Prostate Flashcards
Roach formula
ECE: Risk (%) = 3/2 × PSA + 10 × (Gleason-3)
Seminal vesicle: Risk (%) = PSA + 10 × (Gleason-6)
Lymph nodes: Risk (%) = 2/3 × PSA + 10 × (Gleason-6)
Systemic therapy for m0 castration resistant prostate cancer. If psadt<10 months
Preferred regimens: • Apalutamide(category 1) • Darolutamide(category 1) assessment (PSA and imaging) • Enzalutamide (category 1) Other recommended regimens: • Other secondary hormone therapyt
Matastatic castration naive prostate cancer treatment
ADTt with one of the following: • Preferred regimens: Abiraterone (category 1)t,ff Apalutamide (category 1)t Docetaxel 75 mg/m2 for 6 cyclesxx (category 1)yy Enzalutamide (category 1)t
• EBRTo to the primary tumor for low-volume M1xx or ADTt,rr
ISUP consensus grouping of gleason score
<-6 =grade 1 3+4=7 grade 2 4+3=7 grade 3 8 grade 4 9-10 grade 5
PSA level increased in
prostatitis urinary retention DRE Ejaculation TRUS biopsy TURP BPH
prognostic factors
cinical staging by DRE, pretreatment PSA GS/Grade grouping on biopsy number of biopsy core involved with cancer cancer volume PNI on biopsy presence of disseminated cancer cells
indication of adjuvant RT
pT3a
+ve margin
seminal vesicle involvement
radiotherapy dosage of prostate
Hypofractionated:
- 60 gy in 20 fraction (+/- pelvic nodes) over four weeks ( Cheap protocol)
Conventional:
- 78 gy in 39 fractions (+/- pelvic nodes) over eight weeks
• Ultra-hypofractionated: 42.7 Gy in 7 fractions over two and a half weeks
• SBRT: 36.25 Gy in 5 fractions over five days
• Prostate bed: 66 Gy in 33 fractions given in six and a half weeks
prostate 2D border
upper: L5-S1 to lower border of ishial tuberosity
lat border: 1.5-2 cm lateral to bony pelvis
lateral view:
ant margin 0.5-1 cm posterior to projected cortex of symphysis pubis
posterior: S2-3 interspace to include presacral LN
Prostate 3D volume post op area
inferior border 5mm cranial to the superior border of penile bulbe
superior: base of seminal vesicle if risk below 15%
entire seminal vesicle if more risk
ant: post aspect of symphysis pubis
(<2cm above the vesicourethral anastomosis)
post 1/3rd of bladder wall (>2cm above anastomosis)
posterior: anterior rectal wall
lateral: medial border of obturator internus and levator ani muscle
Target volume in short: in localized
low risk: prostate + proximal sv
int risk: prostate +sv
high risk: prostate+sv+pelvic ln
Risk factors for prostate
Age:>50 Race: african american Nationality Family history: 1 1st degree 2 folds increase 2 1st degree 9 folds Hormonal influence Diet: red meat, high fat dairy product Obesity Smoking Enivrionmental factors STds Vasectomy
Prognostic factors for ca prostate
Stage
Positive surgical margin
Tumor grade
Involvement of seminal vesicle
Extension of tumor beyond seminal vesicle
High PSA value and short PSA doubling time
Molecular prognostic marker: loss of PTEN, P53 mutation, over expression of MYC
Prognostic nomograms: partin tables,
Side effects of hormonal therapy
Reduced or absent libido Impotency or erectile dysfuntion Shrinking of testicle Hot flashes Breast tenderrness Osteoporosis Weight gain Metabolic: increase TG, low HDL Anemia, fatigue Cognitive impairment Loss of muscle bulk GIT disturbance.
Prostate very low risk group
Has all of the following
CT1c
Grade group 1
PSA<10ng/ml
Fewer than 3 prostate biopsy fragments/cores positive, </50% cancer in each fragments
PSA densitiy <0.15ng/mL/g
