Allen Edel

Patient advocate, writer

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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: https://t.co/xn6R1EeHNm

[Allen Edel @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: https://t.co/fe56um6WXB

[Allen Edel @TallAllen]

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

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

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

[Allen Edel @TallAllen]

@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%

[Allen Edel @TallAllen]

@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)?

[Allen Edel @TallAllen]

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

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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?

[Allen Edel @TallAllen]

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

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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.

[Allen Edel @TallAllen]

@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:" https://t.co/HIlw7opnls

[Allen Edel @TallAllen]

@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.