Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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