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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly