Daniel E Spratt
@DrSpratticus
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The comments & viewpoints are my own and are not endorsed or necessarily representative of UH CMC, CWRU, NCCN, FDA, NCI, or NRG. They are my personal opinion.
Cleveland, OH
Joined October 2016
X-torial: Cleaning up the misinformation about @JoeBiden and #ProstateCancer that I am reading everywhere. The purpose of this is to provide education from someone who treats and studies PCa for a living, lead the USA @NCCN PCa guidelines, hold leadership in @NRGonc @theNCI
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Nothing wrong with coming off AS at 18 months, however a huge number of patients on AS series like Canary PASS come off of AS at time of confirmatory biopsy and thus were not on AS. Need as a field to standardize AS reporting to start at time of confirmatory test which is the
@DrSpratticus @ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw The most common GG2 today is low volume pattern 4 and favorable subtype -- clinically and biologically barely distinguishable from GG1. There's also nothing wrong with 18 mos AS - pts that don't rush into tx and show early signs of progression have less decision regret.
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Who gets to decide when Americans are taxed — the President or Congress? In the latest Courtside Commentary, NCLA’s Mark Chenoweth sits down with attorney Steffen Johnson to unpack the Supreme Court cases challenging President Trump’s “emergency” tariffs under the International
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They are old and would love better data, but it is the best data we could find. We asked experts for the best data on safety of AS in intermediate risk disease and you can see we have very few patients with followup beyond 10 years, let alone 15. This is where the Mets events
@DrSpratticus @ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw PIVOT, SPCG4, Sunnybrook, and ProtecT are all ancient history in terms of dx SOC, as is clear from ProtecT table S4 in the 2023 pub. Dx standards are completely different today even from early Canary days.
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Prescient conclusion from @LotanLab #pcfretreat25: “Diagnosis and grading of prostate cancer are poised to become pathologist-supervised rather than pathologist-driven” @PCFnews
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physics exam: 📝🫣 bubble tea: 🧋 💫 Balance restored. @RadOncUH residents before and after physics midterms. Also featuring ProsTea (now with D95 coverage 😎)
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Our AI-powered platform helps you deliver digital innovation faster and with less risk by providing a fundamentally better approach to test automation.
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@ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw 8/8 When we made the FIR/UIR system this was to guide ADT use with RT, not AS. Please share AS data that GG2 (not FIR which includes GG1 patients) can safely be followed 15+ years on AS. ProtecT (not AS) we now know the importance of intraductal histology. Guidelines need to
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@ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw 7/n This was an eye opening analysis as we have no good evidence that supports AS with GG2 patients (this is different than GG1 with PSA of 10-20) with long-term followup of 15 years where we see across all of the studies mets risks of 10-30% depending on trial, era, and
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@ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw 6/n So what data with long-term followup do we have that AS is safe for biomarker unselected GG2 disease? Please send me the data as across the historical Sunnybrook data and Canary PASS there are only 5 patients at risk at 15 years, and almost all events occur at or beyond 10
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@ChapinMD @HimanshuNagarMD @AmarUKishan @DrAndrewLoblaw 5/n If WW, AM, and older AS data in IR and GG2 data is not safe, what about contemporary AS, usually with MRI? We turned the Canary PASS data into time to event data, and there still is 10% mets risk at 15 years in GG2 patients. Not great! Also note the events occur around or
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apparently the bubble in people searching for ‘AI bubble’ has burst
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@ChapinMD @HimanshuNagarMD @AmarUKishan 4/n If WW in IR and AM in GG2 are not safe, then what about AS in GG2? Sunnybrook data shows that this still is not very safe with 15 year mets risk of 16% in their historical data published. Note that almost all mets events occur around or beyond 10 years. @DrAndrewLoblaw
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@ChapinMD @HimanshuNagarMD @AmarUKishan 3/n If WW is not safe in IR, what about active monitoring (AM) in GG2 prostate cancer? This also is not safe in unselected GG2 patients (more on impact of intraductal/cribiform later). Data from ProtecT trial shows a 17% 15-year mets risk with AM.
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2/n How safe is it to not give treatment in intermediate-risk PCa? We know it is unsafe in men receiving watchful waiting (WW) from SPCG-4 and PIVOT trial with 30% risk of mets at 15 years @ChapinMD @HimanshuNagarMD @AmarUKishan
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New out in @TheLancetOncol with Ted Schaeffer: https://t.co/mdc6hQNpUN "Revisiting prostate cancer active surveillance candidacy" A close look at the fallacy and risks of active surveillance (AS) in unselected intermediate risk (IR) men. @wandering_gu @TylerSbrt
pubmed.ncbi.nlm.nih.gov
Revisiting prostate cancer active surveillance candidacy
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Truly honored to speak @PCF_Science in front of countless giants in the field to discuss the ongoing legacy of @felixfengmd and our practice changing results showing for the 1st time in history a prospectively validated predictive biomarker for hormone therapy in prostate cancer!
@DrSpratticus giving the Felix Feng Legacy Lecture Felix’s impact on patients is mind boggling. And will continue for decades, at minimum Amazingly, his impact on team science and mentoring in #ProstateCancer may be even larger!
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We're hosting a Space tomorrow at Nov 4th @ 2:30pm ET (watch your clocks from Sunday!) featuring @Moon_Settler from @MonkeDAO talking about $SOL on SURGE (and our first game, SPOT ON) what's happening over at @MonkeFoundry $BTC trading and what community means to us.
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NRG-GU006 trial for post-prostatectomy radiation therapy. @DrSpratticus @caseccc joins @jmmrad @WashUMedRadOnc to present the NRG GU006/BALANCE trial results, demonstrating PAM50 molecular subtypes as the first prospectively validated predictive biomarker guiding hormone therapy
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If you missed the first session, don't you worry, we have another this afternoon 10/20 at 3p ET!! Hope to see you there to discuss the next steps of your medical physics journey!!!
Looking for an awesome medical physics residency? Look no further than University Hospitals Case Western Reserve. We have everything you need! Look for the sign up on AAPM's STSC Page. First open house is tomorrow 10/7!!
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To operate or not on panc NETs <2 cm…? The answer is NOT. Excellent presentation by @spartelli on the long term outcomes of the ASPEN trial. Almost 1000 patients observed w/o resection and progression was uncommon, mets rare and survival the same as with resection.
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Galleri promises to detect multiple cancers but new evid casts doubt on this much hyped blood test: A blood test being trialled in large numbers of people in @NHSEngland is facing mounting evidence against its implementation as a screening tool for early cancer. @mgtmccartney and
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Saying this again louder for the #ESMO25 audience. If OS couldn’t be shown due to crossover, the correct interpretation is that the drug can be reserved at the next line without compromising outcomes.
@oncology_bg @oncodaily @TheLancetOncol @SamuelXStevens @lateuwen Thanks. So much good stuff in there but here is one of the most important: crossover. If crossover contaminates OS then it simply tells you there is no OS value in bringing the drug earlier or combining with earlier line treatment - you could and should just use it sequentially.
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Robotic surgery isn’t just better for the patient — it’s better for the surgeon too. I finished a very challenging Whipple and still felt energized enough to do an hour on the StairMaster. If it were open, I’d probably be lying down with neck and back pain.. #roboticsurgery
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