A New Option for Intermediate-Risk Prostate Cancer — and Why It Matters
By Stuart Jordan
A clinical trial exploring a new treatment option for intermediate-risk prostate cancer has produced a striking result. Across 42 patients enrolled in the RTIRE trial at Weill Cornell Medicine, none of the 12-month biopsies showed evidence of recurrent cancer. That outcome is now driving a major Phase III randomized trial — called IRRADIANT — launching at some of the top cancer centers in the country, including Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, Moffitt Cancer Center, Fox Chase Cancer Center, UT Southwestern, and Mayo Clinic (MN & AZ).
I was fortunate to be one of those 42 patients. And I want to tell you why I chose this trial, what the experience was like, and what it may mean for men in our community who have been diagnosed with intermediate-risk prostate cancer — Grade Group 2 or 3, or in Gleason terms, 3+4 or 4+3 — and are considering their treatment options.
The core problem RTIRE was designed to solve is one that AnCan knows well. Focal treatments are appealing — less invasive, fewer side effects, and faster recovery. But recurrence remains a significant concern, and RTIRE was designed specifically to address that challenge. It combines IRE, a precise nonthermal ablation of the dominant lesion, with reduced-dose MR-guided radiation to cover the entire prostate. Think of the IRE as a boost — targeting the most aggressive area with intensity — while the radiation handles the rest of the gland with less total dose than standard SBRT. The goal is to achieve cancer control comparable to whole-gland treatment while reducing side effects.
When I brought this to AnCan two years ago, the group was skeptical. The questions were fair: why take the risk of focal when standard SBRT has a strong track record? And if you were going focal, why add the complexity of a clinical trial? I had my reasons — the credentials of Drs. McClure and Nagar, the MRLinac technology at MSK, and frankly, the logic of addressing the risk of recurrence directly rather than accepting it as a given. The group respected my reasoning without necessarily agreeing with it.
Today, they are the ones asking me to share this story.
My own outcome has been encouraging: a clean 12-month biopsy, consistently low PSA readings, a clean MRI and PSMA scan, manageable urinary side effects controlled with medication, no bowel issues, and some sexual-function changes, which can occur with virtually any prostate cancer treatment. I am not cured. I remain under routine surveillance and am currently considered low risk, and I have no regrets about the path I chose.
IRRADIANT is now open and enrolling. The trial is randomized, so participants have a 50/50 chance of receiving either the IRE boost plus reduced-dose SBRT or standard SBRT radiation treatment alone. If you have been diagnosed with intermediate-risk prostate cancer and are weighing your treatment options, I am happy to discuss further. Reach out during our session or email me at stuart@ancan.org.
RTIRE – trial details and results‑related info
1. ClinicalTrials.gov – official RTIRE registry (Phase II)
Includes protocol, dose (32.5 Gy/5 or 22 Gy/2), eligibility, endpoints, and status. https://clinicaltrials.gov/study/NCT05345444
2. BMC Urology protocol paper (PubMed)
Full write‑up of the RTIRE Phase II design, rationale, and planned outcomes; registered as NCT05345444. https://pubmed.ncbi.nlm.nih.gov/39054460/
AnCan is grateful to the following sponsors for making this recording possible: Novartis, Blue Earth Diagnostics, and Foundation Medicine.
WELCOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: Using Artificial Intelligence (AI) to understand medical information. (bj)
Topics Discussed New diagnosis with history of BPH and Gleason Score of 3+3; MRI false positive, but fusion biopsy detected PCa; health insurance company don’t want to cover treatment for BPH when PCa present; life insurance companies have turned away men with a Gleason Score of 3 +3; Gleason Score 3 +3 is now Gleason Grade Group 1; VA electronic health records not compatible with other electronic health records makes sharing results across health systems difficult; importance of sharing your all of your healthcare information with all of your doctors, let them decide what is important; chose open prostatectomy because penile implant ruled out robotic prostatectomy; active surveillance contemplating active treatment because PSA rose from 7 to 10 over the past year; how do I advocate for myself post-prostatectomy so that my recovery goes as smooth as possible; advice for dealing with radiation proctitis; preparing for a prostatectomy and concerns about Erectile Dysfunction (ED); using Artificial Intelligence (AI) to understand medical information.
