Download Intermediate risk prostate cancer

PROSTATE CANCER
THE TRIPLE TS
TIPS TRICKS & THOUGHTS
BY
Mostafa El-Haddad
PROSTATE CANCER INCIDENCE
AND MORTALITY
LONG NATURAL HISTORY
STAGING SYSTEM
• Pathological T2 substages may not confer any prognostic value
for predicting biochemical recurrence after RP.
P
CaPSURE database
Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database
Staging errors occurred in 1370 of the 3875 men (35.4%)
who met the study inclusion criteria.
IS IT TIME FOR PRE-BIOPSY MRI?
IS IT TIME FOR FUNCTIONAL IMAGING?
GALIUM OR CHOLINE PET
IS IT TIME DYNAMIC ENHANCED MRI?
IS IT TIME MRS?
NEW AJCC
EXPECTED
JANUARY 2017
INTERMEDIATE
RISK DISEASE
DILEMMA
?
INTERMEDIATE RISK?
•Stage T2b or T2c.
•Gleason score of 7.
•PSA10–20 μg/L.
The NCCN guidelines also allow, but do not require, patients with multiple intermediate risk factors to be classified as high, rather than
intermediate risk.
HETEROGENOUS
• 85-year-old man with
clinical stage T1c
prostate cancer, a
Gleason score of
3+4=7 affecting 1 of
12 biopsy cores, and
with PSA of 6 μg/L.
<50% of the core
affected.
Active Surveillance
• 55-year-old man with
tumour at clinical
stage
T2c,
a
Gleason score of
4+3=7 in 12 of 12
cores, and a PSA of
19 μg/L.
Not a Candidate for Active
Surveillance
HIGH RISK DISEASE
DILEMMA
DIFFERENT DEFINITION FROM
DIFFERENT BODIES
NEW GLEASON SCORING
SYSTEM
COMBINED IN
POSTOPERATIVE SERIES
Pere Borrell del Caso (Spanish, 19th century), Escaping Criticism, 1874,
BIOLOGY IS THE ONLY
SOLUTION
Pere Borrell del Caso (Spanish, 19th century), Escaping Criticism, 1874,
CAN ANSWER MANY QUESTION?
• Risk stratification?
• Which patient benefit from Dose escalation?
• Which patient benefit from Combined RT/HT more?
• Which patient should be treated by Long term
androgen blockade?
• Which patient may benefit from combined androgen
blockade?
• Should all patients with metastatic prostate
cancer be treated with ADT plus chemotherapy?
• How can we identify patients who are most likely
to benefit from chemotherapy?
• How can we identify patients who are most likely
to do well without the addition of chemotherapy?
NEMROCK
NICC