Jeff Michalski

Professor of Radiation Oncology at Washington University and the Siteman Cancer Center. Opinions expressed here are my own.

[Jeff Michalski @jmmrad]

@TylerSbrt @felixfengmd @Sophia_KamranMD @HimanshuNagarMD @NRGonc @davidjeinstein @DrRanaMcKay @alison_tree @urotoday @OncoAlert @PCF_Science @ASTRO_org @angela_jia_ @DrSpratticus @AmarUKishan @rtdess @drjefstathiou @NicholasZaorsky @a_dalpra @seanmmcbride After ‘26 report of BALANCE Trial I asked @DrSpratticus if STADT could substitute for the Apalutamide that helped the LuminalBs. This analysis of SPPORT supports that and can justify omission of ADT for many patients needing SRT. I may still offer for some HR decipher or high PSA

[Jeff Michalski @jmmrad]

Dr vanAs reports results of PACE-A confirming that SBRT is a safe, effective alternative to radical prostatectomy. Don’t miss the QoL results to be updated soon!

[Jeff Michalski @jmmrad]

@StephenChunMD @UTMDAnderson @JenniferLitton @PrajnanDasMD Congratulations. Stephen!

[Jeff Michalski @jmmrad]

@stuxrt @LevineCancer @AtriumHealth @WakeCancer Congratulations!

[Stephen Chun @StephenChunMD]

The @NRGonc podcasts turns 2 today! Thanks to all our guests and listeners for continued growth/reach. @lauren_henke @Qle_stanford @MitchMachtay @RTOGFoundation @GOG @NSABPFoundation @tambreleighn @NiuSanford @IyengarPuneeth @vinaigondi @wallyjc @A_THOMASMD @DrSpratticus

[Jeff Michalski @jmmrad]

@DrMLChua Congratulations!

[Jeff White @PRJeffWhite]

Hey you Early Birds! Tomorrow (Thur 6/25) is the early bird reg deadline for #ASTRO26.
You know you want to be there, so lock in the lowest rate & book your Boston hotel.

[Jeff Michalski @jmmrad]

Totally agree, Chris. Their argument for ADT in the control arm was that patients couldn't be blinded to what they were receiving. So give 100% of patients side effects for a meaningless study endpoint?

Ironic, in RO we have conducted practice changing studies without blinding.

[Chris Parker @PCaParker]

@TylerSbrt @jryckman3 @cpeedell @urotoday @zklaassen_md @DanaFarber @TDorffOnc @cityofhope 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)?

[Jeff Michalski @jmmrad]

@Prof_Nick_James @SbrtSean Agree, @Prof_Nick_James! They’ve substituted a meaningful but unattainable endpoint with a meaningless attainable endpoint.

[Jeff Michalski @jmmrad]

@ChrisSweens1 @declangmurphy @gu_onc @Uromigos @ANZUPtrials @Prof_IanD Totally agree! While it’s important to capture PET based DMFS, we shouldn’t be equating it with CI endpoints.

[Jeff Michalski @jmmrad]

@dr_coops @declangmurphy Incomparable endpoints. PET inProteus, CI in Enzarad

[Jeff Michalski @jmmrad]

I fear this will be used to offer inappropriate surgery in HR PCA patients that are better served with a treatment that has proven to improve survival in men with HR PCa, XRT and ADT.

[Jeff Michalski @jmmrad]

I’m puzzled that a treatment that almost no one considers as an SOC (ADT and surgery) is the control arm. What difference does it make that apalutamide improved PET based MFS if it wasn’t compared to surgery w/o ADT (with appropriate salvage therapy).

[Daniel E Spratt @DrSpratticus]

11/n #ASCO26

In summary, congrats to a large well conducted trial. Amazing team.

The take home message to me is that the addition of 1 year of ADT+Apa to RP improves BCR and EFS as expected, which can be captured in PET-based MFS which they changed their primary endpoint to include. No data has been shown with large enough effect sizes to believe this will ever translate into conventional imaging MFS, or more importantly OS signals, to make me excited about this for patients.

Does a man want 1 year of ADT/ARPI+RP and still high rates of post-op RT+ADT....when they can now simply get RT+ADT without any ARPI based on Enzarad?

@prostatemd @SbrtSean @PCF_select @urotoday @ASCO @AmarUKishan @Soum_Roy_RadOnc @CaPsurvivorship @wandering_gu @ChapinMD @SeanMcGuireMD @seanmmcbride @TylerSbrt @HimanshuNagarMD @DrPaulNguyen @DrHowardSandler @aleberlin2 @neerajaiims @ChadTangMD @DrMLChua

[Jeff Michalski @jmmrad]

If this is a registration trial, I cannot see the FDA approving it with only a PET based MFS benefit. So, physicians can prescribe off label but payer may choose not to cover because the endpoints are not meaningful.

