Prostate - General Managment

Question 1

Low-risk local disease
Life expectancy less than 10yrs
no nodal or distant metastatic disease

Answer 1

watchful waiting

Question 2

Low-risk local disease
Life expectancy of 10-20yrs
no nodal or distant metastatic disease

Answer 2

active surveillance

Question 3

Low-risk local disease
Life expectancy of 20yrs or greater
no nodal or distant metastatic disease

Answer 3

active surveillance 
OR
EBRT and/or brachy
radical prostatectomy +/- plelvic LN dissection
NO ADT

Question 4

Intermediate risk local disease
no nodal or distant metastatic disease
Life expectancy less than 10yrs

Answer 4

WaWa
EBRT +/- ADT(4-6m) +/- brachy
OR
Brachy alone

Question 5

Intermediate risk local disease
no nodal or distant metastatic disease
Life expectancy greater than (or equal to) 10yrs

Answer 5

WaWa
EBRT +/- ADT(4-6m) +/- brachy
OR 
Brachy alone
OR 
RP +/- PLND

Question 6

High risk local disease

no nodal or distant metastatic disease

Answer 6

EBRT + ADT(1.5-3yrs) 
OR 
EBRT + Brachy +/- ADT (1.5-3yrs)
OR 
RP +/- PLND

Question 7

Very high risk local disease

no nodal or distant metastatic disease

Answer 7

EBRT + ADT(1.5-3yrs) 
OR 
EBRT + Brachy +/- ADT (1.5-3yrs)
OR 
RP +/- PLND (in select pts)

Question 8

treatment when there is nodal metastatic disease

Answer 8

EBRT + ADT (1.5-3yrs)
OR
ADT alone

Question 9

treatment when there is distant metastatic disease

Answer 9

ADT +/- systemic therapy

Question 10

treatment for biochemical recurrence after surgery

Answer 10

salvage EBRT +/- ADT

Question 11

What structures are included in the RT volume for intact low and intermediate risk prostate ca?

Answer 11

prostate +/- seminal vesicles

Question 12

What structures are included in the RT volume for intact high risk prostate ca?

Answer 12

prostate +/- seminal vesicles +/- pelvic nodes

Question 13

Fiducial markers should be placed in what time frame before simulation

Answer 13

1 or more weeks

Question 14

What are the recommended preparations prior to simulation?

Answer 14

NPO and stool softener night before and morning

contrast 15 mins prior

Question 15

CTV and PTV for low - intermediate risk disease

Answer 15

CTV = prostate and proximal seminal vesicles
PTV = CTV + 7mm margin all around except 5mm posteriorly

Question 16

CTV and PTV for high risk disease

Answer 16

CTV1 = prostate and proximal 2cm of seminal vesicles
CTV2 = CTV1 + elective pelvic nodes

PTV = CTV1 + 7mm margin all around except 5mm posteriorly

Question 17

Possible dose fractionation schedules:

T1-T2/psa <10, gleason <7

T3-T4/psa >10, gleason >7

Answer 17

T1-T2/psa <10, gleason <7
7200-7800/36 (conv)
7280 (p) + 6300 (SV) OR 6000/20 (hypo)

T3-T4/psa >10, gleason >7
conv 7800/39 (p); 4600-5000/ (ln)
OR
hypo 7000/28 (p) + 5040 (ln)

Question 18

half life and energy of I-125

Answer 18

60 days

28keV

Question 19

half life and energy of Pd-103

Answer 19

17 days

21keV

Question 20

reasons not to use brachy

Answer 20

TURP defect
t3+ disease
large median lobe
pubic arch interference
poor baseline urinary function
prostate greater than 60cc (can shrink first then proceed)
prostate less than 20cc

Question 21

difference between adjuvant and salvage RT in post-op

Answer 21

adjuvant - psa undetectable

salvage - psa detectable

Question 22

doses for post op RT (low vs high risk)

Answer 22

low risk 65

high risk 66-70