MRI-LINAC Radiation for Prostate Cancer with Dr. Michael J. Zelefsky
What if prostate cancer treatment weren’t months of daily radiation—but five ultra-precise sessions guided in real time by MRI? Today, Dr. Michael J. Zelefsky (Professor of Radiation Oncology, NYU Grossman School of Medicine) explains how MRI-LINAC and adaptive planning are redefining accuracy, reducing side effects, and personalizing care. A pioneer behind IMRT and image-guided radiotherapy, Dr. Zelefsky breaks down SBRT vs. IMRT, protons vs. photons, HDR brachytherapy, when to add hormone therapy, and how genomics + AI are shaping what’s next.In this conversation, Dr. Zelefsky charts the evolution from long-course radiation to short-course SBRT with outcomes comparable to 7–9 week regimens—thanks to precision imaging and planning. He clarifies where IMRT ends and SBRT begins, why protons haven’t shown superiority over photons in prostate cancer, and where HDR brachytherapy (Ir-192) shines—especially as a boost in higher-risk disease. We dig into dose equivalence (why 5×8 Gy can match ~80–90 Gy long-course), risk-based treatment + ADT duration, and how Decipher/Artera scores can refine decisions. Most exciting: MRI-LINAC with continuous motion monitoring keeps the prostate in a virtual “bullseye,” enabling whole-gland treatment with focal boosts today—and potentially true focal therapy tomorrow as biologic imaging and AI mature.Time-Stamped Highlights00:00 – Welcome 02:00 – Why Dr. Zelefsky’s work is so respected; career arc and impact04:00 – What changed: CT/MRI planning → 3D-CRT → IMRT → SBRT12:45 – IMRT vs. SBRT: definitions, session counts, who gets what19:10 – Energy sources overview: photons, protons, brachytherapy20:30 – Protons vs. photons: evidence, indications, cost, access24:00 – HDR brachytherapy (Ir-192) as a temporary “in-and-out” boost28:00 – Dose logic: why 5×8 Gy (~40 Gy) ≈ long-course 80–90 Gy29:30 – Risk groups (low/intermediate/high) and when ADT is crucial33:00 – ADT durations (6–36 months): what trials actually showed37:00 – Genomics (Decipher/Artera): resolving risk discrepancies39:00 – What MRI-LINAC adds: real-time adaptive planning43:00 – Continuous Motion Monitoring (CMM): beam stops if target moves47:00 – Treat whole gland + boost the DIL (FLAME study approach)49:00 – Toward focal therapy with better biologic imaging + AI54:00 – How to choose: values, side-effects, lifestyle, comorbidities01:01:00 – Final guidance: don’t be overwhelmed—multiple good option🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet — Enjoy fasting benefits with food. Supports cellular renewal, metabolic health, and fat loss. Special offer for our listeners: Get the ProLon kit for $148 → https://bit.ly/3TVehAxAG1 by Athletic Greens — 75 high-quality vitamins, minerals, probiotics, and adaptogens in one daily scoop. Supports gut health, immunity, energy, and focus. Try it here → https://bit.ly/3mA2tVV💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. →