AnCan – Rick sent a chat · 8:12 PM
MRI 2nd opinions https://ancan.org/2nd-opinions-for-mris/
RonnieKeys (Sharon,Pa) sent a chat · 8:25 PM
ronniekeys@gmail.com
Larry in AK sent a chat · 8:44 PM
A cheap laptop can be had for ‘way less than $1,000 – maybe $500 on sale. Optical disk (CD/DVD) reader for under $50, sometimes $20 on sale.
AnCan – Rick sent a chat · 8:54 PM
ECE is not automatically T3
Larry in AK sent a chat · 9:07 PM
A well-exercised and well-nourished body withstands the rigors of treatment (ADT, radiation, surgery, whtever) better much better.
Larry in AK sent a chat · 9:14 PM
Sorry, everyone. I gotta go
AnCan – Rick sent a chat · 9:40 PM
You need to run the MSKCC nomograms -http://nomograms.mskcc.org/Prostate/index.aspx
David in Portland, OR sent a chat · 9:52 PM
Add this to all AI questions: When answering, rely only on medically and scientifically credible sources, and provide links to your sources. Double check the accuracy of the links before including them, because you’ve been making a lot of errors lately in inserting incorrect links. Use only PubMed.gov pages as the clickable links in the citations, rather than pasting raw URLs. Avoid weaker secondary sources. Give preference to studies published in the past seven years, especially any meta-analyses and review articles published in well-respected medical journals, but also include any older studies of notable importance. Omit all images.
Ignacio – San Jose sent a chat · 9:53 PM
Thank you!
AnCan – Rick sent a chat · 9:56 PM
Has he had germline testing?
RonnieKeys (Sharon,Pa) sent a chat · 9:57 PM
It’s 9:53 here, and I have an early start tomorrow. Thanks for all your support and interesting discussions!
Jim Ekrut, Ft. Worth TX sent a chat · 10:05 PM
Gentlemen, thanks so much for an excellent and helpful session. I have sent a message to my gastroenterologist about hyperbaric oxygen treatIment. I appreciate your help.
AnCan – Rick sent a chat · 10:08 PM
Paul Maroni Denver, colorado Anschutz https://www.uchealth.org/provider/paul-maroni-md
AnCan – Rick sent a chat · 10:12 PM
Brian Helfand https://www.northshore.org/apps/findadoctor/physicians/brian-t.-helfand
Ignacio – San Jose sent a chat · 10:12 PM
Thank you all for the support and encouragement. Have a good evening.
A relatively new year, new guidelines, and new tools for prostate cancer screening and monitoring.
In recent months, the AUA updated its 2023 guidelines specifically for early detection of prostate cancer (https://www.auanet.org/guidelines-and-quality/guidelines/early-detection-of-prostate-cancer-guideline). Along with those guidelines, two other organizations have updated or developed additional tools that are beneficial to all men, regardless of where they are on the prostate cancer journey (or even those not yet on a journey).
Consider them collectively as an introduction to screening (NCCN), an AS-focused source (ASPI), and a comprehensive guide for early-stage prostate cancer.
I would not consider any of them as a standalone product for all the information a man might need. The NCCN guidelines are focused on screening and are relatively basic. ASPI’s product is focused on AS, but some may find the scope and scale of information a bit overwhelming without someone to advise and assist them. The appendix at the end of the pamphlet would be exceedingly useful for anyone beginning their prostate cancer journey. Finally, the AUA guidelines are broader and developed more for urologists.
AnCan frequently recommends second opinions on prostate cancer and genitourinary (GU) pathology slides – whether it be from biopsy, surgery or another protocol. Our recommended providers are:
AnCan is grateful to the following sponsors for making this recording possible: Novartis, Blue Earth Diagnostics, and Foundation Medicine.
WELCOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: New prostate cancer (PCa) diagnosis with potential Lynch Syndrome in the family. (bj)
Topics Discussed New diagnosis with potential Lynch Syndrome in the family; exploring genetic testing as well as somatic vs germline testing; be careful about interpreting test results as a guarantee; two types of prostate cancer bioposies—transperineal carries less infection risk; primer on different radiation treatments for prostate cancer; focal treatment carries high recurrence risk with Gleason Score 4+3 or higher; cyber knife, nano knife, heat therapy are forms of focal treatment; things to expect three weeks after a radical prostatectomy; dealing with anxiety following a radical prostatectomy or PSA changes following treatment; Artera AI as a predictor of biochemical recurrence.
