A compilation of my threads about academic medicine, research, oncology, radiation oncology, prostate cancer, metastasis, public health, and more:

bit.ly/ZaorskyEducati…

Treatment options for a rising PSA after prostatectomy for prostate cancer

A brief video for patients and physicians

youtu.be/GBxcGlMmc5g

And now the extended version:

Rising PSA After Prostatectomy: What Physicians Should Know in 2026
youtu.be/LTDDCdy1Kzo

We discuss key trials: ARO 9602, EORTC 22911, SWOG 8794, RAVES, RADICALS-HT, GETUG-17, ARTISTIC, SHORTER, RTOG 9601, RTOG 0534, GETUG-AFU 16, SPPORT, RADICALS-HD, POSEIDON, and DHARMA.

We also review guidelines, atlases, tools from @NCCN @Uroweb @ASTRO_org @NRGonc

Novel Tool to Predict Primary Tumor Location in the Setting of Metastatic Cancer With Unknown Primary. Co-authored by @NicholasZaorsky.

Read the full article. bit.ly/3WrsmsL

The “golden age of grift” may be coming to medicine.

Prediction markets are now being introduced to clinical trials, creating opportunities for insider trading, conflicts of interest, and manipulation of trial outcomes.

My new paper in @JCO_ASCO @ASCO: doi.org/10.1200/JCO-26…
pubmed.ncbi.nlm.nih.gov/42874020/

@profgalloway @edels0n

Beta version of our app to predict the site of primary cancer in the setting of metastatic cancer (e.g., based on imaging without biopsy):
primarycancerpredictor.netlify.app

The accuracy is ~85%.

Full manuscript coming soon.

Full manuscript and video now available:
x.com/NicholasZaorsk…

Can we predict where metastatic cancer originated when the primary tumor is unknown? 🔬

Our new study in @JCOOP_ASCO @ASCO analyzed 689,715 patients to develop a prediction tool with excellent accuracy.

📄 pubmed.ncbi.nlm.nih.gov/42863101/

🧮 Free prediction tool:
primarycancerpredictor.netlify.app

🎥 I explain our findings and demonstrate the tool:
youtu.be/wJU7OR5o6FE

Every cancer organ gets the same sequence: surgery is the standard, then trials show you often don't need it, then surgery becomes the salvage.

Breast, larynx, limb, rectum, esophagus, mesothelioma.

Bladder is next. Patients want their organs. 🧵

🚨 5-yr BCR-free after prostate RT = functional cure? Depends who you are 🚨

@EurUrolOnco (RAPTOR)

👥 3,120 men, intermediate (89%) / high-risk (11%) #prostatecancer, 11 RCTs
📊 Post hoc IPD analysis, HDRT ± ADT, trials accrued 1997 to 2012
⏱️ Median f/u 124 mo (HDRT alone ree at 5 yr, adjusted 8-yr distant mets:
6.6% HDRT alone
11% HDRT + short-term ADT
16% HDRT + long-term ADT
✅ 10-yr PCa-specific mortality 2.5% / 4.0% / 3.0%

⚠️ Retrospective, BCR definitions varied by trial, pre-PSMA era; ≤10% was the prespecified "favorable" bar

🎯 One benchmark does not fit all risk groups.

🔗 doi.org/10.1016/j.euo.…
@AmerUrological @UroOnc @PCFnews @AmarUKishan @UrologyTimes @renalandurology

Surgery vs Radiation for Prostate Cancer: New PACE-A Trial Results

I discuss the randomized trial presented at #ASTRO26 @ASTRO_org

Kudos @nickva1 @alison_tree et al

youtu.be/N9zDC7sInwM

Pick any medical specialty other than your own. Who’s the most famous physician in it? You probably can’t name one.
Almost none of us will be known outside our field, and even those who achieve real professional fame are mostly forgotten within a few decades.
Fame is a poor ife to medicine. The work itself matters more: caring for patients, discovering new knowledge, and teaching the next generation.

Cancer cases in sexual and gender minorities are projected to rise 144% in the next 20 years

Via @CEBP_AACR

pubmed.ncbi.nlm.nih.gov/42770946/

Oncologists should anticipate a “rainbow tsunami” 🏳️‍🌈, akin to the "silver tsunami" of elderly patients

pubmed.ncbi.nlm.nih.gov/27371756/

My author copies arrived! 📚

Writing a Medical Research Manuscript is a practical guide to turning a research idea into a clear, rigorous, publishable paper.

I hope it’s useful for students, physicians, researchers, and anyone trying to become a better scientific writer. ✍️ Cu

amazon.com/Writing-Medica…

In American medicine, research is the price of admission but rarely a viable career. Trainees are told it's essential for competitive medical school and residency positions. As faculty, they confront scarce protected time, billing-driven productivity metrics, low grant-funding rates, long funding cycles, and salary-cap gaps their institutions are asked to absorb, just as family and financial obligations grow. Pragmatic clinical research is poorly supported, especially outside well-resourced centers. The incentives favor delivering costly care over improving it.

Trends in cutaneous melanoma in the United States 🇺🇸

pubmed.ncbi.nlm.nih.gov/42637051/

authors.elsevier.com/a/1noaQ_4Lula9…

From 1992-2022, incidence increased from 20.7→52.1/100K, driven increasingly by melanoma in situ, which surpassed invasive melanoma. Meanwhile, survival improved, immunotherapy use expanded, and melanoma accounted for a declining share of deaths.

So, rising incidence ≠ rising
We are detecting more low risk disease that would likely benefit from surveillance, akin to cancers of the prostate, breast, kidney, etc.

Need to take a break from scientific sessions at @ASTRO_org?!

Join us on Sun for this fun and informative session on financial planning! 💰📈

Submit anonymous questions here: docs.google.com/forms/d/e/1FAI…

Submitting a manuscript is like applying to college, except you can apply to only one school at a time and must wait for its decision before applying elsewhere. Naturally, people start with their dream school. But after several rejections, enthusiasm can give way to discouragement.

Rejection is the norm, especially at highly selective journals. Success is going from failure to failure without losing enthusiasm. Learn from the feedback, revise the manuscript, and submit again. A manuscript rejected by multiple journals can still be published, earn hundreds of citations, and change the field.

Rule of 3s for local excision of T1N0 rectal cancer:
Tumor <3 cm
<1/3 of rectal circumference
R0 by >3 mm
No G3 histology
No sm3 invasion
No LVI or PNI (both 3 letters)
<3 × 3 cm (9 cm) from the anal verge (technically 8 cm)
No stage III — no suspicious LNs

This came up during our #radonc resident didactics -- good mnemonic for your board exams @ASTRO_org @ARRO_org :-)

🚨 We’re hiring at @MayoClinic Florida #RadOnc ☢️

We’re looking for a radiation oncologist specializing in metastatic disease and stereotactic radiotherapy.

Great opportunity to build a clinical and academic practice in a growing program, with strong multidisciplinary collaboration and research opportunities.

Please reach out if interested — and please share with anyone who may be a great fit!

@LauraVallow @DanTrifMD @KarinaNietoMD @HoppeBrad @albertattia7