It is true that most trials are designed to determine if X intervention is better, but they should not be designed in a way that this outcome is pre-ordained.I would argue that most trials are done to generate “X” intervention is better (see: VISION trial and others for Pluvicto, huge problems with the control arms for those trials…designed that way to show superiority of Pluvicto). Relatively speaking, the designs and analysis of the 2 spacing trials are reasonable.
In my neck of the woods, everyone does it. Urorads, every academic center/satellite, just about everyone. I don't do them personally and have no interest in learning to do so. I send most of our patients to have it done because it's our standard institutional practice and our urologists actually do a really good job with them, but 50% of the Urorads patients that somehow make it to me have terrible spacers. The money trickling out of boston scientific is diminishing since they have mostly cornered the market. However, now that barrigel is approved and trying to gain market share they're wining and dining our admin and providing consulting fees to some of our radoncs and there's now a push to change over. It's insane how much money is involved in this stuff and the vast majority of us never see a penny.In my neck of the woods, there are more people doing spacing in the community than academics (I would guess 50% patients in community, 25% in academics - mostly for SBRT). Are your all experiences the opposite?