Chat
Stuart sent a chat · 7:50 PM
Dr. Ming Zhou Mount Sinai Health System Department of Pathology, Box 1194 Annenberg Bldg. 15th FL 1468 Madison Ave New York, NY 10029 Email: Ming.zhou@mountsinai.org Telephone: (212)241-8881
Stuart sent a chat · 7:51 PM
Dr. Jonathan Epstein – https://advanceduropathology.com/ Tel:516-760-2037 jepstein@imppllc.com
AnCan – Boykin sent a chat · 8:12 PM
Last Low/Intermediate Video Chat on YouTube (same as above) https://www.youtube.com/watch?v=-jMy0byKzdE
AnCan – rick sent a chat · 8:24 PM
Also Jesse McKenney at Cleveland Clinic mckennj@ccf.org Expert on cribriform
AnCan Bill sent a chat · 8:53 PM
stuart@ancan.org & bfranklin@ancan.org
medium.com/@mperloesent a chat · 8:54 PM
Is brachy indicated after sepsis from the biopsy? I’d sure be leery of that.
Steve in Malaysia sent a chat · 9:05 PM
The canadian health system is per province vs national.
Steve in Malaysia sent a chat · 9:05 PM
Sunnybrook in Toronto is the most advanced center and has all modalities including MR Linac
Steve in Malaysia sent a chat · 9:07 PM
i believe there is also MR Linac in Calgary.
AnCan – rick sent a chat · 9:08 PM
We’re aware, Steve. BC is not too bad. Also v. familiar with Sunnybrook/Klotz
Steve in Malaysia sent a chat · 9:08 PM
👍
Bob in Georgia sent a chat · 9:17 PM
I leave next tuesday, preop on Wed, spacor on Thurs
AnCan – Boykin sent a chat · 9:21 PM
boykin@ancan.org
AnCan Bill sent a chat · 9:22 PM
Ask for a referral to Pelvic Floor Physical Therapy.
Bob in Georgia sent a chat · 9:27 PM
Going to Sloan Kettering with Dr Nagar
Mark WV sent a chat · 9:28 PM
nite
AnCan – Boykin sent a chat · 9:29 PM
Good nite Mark!
AnCan Bill sent a chat · 9:33 PM
May 21st at 8 p.m. Eastern is the next MSF.
AnCan – rick sent a chat · 9:33 PM
Next MSF meeting … in this room same time on Thu May 21
Larry S – ADT by estradiol sent a chat · 9:49 PM
Re: When to stop PSA testing. I have not read this yet (it just came into my inbox this morning), but the synopsis looks hopeful for more men getting screened later in life and having those tests INTERPRETED MORE INTELLIGENTLY so as to avoid alarm and unnecessary procedures. https://www.news-medical.net/news/20260428/NCCN-publishes-new-patient-guide-for-prostate-cancer-screening.aspx?utm_source=news_medical_newsletter&utm_medium=email&utm_campaign=prostate_cancer_newsletter_10_may_2026
AnCan – rick sent a chat · 9:49 PM
from Joel…”Got it. Thank you Rick”
Bob in Georgia sent a chat · 9:53 PM
Nite
AnCan – Boykin sent a chat · 9:53 PM
Good night Bob!
AnCan – Boykin sent a chat · 9:59 PM
Artera AI https://artera.ai/
Fritz sent a chat · 10:05 PM
Thanks so much -I’ll report back next meeting. Safe journey everyone
Jim E., Ft. Worth TX sent a chat · 10:11 PM
Have to go for now. Thanks so much!
AnCan is grateful to the following sponsors for making this recording possible: Novartis, Blue Earth Diagnostics, and Foundation Medicine.
WELCOME all to our newly recorded Low/Intermediate Prostate Cancer Group. To receive notice when new recordings are posted, either follow us on this YouTube Channel or sign up to our Blog via https://ancan.org/contact-us/ – check New Blog box.