[Daniel E Spratt @DrSpratticus]

10/n

Other things ppl need to appreciate:
1. This is supposedly in M0, yet baseline PSAs were as high as 2798. This is same problem in STAMPEDE M0 subset analysis. These are M1 patients and can drive the entire trial results (notably Enzarad was negative for conventonal MFS, but STAMPEDE was positive for MFS...).
2. They state this is a final analysis at just 5 yr followup w/o mention of OS data. Early followup will massive favor EFS and PET-based MFS outcomes as usually with longer followup curves start to converge unless true cures are increased. Really hope this is not final analysis...if so that is very concerning as almost no competing risks will have happened in 5 years.
3. pCR/MRD is also not a surrogate endpoint and of no established value yet in prostate cancer. Namely bc patients can simply receive post-op RT with high success rates with lower toxicity than most systemic agents.

[Jeff Michalski @jmmrad]

@drkeithsiau Gout, psoriatic arthritis, rheumatoid arthritis are my top considerations.

[Neha Vapiwala @NehaVapiwala]

@TylerSbrt breaks down #radiotherapy of primary in patients w/ metastatic hormone sensitive #prostatecancer @APCCC_Lugano.
Check your biases, follow the data & don’t withhold prostate RT in pts with PSMA PET-only mets! (Yes, the Will Rogers phenomenon is real:-) @Silke_Gillessen @AOmlin @ChrisSweens1 @DrYukselUrun @Prof_Nick_James @AlbertoBossial @piet_ost @PBlanchardMD @KOSJ12 @BarbaraJereczek @jmmrad @DrSpratticus @drjefstathiou

[Dr. Jason Efstathiou @drjefstathiou]

@MassGenBrigham @urotoday @PBlanchardMD @EdwardSchaeffer @Tilki_De @ChrisSweens1 @jmmrad @BertrandTOMBAL @declangmurphy @DrRanaMcKay @ValerieFonteyne @piet_ost @KOSJ12 @aaparicioMD @Prof_IanD @DrYukselUrun @fizazi_karim @quimmateo @SandhuShahneen @CaPsurvivorship @LoebStacy @NehaVapiwala @nachoduranm @nickva1 @charlesryanmd @Nicola_Fossati @ProfJOSullivan
#APCCC #ProstateCancer #PrecisionMedicine #genomics #ArtificialIntelligence #CancerCare #Oncology #MedicalInnovation

[Dr. Jason Efstathiou @drjefstathiou]

APCCC 2026 kicked off today! Big congratulations and thanks to our wonderful hosts and organizers @Silke_Gillessen @AOmlin!

Among the lakeside beauty of Lugano, Switzerland with the Italian border just across the water, thought leaders in prostate cancer are convening for the Advanced Prostate Cancer Consensus Conference (APCCC) 2026.

Set against a striking landscape, this globally recognized meeting remains one of the field’s most important forums for tackling the complexities of advanced prostate cancer. As innovation accelerates, so does the challenge: translating an expanding array of data, tools, and therapies into clear, evidence-based decisions for patients.

This year’s discussions are spanning next-generation imaging, biomarkers, molecular characterization, and evolving treatment strategies, all aimed at more precisely individualizing care.

I conducted a session today exploring a central question: can genomics and AI help minimize over- or undertreatment?

As the science advances, so too must our collective approach, ensuring we deliver the right treatment, for the right patient, at the right time.

@MassGenBrigham @urotoday

#APCCC #ProstateCancer #PrecisionMedicine #Genomics #ArtificialIntelligence #CancerCare #Oncology #MedicalInnovation

[UroToday.com @urotoday]

#Debate Patients with high-risk localized #ProstateCancer need the addition of an ARPI to radiotherapy + long-term ADT – Against the addition of ARPI to radiotherapy + ADT. Presentation by @jmmrad @WashUMedRadOnc. #APCCC26 written coverage by @zklaassen_md @GACancerCenter > https://t.co/rA8vNzjzQY @APCCC_Lugano

[Piet Ost @piet_ost]

1/7 🧵 New in @LancetOncology: we built a Delphi consensus on primary endpoints for MDT trials in oligometastatic cancer — because the endpoints we've been using were designed for drugs, not for ablation.
On behalf of the EORTC–ESTRO OligoCare consortium.