Prostate Cancer - Clinically Localized Flashcards

1
Q

What is used to risk stratify newly diagnosed prostate cancer patients?

A

T stage
PSA
Gleason grade group
Tumor volume
MAY use genomic biomarkers
Assess patient to guide germline testing decision
Do NOT routinely use CT with intermediate risk
Bone scan/CT if high risk
Molecular imaging is an option

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2
Q

Should CT or bone scan be used for intermediate risk prostate cancer?

A

Nope

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3
Q

Preferred management for low risk prostate cancer

A

AS

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4
Q

Preferred management for favorable intermediate risk prostate cancer

A

WW if limited life expectancy
AS
RT
RP
Ablation lacks high quality data

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5
Q

Preferred management for unfavorable intermediate risk or high risk prostate cancer

A

WW if life expectancy <10 years
RP
RT + ADT
NO ablation outside of clinical trial
Palliative ADT if limited life expectancy

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6
Q

AS process

A

Serial PSA
Repeat biopsy
MRI (but this does not replace biopsy)

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7
Q

What does pelvic LNectomy do?

A

Stage
Does NOT improve outcomes
Use nomograms to determine risk

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8
Q

Should RP be completed if suspicious nodes identified?

A

Yes

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9
Q

RP, found to have N1 with PSA 0 –> next steps?

A

adjuvant therapy or observation

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10
Q

Principles of RT for prostate cancer

A

Target localization
Normal tissue avoidance
Simulation
Advanced treatment/delivery
Image guidance procedures
Use dose escalation

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11
Q

Type of RT and characteristics

A

Proton therapy - no evidence of superiority
EBRT - can be moderate or ultra hypofractionated
Permanent low-dose seed implant
Temporary high dose implant

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12
Q

Should nodes be radiated in low or intermediate risk prostate cancer?

A

No

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13
Q

Should favorable intermediate risk prostate cancer patients getting RT be given ADT?

A

No

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14
Q

Should unfavorable intermediate risk prostate cancer patients getting RT be given ADT?

A

Yes - 4-6 months

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15
Q

RT options for high risk or unfavorable intermediate risk prostate cancer

A

hypofractionated EBRT or EBRT+brachy + ADT x18-36months
Can offer node radiation (use IMRT 45-52Gy)

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16
Q

Who should have bone and soft tissue (or PSMA-MET) imaging?

A

unfavorable intermediate or worse

17
Q

Boundaries for extended node dissection

A

pelvic side wall, internal iliac, inguinal ligament,

18
Q

Bradycardia during insufflation DDx - Rx

A

Air embolus
Cardiac event
Vagal response

Look for injury, desufflate, wait

19
Q

Approach to radiating pelvic nodes

A

Don’t do it for intermediate risk or lower
IMRT 45-52Gy otherwise