Prostate Cancer

Question 1

What stage is a non palpable prostate cancer that is detected via a biopsy due to raised PSA?

Answer 1

T1c

Question 2

What stage is a prostate cancer with palpable nodules and involving >50% of one lobe?

Answer 2

T2b

Question 3

What stage is a prostate cancer with palpable nodules that is involving both lobes?

Answer 3

T2c

Question 4

What drug can be used for non-metastatic prostate cancer that is no longer responding to ADT?

Answer 4

Daralutamide

Question 5

What is the rate of febrile neutropenia with upfront docetaxel?

Answer 5

32%. Therefore always give primary prophylactic GCSF

Question 6

Is there a survival benefit with giving prostate radiotherapy in hormone sensitive metastatic prostate cancer?

Answer 6

Significant survival benefit in low volume metastatic patients but not high volume metastatic patients.

Can give either 55Gy/20# over 4/52 or 36Gy/6# given weekly over 6/52

Question 7

When would you use a PSMA PET?

Answer 7

When there is failure post radical treatment of you are considering salvage therapy

Question 8

What dose of SABR is used?

Answer 8

36.25Gy/5# (?alt days)

Contour prostate and 1cm SV. 5mm expansion to PTV with 3mm posteriorly

Question 9

What is the dose of EBRT and HDR boost when given together?

Answer 9

15Gy/1# (iridium source) followed by EBRT planning scan 1/52 later and 37.5Gy in 15# over 3/52

Question 10

How would you treat N1M0 disease?

Answer 10

Grey area. Lots of variation.

If low volume nodal disease could consider Prostate and pelvic node XRT (with hormones) with chance of cure

If higher volume nodal disease to treat as metastatic with hormones and upfront docetaxel but then give prostate XRT as survival benefit in low volume metastatic disease.

Question 11

Which patients should have a bone scan as part of staging investigations?

Answer 11

All high risk and unfavourable intermediate risk groups

Question 12

According to NICE what men can request a PSA?

Answer 12

All men >50y and high risk men >40y

Question 13

What treatments can be offered in patients who present with newly diagnosed hormone sensitive metastatic prostate disease?

Answer 13

All pts should have ADT
Offer upfront docetaxel OR ~2y abi or enza

Discussion with pt re pros and cons of each

Question 14

When can you offer intermittent hormone therapy?

Answer 14

In biochemical failure post radical treatment if non-metastatic. No evidence of adverse outcomes.

Should avoid in metastatic disease as evidence of poorer outcomes.