Management Flashcards
(20 cards)
How can management options for localised tumours sometimes be decided on?
CPG group
What are the management options for CPG 1,2 and 3 ( localised T1-T2) ?
Active surveillance
Radical prostatectomy (-/+ hormones)
Radical BT / RT (-/+ hormones)
What are the management options for CPG 4 and 5 ( locally advanced T3 - T4)?
Watchful waiting
Prostatectomy?
Radical RT / BT (-/+ hormones)
What is active surveillance (localised)?
Monitors disease in pt with localised tumour who are eligible for radical treatment in future
Only for pt with progressing disease or opt for treatment are considered for RT
Avoid/ delay need for surgery IRT
Regular PSA testing, MRI + biopsy
What is watchful waiting?
Aims to control rather than cure → for people who are not eligible for radical treatment options (any stage)
Involves the deferred use of hormone therapy
Less regular than active surveillance → via GP
What the advantages of active surveillance and watchful waiting?
Avoids side effects → quality of life maintained
less disruption to daily life -→ no treatment at hospital
Disadvantages of watchful waiting and active surveillance?
Anxiety → around not treating and scans
Biopsies can lead to infections and side effects
Rarely - cancer grows faster than expected and practical options no longer suitable (if on active)
General health may deteriorate → no RT
What is radical prostatectomy?
Surgical removal of the entire prostate gland
Laparoscopic and robotic assisted laparoscopic surgery or open surgery is equally as effective
What are the side effects of radical prostatectomy?
Urinary leakage / incontinence
Erectile dysfunction (impotence )
< 5% men develop acute urinary retention - medical emergency
What pt are suitable for radical prostatectomy?
With localised prostate cancers → used with neo adjuvant hormone therapy
What is the pre treatment bladder and bowel preparation?
Micro enema to empty rectum
If a full bladder - void, drink 2 -3 cups, wait 20 minutes
If empty badder - void before treatment
What are rectal spacers?
Aim to reduce bowel side effects by moving rectum out high dose region
Hydrogel liquid injected through perineum under local/ general anaesthetic with ultrasound guidance → remains in place for 3 months then naturally absorbs by body at 6 months or excreted in urine
What is the dose and fractionation of treatment?
60 Gy / 20#/ 4 weeks → prostate only
What is the dose and fractionation of treatment if pt can’t have hypo fractionated RT (according to NICE not RCR)?
74 -78 Gy /37 - 39#/ 7.5 weeks
What is the nodal irradiation dose and fractionation ?
50Gy / 25#/ 5 weeks → or equivalent (grade A evidence)
What is the post surgery dose and fractionation?
66Gy/33#/6.5 weeks → used as a salvage treatment if PSA rises again ( radicals trial )
What happens if target volume indicates the pelvic lymph nodes, seminal vesicles (T3) or pt is post -prostatectomy?
conventional RT may be offered instead of hypo-fractionated regime
•NICE guidance: Do not offer immediate post-operative RT after radical prostatectomy, even to people with margin-positive disease, other than in a clinical trial. [2008]
What are the key hypo fractionated trials ?
CHHiP
HYPRO
HYPO
PROFIT
RTOG 0415
What is pace -B?
A randomised trial for men with prostate cancer → compared stereotactic body RT with conventional RT
Pace -B pt are not on ADT
What are EBRT radiotherapy side effects?
Radiation cystits ( increased frequency and pain) nocturia or retention
Radiation proctitis( tenesmus, diarrhoea, mucus, urgency, rectal bleeding)
Radiation enteritis (abdominal pain, bloating, nausea, vomiting, fatigue )
Sexual dysfunction ( changes to ejaculation)
