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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
