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Prostate Rad Onc
| Question | Answer |
|---|---|
| Work-up (8) | -H&P -PSA -Testosterone -CBC -LFTs -TRUS-guided biopsy (>8 cores, and the highest GS is used) -bone scan and plevic CT or MRI are ordered for T3-T4 or GS>= 8 or PSA >=20 -In-111 Ab (prostascint) has limited sensitivity, can used for high-risk disea |
| Prostate T1 | clinially inapparent tumor neither palpable nor visible on imaging |
| Prostate T1a | Tumor incidental histologic finding in 5% or less of tissue |
| Prostate T1b | Tumor incidental finding in more than 5% of resected tissue |
| Prostate T1c | Tumor identified by needle biopsy (eg, because of elevated PSA) |
| Prostate T2 | Tumor confined within the prostate |
| Prostate T2a | Tumor involves 1/2 of one lobe or less |
| Prostate T2b | Tumor involves more than 1/2 of one lobe but not both lobes |
| Prostate T2c | Tumor involves both lobes |
| Prostate T3 | Tumor extends through prostate capsule |
| Prostate T3a | Extracapsular extension (unilateral or bilateral) |
| Prostate T3b | Tumor invades semial vesicles(s) |
| Prostate T4 | Tumor is fixed to or invades adjacent structures other than seminal vesicles: bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall |
| Prostate N1 | regional lymph node mets |
| Prostate M1 | Distant mets |
| Prostate M1a | Non-regional LN mets |
| Prostate M1b | Bone mets |
| Prostate M1c | Other site(s) with mets with or without bone mets |
| Prostage G1 | Well-differentiated (slight anaplasia, Gleason 2-4) |
| Prostate G2 | Moderately-differentiated (moderate anaplasia, Gleason 5-6) |
| Prostate G3-4 | Poorly differentiated/undifferentated (marked Gleason 7-10) |
| Stage I Prostate Adenocarcinoma | T1aN0M0 G1 |
| Stage II Prostate Adenocarcinoma (2) | T1aN0M0 G2-4 T1-2N0M0 any G |
| Stage III Prostate Adenocarcinoma | T3N0M0 any G |
| Stage IV Prostate Adenocarcinoma (3) | T4N0M0; any T N1 M0; any T any N M1 |
| D'Amico & MD Anderson Risk Stratification for Prostate is based on... | 5/10 yr bPFS after EBRT |
| D'amico risk classification for prostate low and 5/10 YR bPFS | T1-2a & GS<= 6 & PSA <=10; 85-90%/80-85% PFS |
| D'amico risk classification for prostate intermediate and 5/10 YR bPFS | T2b (MD Anderson T2b-T2c) &/or GS 7 &/or PSA 10-20. Low-intermediate risk: <=50% of biopsies; high-intermediate risk: >50% of biopsies; 70%/65% |
| D'amico risk classification for prostate high and 5/10 YR bPFS | >=T2c (MD Anderson T3-T4) or GS 8-10 or PSA >20; 40%/35% |
| Low risk prostate ca treatment recommendations for life expectancy <10 yrs | For life expectancy <10 yrs, expectant management or definitive RT (3DCRT, IMRT, or brachytherapy) For life expectanct >=10 yrs, RT alone (3DCRT, IMRT, or brachytherapy), radical prostatectomy (RP) +/- pelvic LN dissection, or expectant management |
| Low risk prostate ca treatment recommendations for life expectancy >10 yrs | For life expectanct >=10 yrs, RT alone (3DCRT, IMRT, or brachytherapy), radical prostatectomy (RP) +/- pelvic LN dissection, or expectant management |
| Low risk prostate ca treatment recommendations if RP margins positive | adjuvant RT (preferred) or expectant management |
| Intermiedate risk prostate treatment recommendations for life expectantcy <10 yrs | expectant management or definitive RT +/- short-term hormones (4-6 mos) |
| Intermiedate risk prostate treatment recommendations for life expectancy >10 yrs | RT + short-term hormones (4-6 mos) (preferred); high-dose RT alone; or RP +/- pelvic LN dissection; RT may be 3DCRT or IMRT +/- brachytherapy boost, consider whole pelvic RT |
| Intermiedate risk prostate treatment recommendations if RP margins positive | adjuvant RT +/- short term HT (preferred) or expectant management. |
| Intermiedate risk prostate treatment recommendations if RP margins positive & LN + | androgen ablation +/- RT or expectant management |
| high risk prostate cancer treatment recommendations | RT (3DCRT or IMRT +/- brachytherapy boost) + long term HT (>= 2 yrs). Consider whole pelvic RT |
| Prostate cancer treatment recommendations if LN + | RT (3DCRT or IMRT +/- paraaortic RT + long-term HT; or androgen ablation alone |
| Metastatic prostate cancer treatment recommendations for hormone responsive disease | Androgen ablation +/- palliative RT +/- bisphosphonates |
| Metastatic prostate cancer treatment recommendations for hormone-refractory disease | Docetaxel + prednisone or estramustine prolongs survival (vs mitoxantrone + prednisone) |
| Prostate cancer recommendations for residual or maybe recurrent prostate cancer after RP | RT +/- HT |
| Prostate cancer recommendations for residual disease or recurrent disease after RT. If biopsy + & no evidence (or low risk) of mets | surgery or salvage brachytherapy |
| Prostate cancer recommendations for residual disease or recurrent disease after RT. If disease is metastatic or patient is not a candidate for local therapy | androgent ablation or observation |
Created by:
aherskovic
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