Prostate Cancer 5 Flashcards
Recite the management options and be able to discuss the pros and cons of each.
1
Q
Describe active surveillance for prostate cancer.
A
- Involves monitoring patients with PSA testing every 3 to 6 months
- Perform surveillance needle biopsies of the prostate every 1-2 years
- Usually reserved for men with less than a 10 year life expectancy and Gleason < 6 disease
- Active surveillance is more risky in patients with a long life expectancy or a higher grade tumor
- Drawbacks of active surveillance are that 30%-40% of patients are “undergraded” or “understaged” on their initial biopsy, and up to half of patients who receive delayed treatment are not cured following delayed treatment
2
Q
Describe the process of radiotherapy for prostate cancer.
A
- More often used to treat older patients or patients who are not suitable candidates for surgery due to co-morbid medical conditions or because their tumor may be too advanced for complete surgical excision
- There are several options for delivery of radiotherapy:
- external beam (intensity-modulated radiation therapy [IMRT]
- proton-beam
- Cyberknife
- radioactive “seeds” [brachytherapy]
- combination of external beam and brachytherapy
- Drawbacks of radiotherapy:
- not all cancer cells are sensitive to radiation doses that can be safely delivered
- geographic misses can spare some cancer cells
- the genetic changes that caused the first prostate cancer can induce second cancers
- the risks for bladder (radiation cystitis), rectal (radiation proctitis), and sexual side effects
- If there is tumor recurrence after radiation therapy, the patient cannot safely receive more radiotherapy or radical prostatectomy, and salvage treatment with cryoablation or hormonal therapy is never curative
3
Q
Describe the process of radical prostatectomy as a treatment for prostate cancer.
A
- Performed as an open surgical procedure (through an abdominal or perineal incision) or as a robotic-assisted laparoscopic approach
- The advantages of surgery are that removal of the prostate gland eiminates the possible development of subsequent de novo cancers arising within the gland
- potentially curative adjuvant or salvage external-beam radiotherapy can be used for patients who have adverse pathology findings or evidence of tumor persistence or recurrence
- The disadvantage of radical prostatectomy is the risk for surgical complications and erectile and urinary dysfunction
- in general, younger patients with a tumor that appears to be highly likely confined to the prostate are the ideal candidates for nerve-sparing (i.e., erection sparing) radical prostatectomy
4
Q
Describe the process of cryoablation used for prostate cancer therapy.
A
- Can be used as whole-gland or focal therapy
- Argon gas is circulated through hollow needles to freeze the prostate while at the same time, helium gas is circulated to warm the urethra
- It is currently used primarily as salvage treatment of local tumor recurrence following radiotherapy
- The initial results have been suboptimal, with high complication rates, including perineal pain, erectile dysfunction, and rectourethral fistula
5
Q
Describe the process of using HIFU for prostate cancer therapy.
A
- Can be used as whole-gland or focal therapy
- The prostate tissue is heated up to 100 degrees C, which produces a cavitating lesion over days to months
- It can be repeated if necessary
- A large prostate volume is a limiting (40cc) factor, and a preliminary transurethral resection of the prostate (TURP) is often required
- Complications are similar to those that occur with cryoablation