Prostate Workup, Imaging, Contouring

Question 1

What are the Gleason Grade Groups?

Answer 1

Grade 1: 3+3
Grade 2: 3+4
Grade 3: 4+3
Grade 4: 4+4, 3+5, 5+3 
Grade 5: 4+5, 5+5

Question 2

What are the NCCN recommendation for getting staging CT abd/pelvis or MRI?

Answer 2

Longer life expectancy, favorable intermediate or higher risk disease, risk of LN involvement >10%

Question 3

What are the chances of a NM bone scan showing something detectable w/ PSA >10?

Answer 3

4%

Question 4

MRI of the prostate; what is the best series to look for cancer?

Answer 4

T2; prostate cancer looks dark, hypodense

Question 5

Constraints for intact prostate (give 2) conventional fractionation:

Rectum
Bladder

Answer 5

Rectum

• V65 < 15%
• V45 <50%
• Dmax <81.5 Gy

Bladder

• V70 <15%
• V50 <50%

Question 6

Constraints for postop prostate (give 2):

Rectum
Bladder

Answer 6

Per RTOG 0534 “SPORT”

Rectum

• V65 < 35%
• V40 <55%

Bladder

• V65 <50%
• V40 <70%

Question 7

PTV margins for:

• Non-SBRT prostate (comment separatly for prostate vs LN)
• SBRT prostate

Answer 7

Non-SBRT:
7 mm PTV except 5 mm posteriorly; 5 mm on LN PTV

SBRT:
5 mm PTV except 3 mm posteriorly

Question 8

Brachytherapy

• Pd-103 monotherapy dose vs boost dose
• I-125 monotherapy dose vs boost dose

Answer 8

• Pd-103 monotherapy dose vs boost dose
  (110 mono, 100 boost)
• I-125 monotherapy dose vs boost dose
  (145 mono, 110 boost)

Question 9

Unfavorable intermediate-risk (UIR) PCa is defined as:

Answer 9

Any intermediate-risk patient with:

• primary Gleason pattern of 4
• positive biopsy cores (PPBC) ≥ 50%
• multiple intermediate-risk factors (IRFs; cT2b-c, prostate-specific antigen [PSA] 10-20, or Gleason score 7).