The first three episodes established the foundation – anatomy, risk groups, workup, and surveillance. Now, we begin treatment. This episode explores the physics and biology of dose delivery to the prostate. We'll cover three key areas: First, the benefits of higher doses for biochemical control and what long-term data reveals about distant metastasis and cancer-specific mortality. Second, the rise of moderate hypofractionation as the standard of care, including supporting trials, radiobiologic principles, and important toxicity signals. Third, the FLAME concept – boosting the MRI-visible dominant lesion – and the importance of prioritizing OAR constraints.

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This is Episode 1: Prostate – Anatomy, Pathology, Risk Groups, and Natural History. This foundational episode covers everything in the prostate series – dose escalation, hypofractionation, brachytherapy, ADT integration, salvage, and oligometastatic management – as we delve deep into three key areas. First, prostate anatomy, including zonal architecture, lymphatic drainage, and adjacent structures that influence local cancer extension and target volume design. Second, risk stratification using Grade Group, PSA, T stage, and biopsy tumor volume – the four key variables for prostate cancer patient classification. Third, natural history, examining landmark data to identify aggressive cancers, understand non-lethal cases, and apply competing-risk thinking to determine appropriate treatment strategies.

This is Episode 39a: Sinonasal II Maxillary and Ethmoid SCC and SNUC Management. In our last episode, we established the anatomic and histologic foundations for sinonasal cancers. Now, we apply that knowledge. This clinical decision-making episode will guide you through NCCN algorithms for maxillary and ethmoid sinus tumors. We'll cover recommending elective neck irradiation, orbital preservation vs. exenteration, and the induction chemotherapy paradigm for SNUC, which has revolutionized the management of aggressive sinonasal tumors. The episode uses two cases to represent the clinical scenarios you'll encounter on oral boards: a resectable maxillary sinus SCC and a SNUC with skull base involvement. By the end, you'll confidently navigate both algorithms.

This is Episode 38: Sinonasal I Anatomy, Histology Diversity, and Multimodality Logic. We are now entering a block of head and neck oncology that is genuinely unique. Sinonasal cancers represent fewer than 2,000 cases per year in the United States — less than 1% of all malignancies — yet they pack an outsized punch on written and oral board examinations. Why? Because these tumors test everything at once. You need to know complex three-dimensional anatomy at the interface of the skull base, orbit, and brain. You need to navigate a histologic landscape unlike any other site in the head and neck, where SCC predominates, but a long tail of histologically distinct tumors — esthesioneuroblastoma, adenoid cystic carcinoma, SNUC, mucosal melanoma, and others — each demand fundamentally different management algorithms. And you need to understand why multimodality therapy is the default — not because of randomized trials, which essentially do not exist — but because the retrospective evidence and the anatomic realities of this site demand it. This episode is your anatomic and conceptual foundation. We will map the sinuses and nasal cavity in board-relevant detail, walk through the histology types you must recognize on sight, learn two separate staging systems, and understand the evidence behind the multimodality paradigm. In subsequent episodes, we will tackle site-specific and histology-specific management, planning around the orbit and skull base, and esthesioneuroblastoma as its own entity.

Today we simulate the oral boards exam in three clinical blocks plus a lightning round. Block One walks through comprehensive postoperative management. Blocks Two and Three test specific decision pivots, perineural invasion stop points and metastatic biomarker-driven therapy. Then we close with rapid-fire pearls.