Rx give a 120% hotspot, but they did not even allow dose much over 38 Gy to hotspots! PACE-B gave Rx of 40 Gy with hotspots over 44 Gy. This may not seem like a lot to you, but it is a big difference. Hilarious this is coming from the biggest proponent of focal therapy who cant even run a single RCT to prove it helps patients.

Have this weird feeling that Gianni Infantino will pull off his mask to reveal Sepp Blatter.

The CO2A sitting is 27 August — about five weeks out. I'm a consultant & I've put a free FRCR 2A question up at a new page — one a day, every day, until the exam and beyond. Answer it, then see why every option is right or wrong, with the source named. frcrvault.com/free-question?…

Football won

#OncTwitter #PCSM

Why should observational cohort data guide treatment in #ProstateCancer where other treatments are supported by quality Phase III evidence? Are we entering an era where oncology is shaped by media headlines and celebrity endorsements rather than the hierarchy of evidence?

Just read the new Light et al. focal therapy paper in European Urology. In short: beyond fatally flawed marketing brochure with a DOI. Here's the autopsy 🧵

Honest title: "In 3,477 Highly Selected, Largely Low-Risk Men With Median 3.3-Year Follow-Up, Focal HIFU/Cryotherapy Resulted in 30% Radical Salvage Rate, With No Comparison to Active Surveillance."

Overturn this. 🧏‍♂️ #USABEL

I think we do know when to add an ARPI to radical prostatectomy: Never. No good reason to add drug cost and toxicity when no benefit in OS, QoL or even MFS (by conventional imaging)?

My @ASTRO_org 2026 GU spring refresher extended "long-course" slide deck is available at drive.google.com/file/d/1xA_… You can also watch the "short-course" 1.5 hour narrated version here:

Interesting that partial gland therapies were not even in the trial. Ivermectin may also offer a better alternative. Perhaps the evidence based conclusion is that active monitoring is the preferred approach based on level 1 data.

I wrote this in a moment I never would have chosen. A sudden pause that made me see my life clearly. The meaning of our work is profound. This experience simply helped me see more clearly what matters most. “Time is Finite” JAMA jamanetwork.com/journals/jam…

Thanks. If I was the patient, I would prefer the STAMPEDE-2 trial, which mandates prostate radiotherapy, and tests the addition of SBRT to the oligomets.

#EAU26 long-term results from randomized ARTO Ph II trial (SBRT + AA vs AA): • bPFS: 43 vs 17 mo (HR 0.49, p<0.001) • rPFS: 44 vs 17 mo (HR 0.48, p<0.001) • OS: NR vs 50 mo (HR 0.55, p=0.02) • PCSS: NR vs NR (HR 0.37, p=0.006) Supports Ph 3 trials of met-directed SBRT + systemic Rx in oligomet CRPC @urotoday

😅

I would stand up, but I need to sit here to finish reading about how sitting is increasing mortality risk.

#GU26 - first visit since COVID. Already bumped into old friends as if I've never been away. Highlighting a piece by @Hannah_Brom describing why we need to do the #ENHANCE trial - high v low dose ARPI @ProstateUKProfs @CRUKresearch @MCRCnews @ManchesterBRC dailynews.ascopubs.org/do/re…

This 2025 review article, led by @DeepOnco of @royalmarsdenNHS, outlines global trends and the evolving diagnostics, treatment, and surveillance of #ProstateCancer: acsjournals.onlinelibrary.wi… @PCaParker @AmarUKishan @VedangMurthy @nickva1 @alison_tree @APCCC_Lugano @ICR_London