AnCan respectfully notes that it does not accept sponsored promotion. Any drugs, protocols or devices recommended in our discussions are based solely on anecdotal peer experience or clinical evidence.
AnCan cannot and does not provide medical advice. We encourage you to discuss anything you hear in our sessions with your own medical team.
AnCan reminds all Participants that Adverse Events experienced from prescribed drugs or protocols should be reported to the pharmaceutical manufacturer or the FDA Adverse Event Reporting System (FAERS). To do so call 1-800-332-1066 or download interactive FDA Form 3500 https://www.fda.gov/media/76299/download
AnCan’s Prostate Cancer Forum is back (https://ancan.org/forums). If you’d like to comment on anything you see in our Recordings or read in our Reminders, just sign up and go right ahead. You can also click on the Forum icon at the top right of the webpage.
All AnCan’s groups are free and drop-in … join us in person sometime!
Editor’s Pick: Treatment at Center of Excellence (COE) preferred over Community Care. (bj)
Topics Discussed Using the Memorial Sloan Kettering Cancer Center (MSKCC) Nomogram to predict the success rate of surgery versus recurrence risk; clinical significance of cribriform patterns in pathology reports; Androgen Deprivation Theory (ADT) & Cardiac Health means understanding the diffference between short- and long-term risks as well as the importance of cardio-oncology monitoring; getting second opinions from on pathology reports are important to confirm Gleason score and identify other potential concerns; treatment at a Center of Execellence (COE) preferred over Community Care because COE offer integrated, multi-disciplianary and access to advanced technologies.
Chat
AnCan – Boykin sent a chat · 8:01 PM Dr. Ming Zhou Mount Sinai Health System Department of Pathology, Box 1194 Annenberg Bldg. 15th FL 1468 Madison Ave New York, NY 10029 Email: Ming.zhou@mountsinai.org Telephone: (212)241-8881
AnCan – Boykin sent a chat · 8:02 PM Dr. Jonathan Epstein – https://advanceduropathology.com/Tel:516-760-2037jepstein@imppllc.com
Steve Ft Worth sent a chat · 8:15 PM STeven Warwick
AnCan – Rick sent a chat · 8:19 PM GoTo877 582 7011for tech assistance
AnCan Bill sent a chat · 8:31 PM http://nomograms.mskcc.org/Prostate/index.aspx
AnCan – Boykin sent a chat · 8:38 PM Have him run the MSKCC nomogram http://nomograms.mskcc.org/Prostate/index.aspx
David in Portland, OR sent a chat · 8:39 PM Active Monitoring, Surgery, and Radiotherapy for Cribriform-Positive and Cribriform-Negative Prostate Cancer: A Secondary Analysis of the PROTECT Randomized Clinical Trial (Sushentsev, Nikita): https://jamanetwork.com/journals/jamaoncology/article-abstract/2840006?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamaoncol.2025.4125
Jp sent a chat · 8:46 PM Can I ask a question on here by chat ?
Jp sent a chat · 8:47 PM Ok
AnCan Bill sent a chat · 8:49 PM JP – you can put something in the chat. If you wait until the end, we’ll get to you in the virtual room.
Jp sent a chat · 8:50 PM Thank you
My question is about the real side effects of chemo
My doctor wants me to start in September
Jp sent a chat · 8:52 PM Got it thank you
Jp sent a chat · 8:52 PM New
Jp sent a chat · 8:53 PM 🙏
AnCan – Rick sent a chat · 9:07 PM Focal therapy article on our bloghttps://ancan.org/prostate-cancer-focal-therapy-as-primary-treatment/
AnCan – Rick sent a chat · 9:08 PM https://ancan.org/prostate-cancer-focal-therapy-as-primary-treatment/
David in Portland, OR sent a chat · 9:55 PM A Phase III Randomize Controlled Trial of Sterotactic Body Radiotherapy in Localized Prostate Cancer: Pace-B Trial (van As, Nicholas): https://pmc.ncbi.nlm.nih.gov/articles/PMC7616714/?utm_source=chatgpt.com
AnCan Bill sent a chat · 9:58 PM https://ancan.org/events/month/
