Prostate Cancer - Clinically Localized Flashcards
What is used to risk stratify newly diagnosed prostate cancer patients?
T stage
PSA
Gleason grade group
Tumor volume
MAY use genomic biomarkers
Assess patient to guide germline testing decision
Do NOT routinely use CT with intermediate risk
Bone scan/CT if high risk
Molecular imaging is an option
Should CT or bone scan be used for intermediate risk prostate cancer?
Nope
Preferred management for low risk prostate cancer
AS
Preferred management for favorable intermediate risk prostate cancer
WW if limited life expectancy
AS
RT
RP
Ablation lacks high quality data
Preferred management for unfavorable intermediate risk or high risk prostate cancer
WW if life expectancy <10 years
RP
RT + ADT
NO ablation outside of clinical trial
Palliative ADT if limited life expectancy
AS process
Serial PSA
Repeat biopsy
MRI (but this does not replace biopsy)
What does pelvic LNectomy do?
Stage
Does NOT improve outcomes
Use nomograms to determine risk
Should RP be completed if suspicious nodes identified?
Yes
RP, found to have N1 with PSA 0 –> next steps?
adjuvant therapy or observation
Principles of RT for prostate cancer
Target localization
Normal tissue avoidance
Simulation
Advanced treatment/delivery
Image guidance procedures
Use dose escalation
Type of RT and characteristics
Proton therapy - no evidence of superiority
EBRT - can be moderate or ultra hypofractionated
Permanent low-dose seed implant
Temporary high dose implant
Should nodes be radiated in low or intermediate risk prostate cancer?
No
Should favorable intermediate risk prostate cancer patients getting RT be given ADT?
No
Should unfavorable intermediate risk prostate cancer patients getting RT be given ADT?
Yes - 4-6 months
RT options for high risk or unfavorable intermediate risk prostate cancer
hypofractionated EBRT or EBRT+brachy + ADT x18-36months
Can offer node radiation (use IMRT 45-52Gy)
