Case presentation Treatment of prostate...

Case presentation

Treatment of prostate cancer

Phichai Chansriwong, MD

Ramathibodi Hospital, Mahidol University

Male 60 ys, ECOG 0: DM, HT, DLP

• 6/2554 he has diagnosed with BPH, and found high PSA. Plan biopsy prostate but he loss F/U.

• 2/58 Prostate biopsy : Adeno CA, GS 3+3

Date 6/54 12/57 2/58 8/58 12/58 2/59 3/59 5/59 6/60

PSA 14 17 18 7.45 1.78 1.56 0.18 0.003

Loss F/U

BX prostatectomy

Bone scans 18/6/2558

• Normal

• 26/6/2558 : prostatectomy

Pathological report

• Adeno CA, GS 4+5 , invade both lobe, + margin, not involved seminal vesicle. No nodal involvement

• T2cN0M0 : IIb

• PSA 7.5

What is the proper treatment?

MRI lower abdomen 11/2558

• Post radical prostatectomy, there is a 1.5 x2.2x 2.7 cm local tumor recurrence, extending posterior to anterior rectal wall.

• 760 case post prostatectomy + LN ( T2,3 and node negative) then PSA rising to 0.2-0.4 ng/ml

• RT + bicalutamide 150 mg/d * 24 months

• VS Rt + placebo

• F/U 13 years • OS at 12 years: 76.3% vs 71.3 % ( HR0.77, P 0.04) • 12 year incidence of death from PC 5.8% vs 13.4% P 0.001 • Distant metastases at 12 year : 14.5% vs 23.0% (P 0.005) • AE from RT similar in 2 groups • Gynecomastia 69.7 % vs 10.9%

IMRT 3/12/58

• Total dose 74 Gy to prostate bed and seminal vesicle

• GnRH agonist q 3 months

• 2/2559 : PSA 1.78

11/2559

• U/S whole abdomen: Liver normal. Hypoechoic lesion 1.9 x 2.1 x2.4 cm rule out local recurrence post prostatectomy

MRI 30/4/2560

• SD in residual tumor of prostate lesion

• PSA 0.4

What is the proper duration of ADT?

Inconclusive data for duration of ADT in salvage RT

4 months – 2 years

New IN 2017

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Slide 3

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Randomization 10/2000 to 01/2008

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Risk Factors

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Causes of Death

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Slide 10

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

In favor of 18 months of ADT:<br /> <br />- 13/55 items, 6/21 scales<br />Clinically significant: p<0.01<br />-2 items (Hot flushes, enjoyable sex)<br />Clinically Relevant:<br />difference in mean scores ≥10 points

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Quality of Life

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Slide 14

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Slide 15

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Sites of Tumor Relapse

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Slide 17

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting

Conclusion

Presented By Abdenour Nabid at 2017 ASCO Annual Meeting