Prostate - General Managment Flashcards
Low-risk local disease
Life expectancy less than 10yrs
no nodal or distant metastatic disease
watchful waiting
Low-risk local disease
Life expectancy of 10-20yrs
no nodal or distant metastatic disease
active surveillance
Low-risk local disease
Life expectancy of 20yrs or greater
no nodal or distant metastatic disease
active surveillance OR EBRT and/or brachy radical prostatectomy +/- plelvic LN dissection NO ADT
Intermediate risk local disease
no nodal or distant metastatic disease
Life expectancy less than 10yrs
WaWa
EBRT +/- ADT(4-6m) +/- brachy
OR
Brachy alone
Intermediate risk local disease
no nodal or distant metastatic disease
Life expectancy greater than (or equal to) 10yrs
WaWa EBRT +/- ADT(4-6m) +/- brachy OR Brachy alone OR RP +/- PLND
High risk local disease
no nodal or distant metastatic disease
EBRT + ADT(1.5-3yrs) OR EBRT + Brachy +/- ADT (1.5-3yrs) OR RP +/- PLND
Very high risk local disease
no nodal or distant metastatic disease
EBRT + ADT(1.5-3yrs) OR EBRT + Brachy +/- ADT (1.5-3yrs) OR RP +/- PLND (in select pts)
treatment when there is nodal metastatic disease
EBRT + ADT (1.5-3yrs)
OR
ADT alone
treatment when there is distant metastatic disease
ADT +/- systemic therapy
treatment for biochemical recurrence after surgery
salvage EBRT +/- ADT
What structures are included in the RT volume for intact low and intermediate risk prostate ca?
prostate +/- seminal vesicles
What structures are included in the RT volume for intact high risk prostate ca?
prostate +/- seminal vesicles +/- pelvic nodes
Fiducial markers should be placed in what time frame before simulation
1 or more weeks
What are the recommended preparations prior to simulation?
NPO and stool softener night before and morning
contrast 15 mins prior
CTV and PTV for low - intermediate risk disease
CTV = prostate and proximal seminal vesicles PTV = CTV + 7mm margin all around except 5mm posteriorly
CTV and PTV for high risk disease
CTV1 = prostate and proximal 2cm of seminal vesicles CTV2 = CTV1 + elective pelvic nodes
PTV = CTV1 + 7mm margin all around except 5mm posteriorly
Possible dose fractionation schedules:
T1-T2/psa <10, gleason <7
T3-T4/psa >10, gleason >7
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)
half life and energy of I-125
60 days
28keV
half life and energy of Pd-103
17 days
21keV
reasons not to use brachy
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
difference between adjuvant and salvage RT in post-op
adjuvant - psa undetectable
salvage - psa detectable
doses for post op RT (low vs high risk)
low risk 65
high risk 66-70
