GU/Prostate

Question 1

What is the indication for bone scan in prostate cancer?

Answer 1

T1 and PSA>20, T2 and PSA>10, GS >=8, T3/4 or sx+

Question 2

What is the indication for pelvic CT or MRI in prostate cancer?

Answer 2

T3/4, T1-2 with nomogram indication of >10% LNI.

Question 3

What is an LH-releasing analogue?

Answer 3

goserelin.
bicalutamide and flutamide are nonsteroidal antiandrogens.
finasteride is a 5 alpha reductase inhibitor

Question 4

what PSA is concerning and what velocity is also concerning?

Answer 4

PSA velocity thrshold is apprx 0.4ng/mL/yr

PSA velocity change is worrisome if > 0.75/ug/L/yr

Question 5

what is the half life of PSA?

Answer 5

2.2 days

Question 6

as the %free PSA decreases, the risk of prostate cancer increases. True?

Answer 6

yes. as %free PSA drops, the risk of cancer increase. the free to total ratio is less in prostate cancer vs BPH

Question 7

The Bill Axelson RP vs WW showed what?

Answer 7

men =10yrs got eitehr RP or WW. >70% were stage T2, only 12% were T1c.
surgery reduced DM, LF, DSM. HR for death was 0.56 with surgery. hormone tx was allowed in both arms. those that got surgery were less likely to get ADT or palliative RT. at 15yrs RP had a OS benefit. but on subset analysis, men <65yo were the only ones with OS benefit wtih surgery. since this trial was done before PSA screening, the benefit is probably less since there is lead time bias.

Question 8

What is the eligibility criteria for prostate brachy monotherapy?

Answer 8

T1-T2a tumors, GS 6, PSA <30cc)

Question 9

What isotopes are used for LDR prostate brachy?

Answer 9

Pd 103, I 125, Au 89

Question 10

What is the half life and avg energy of I 125?

Rx dose?

Answer 10

60 days, 28 keV. Rx: 145 Gy monotx. if using as bst, 110-120 Gy

Question 11

What is the half life and avg energy of Pd 103?

Rx dose?

Answer 11

17 days, 21 keV. Rx: 125Gy monotx. if using as bst, 90-100 Gy

half life of I 192 is 74 days.

Question 12

what is the outcomes for using brachy for prostate?

LC? Implant characteristics?

Answer 12

T1-2 prostate tx w/ I 125 (68%) and Pd 103 (32%). 8yr BFS 93% when D90=>130Gy., if D90 less than that then BFS was 76%.

Question 13

does dose escalation in prostate cancer benefit OS?

Answer 13

no. but Pollack showed that 78Gy vs 70Gy benefited DFS in thsoe with PSA >10. at 6yrs benefit was nearly 20%. thsoe with PSA<10, no DFS benefit (80%). even 8yr f/u still showed this, with larger benefit. higher GI toxicity.

Question 14

What did Zietman proton dose escalation study show?

Answer 14

question 36