Treatment

Question 1

Radical radiotherapy doses

Answer 1

76-78Gy, or hypofractionated 60Gy in 20 doses over 4 weeks or 70Gy in 28 doses over 6 weeks

Question 2

ADT with RT in intermediate and high risk disease

Answer 2

short term ADT with intermediate risk 4-6 months, 2-3 years with high risk disease

Question 3

Pound data on BCR after radical prostatectomy

Answer 3

JAMA 1999
1997 RP from 1982 to 1997
No adjuvant hormones prior to M+
304 patients 15% developed rising PSA >0.2
of which 103 patients developed M+ 34%
median time to M+ 8 years from PSA elevation
once M+ median time to death 5 years
further analysis high gleason score 8-10 vs 5-7, PSA recurrence under 2 years, PSADT less than 10 months all do worse on MFS

Question 4

EAU low risk BCR and high risk BCR

Answer 4

PSADT >1 year and ISUP grade <4, high risk = PSA DT 1 year or less OR ISUP grade 4-5

Question 5

Brachytherapy CI

7

Answer 5

TURP
Volume more than 50cc or large median lobe
LUTS IPSS more than 12, qmax less than 15
Previous RT
Coagulation discord we

Question 6

Complications RP

Answer 6

Infection bleeding 5-10%
Death 0%_1.5% 1/300
Stricture 10-15%
Incontinece mild 50% improving over 12-18 months long term 5-10% requiring more than a pad a day
Erectile 40-60%
Recurrence 5-25%
Rectal injury 5%

Question 7

Complications EBRT

Answer 7

Cystitis 20%
Haematuria 18%
Proctor is 30% severe long term 3%
Urethral stricture 4-8%
Incontknence 1% severe long term
Leg oedema 6%
ED25-60% occurs over several years
Second cancer 1/300, 1 in 70 in long term survivors

Question 8

Risk of biochemical progression with T3

Answer 8

30-50% over 5 years

Question 9

Bolla study on adjuvant radiotherapy
EORTC 22911
Immediate post RP ART in positive margins T3 disease

Answer 9

503 patients
Vs delayed RT in biochemical progression
In pT3N0M0 disease
Immediate RT improves BPFS but not overall survival

Question 10

Side effects of LHRH agonists 10

Answer 10

Flushing 80% 
Erectile dysfunction 
Osteoporosis
Hyperlipidaemia
Gynaecomastia
Cognitive decline
Diabetes
Anaemia
Loss of muscle mass
Reduced quality of life

Question 11

Metastatic disease survival

Answer 11

5 year 15%
Median survival 42 months
Average 2-3 years with a symptomatic disease
12 months with symptomatic disease
12-18 months to castrate resistance then 14 months to death

Question 12

Action bisphosphonatss

Answer 12

Inhibit osteoclast mediated bone reabsorption
Zolendeonic acid for 15 months reduced skeletal events pathological fracture
Can also reduce pain

Question 13

Metastatic spinal cord compression pathway

Answer 13

Due to vertebral collapse secondary to tumour invasion of from extradural tumour growth

Question 14

Brachytherapy low dose

Dose in Gy

Answer 14

125 iodine
150 Gy
Seeds 60-120
Dose delivered weeks to months 
Acute side effects resolve over months
Radiation protection issues for family

Question 15

Brachytherapy high dose

Answer 15

Iridium 192

Question 16

NICE brachytherapy indications

Answer 16

T2c or less
PSA 20 or less
Gleason 7 or less

Question 17

Action cryotherapy

Answer 17

Protein denaturarion due to dehydration
Rupture of membranes by ice crystals
Vascular stasis micro thrombi resulting in is anemic apoptosis
Two freeze thaw cycles at minus 40

Question 18

Castration level testosterone

Answer 18

50ng/dl in trials

20ng/dl

Question 19

Intermittent hormone therapy

Answer 19

Non inferior
T takes 9 months to recover so must not cycle for less than 9 months
Restart if PSA above 10 in NICE guidelines
Aims to delay androgen resistance
If ADT stopped before cells become androgen independent then further growth may be androgen dependent cells

Question 20

Castrate levels reached on LHRH

Answer 20

2-4 weeks
Vs 8 hours with orchidectomy
3 days with LHRH antagonist

Question 21

Definition of castrate resistant prostate cancer EAU

Answer 21

T level less than 50
And
Radiological progression 
Or
3 consecutive rises in PSA one week apart resulting in 2 x 50% increases over nadir and PSA above 2

Question 22

Causes of androgen resistance

Answer 22

Androgen independent clones
Over expression of androgen receptor
Intra cellular synthesis of T by cancer cells- can be target of abiraterone

Question 23

Docetaxel survival increase

Answer 23

9 months with HSPC but only 2 months survival advantage CRPC

Given every 3 weeks with pred for 8-10 cycles

Question 24

CHIIP trial

Answer 24

60Gy in 20 fractions over 4 weeks non inferior to 74Gy in 37 fractions over 6 weeks in 3216 men