In this episode of the Dr. Geo Prostate Podcast, we welcome Dr. Jonathan Lischalk, Director of Genitourinary Cancers at MedStar Georgetown University Hospital and former Medical Director at NYU’s NYCyberKnife Center. Dr. Lischalk breaks down the evolution of radiation oncology and how cutting-edge imaging and targeted SBRT (Stereotactic Body Radiation Therapy) are reshaping prostate cancer treatment.

We explore how imaging advances like MRI and PSMA PET scans are enabling unprecedented precision, the future of genetic-based personalization in prostate cancer therapy, and why fewer, more focused radiation sessions might soon become the new standard. From understanding the biology of radiation dosing to upcoming trials eliminating ADT in select patients, this is a must-listen for anyone looking to stay informed on the forefront of cancer care.

🔑 Key Learning Points:

• What is SBRT?
• SBRT delivers high-dose radiation with sub-millimeter precision over fewer sessions, minimizing harm to healthy tissue.
• The evolution of imaging:
• MRI and PSMA PET scans now allow radiation to be personalized based on tumor location and surrounding anatomy.
• Radiation then vs. now:
• From “clouds” of radiation in the '90s to sculpted beams today—Dr. Lischalk likens this transformation to upgrading from a flip phone to an iPhone.
• Radiation dose explained:
• It’s not just how much radiation, but how it’s delivered—larger, more targeted doses in fewer sessions are more effective and less burdensome.
• Personalized radiation planning:
• Every radiation plan is customized based on imaging, anatomy, and now genetics. This improves outcomes and reduces side effects.
• The future of personalization:
• Dr. Lischalk discusses new research using genetic tests (like Decipher) to determine who needs radiation, who may avoid ADT, and who may benefit from one single treatment.
• SBRT vs. IMRT and Proton Therapy:
• Head-to-head comparisons show SBRT is equally effective with less treatment time—though more trials are underway, especially for proton therapy.

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