Treatment Of Prostate Cancer Flashcards
What is watchful waiting?
A symptom guided approach
Generally reserved for older patients with lower life expectancy and can be offered for any stage of prostate cancer
Definitive therapy often deferred and hormonal therapy initiated at time of symptomatic disease
Who is active surveillance offered to?
Patients with low risk disease and for some cases intermediate (slow growing, localised prostate cancer)
The aim is to avoid or delay unnecessary treatment and its side effects
What does active surveillance involve?
Monitoring of patients with 3 monthly PSA
6 monthly to yearly DRE
Re-biopsy at 1-3 yearly intervals
Assessing for progression of disease and intervening at appropriate time
Mp-MRI also being increasingly used
What does a radical prostatectomy involve?
Removal of prostate gland, resection of seminal vesicles along with surrounding tissue +/- dissection of pelvic nodes
Open approach, laparoscopically or robotically
What are the side effects of radical prostatectomy?
Erectile dysfunction- affects 60-90%
Stress incontinence
Bladder neck stenosis
Who should radical prostatectomy be considered for?
No evidence of metastatic disease ie localised prostate cancer
May be suitable for some men whose cancer has spread to area just outside prostate (locally advanced)
Can be used to treat cancer that has come back after radiotherapy (not common)
Generally fit and healthy
How does active surveillance differ from watchful waiting?
Main difference= active surveillance- radical treatment may be indicated in future. Watchful waiting not suitable for radical treatment
What alternatives are there to surgery? (Other curative options)
Radiotherapy - external beam radiotherapy or brachytherapy
Describe brachytherapy
Transperineal implantation of radioactive seeds directly into prostate gland
Describe external beam RT
Focused radiotherapy used to target prostate gland - damage cancer cells and limiting damage to surrounding structures
What is the cure rate after radical prostatectomy?
90% for tumours confined to prostate
Does brachytherapy or external beam therapy have fewer side effects?
Brachytherapy - less likely to affect surrounding tissues
What is there a risk of with external beam radiotherapy?
Impotence
Proctitis
Small increased risk of colorectal cancer
When is chemotherapy indicated?
Usually only those with metastatic cancer
What examples of chemotherapy drugs are used?
Docetaxel - men with testosterone resistant cancer
Cabazitaxel - used with prednisolone, recommended for relapsed prostate cancer that has progressed after docetaxel
