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Prostate Rad Onc

QuestionAnswer
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