Prostate Cancer: Intermediate to High Risk (under construction)

Question 1

Prostate Cancer

Name three parameters/prognostic factors considered to stratify patient into risk groups?

Answer 1

clinical T-stage
pretreatment PSA
biopsy Gleason score

Question 2

Prostate Cancer

Intermediate risk:
T (range)

Answer 2

T2b to T2c

Question 3

Prostate Cancer

Intermediate risk:
PSA (range)

Answer 3

10 to 20 ng/mL

Question 4

Prostate Cancer

Intermediate risk:
GS

Answer 4

7

Question 5

Prostate Cancer

What are the parameters that would place a patient in the NCCN high-risk group?

Answer 5

any of the ff:

≥T3a
PSA >20 ng/mL
GS 8 to 10

Question 6

Prostate Cancer

What is the most important predictor of biochemical recurrence in intermediate to high risk patients?

Answer 6

pretreatment PSA

Question 7

Prostate Cancer

What is the most important predictor of cause-specific survival (CSS) in intermediate to high risk patients?

Answer 7

Gleason score

Question 8

Prostate Cancer

What is the Phoenix definition of biochemical recurrence?

Answer 8

a rise of 2 ng/mL or more above the absolute PSA nadir (after EBRT +/- short term ADT).

Question 9

Prostate Cancer
Intermediate and High-Risk

What are the arms of RTOG 9413?

Answer 9

2 months NHT before and during prostate only RT + boost to 70 Gy

2 months NHT + WPRT + boost to 70 Gy

prostate only RT + 4 months of adjuvant HT

WPRT + 4 months of adjuvant HT

Question 10

Prostate Cancer
Intermediate and High-Risk

RTOG 9413
Which arm had a better 4-year PFS?

Answer 10

2 months NHT + WPRT + boost to 70 Gy

-Roach

Question 11

Prostate Cancer
Intermediate and High-Risk

Upon long-term follow-up,
What are the findings of RTOG 9413 regarding the sequence and combination of RT?

Answer 11

NHT and concurrent ADT + WPRT

prostate only RT + adjuvant HT.

(-Pommier)

Question 12

Prostate Cancer
Intermediate and High-Risk

What is the preferred treatment for favorable intermediate risk?
(as is also evidenced by RTOG-0232)

Answer 12

Permanent prostatic implant (PPI) monotherapy

Question 13

Prostate Cancer
Intermediate and High-Risk

What is the ASCENDE-RT trial?

Answer 13

a randomized trial comparing 2 methods of dose escalation for intermediate- and high-risk prostate cancer.

standard arm with 12 months of androgen deprivation therapy, pelvic irradiation to 46 Gy, followed by a dose-escalated external beam radiation therapy (DE-EBRT) boost to 78 Gy, or an experimental arm that substituted a low-dose-rate prostate brachytherapy (LDR-PB) boost

Compared with 78 Gy EBRT, men randomized to the LDR-PB boost were twice as likely to be free of biochemical failure at a median follow-up of 6.5 years.

Question 14

Prostate Cancer
Intermediate and High-Risk

Give some advantages of HDR brachytherapy compared to LDR brachytherapy.

Answer 14

greater flexibility in source positioning

adaption of dose to target and healthy organs

target volume–dose optimization

high-quality planning and dose distribution

lower risk of radiation exposition to health care personnel or public

and reduced cost

Question 15

Prostate Cancer
Intermediate and High-Risk

Usual HDR brachytherapy dose given as a boost?

Answer 15

21 Gy/10.5/2 (24 hrs) - RTOG 0815

15 Gy single dose - RTOG 0924

Question 16

Prostate Cancer
Intermediate and High-Risk

What is the American Brachytherapy Society recommended dose using I-125?

Answer 16

100-110 Gy

Question 17

Prostate Cancer
Intermediate and High-Risk

What is the American Brachytherapy Society recommended dose using Pd-103

Answer 17

80 to 90 Gy

Question 18

Prostate Cancer
Intermediate and High-Risk

What is the optimal duration of short-term ADT combined with EBRT in intermediate-risk patients?

Answer 18

4 months

Question 19

Prostate Cancer
Intermediate and High-Risk

What is the optimal duration of long-term ADT combined with EBRT in high-risk patients?

Answer 19

36 months

Question 20

Prostate Cancer
Intermediate and High-Risk

Name some adverse effects of ADT.

Answer 20

risk of fractures,
fatigue,
weight gain,
osteoporosis,
depression,
decreased cognitive function,
erectile dysfunction,
loss of libido,
gynecomastia,
anemia,
decreased high-density lipoprotein,
insulin resistance,
hot flashes