Prostate Cancer: Treatment choices

1
Prostate Cancer Treatment choices

• Winston W Tan MD FACP
• Senior Consultant
• Genitourinary Oncology
• Mayo Clinic Florida

2
Incidence

• 230,000 cases each year
• 30,000 deaths each year
• Indolent
• Aggressive disease
• Jemal et al 2009

3
Biopsy

• Sextant biopsy
• Template biopsy
• Importance for diagnosis
• PSA of 50 and above

4
Diagnosis

• PSA
• Gleason Score
• Stage
• Metastasis or not

5
Gleason score

• Microscopic appearance
• 1 well differentiated
• 5 poorly differentiated
• Maximum score of each site5
• Add score of 2 sites

6
Treatment Options

• Radical Prostatectomy
• External beam radiation
• Brachytherapy( interstitial seed implant)
• Combination of external beam radiation and seed
  implant
• Observation

7
Radical prostatectomy

• Full evaluation of pathology
• Risk of anesthesia
• Impotence
• Urinary incontinence
• Morbidity from surgery

8
External beam radiation

• Treat more area if there is extracapsular
  involvement
• Gastrointestinal complications
• Radiation cystitis
• Radiation proctitis
• Urinary incontinence

9
Brachytherapy

• Not for everybody
• Low risk
• More radiation cystitis
• Inadequate cure of cancer

10
Observation

• Scandinavian studies
• Low gleason score 6 and below
• Elderly patients
• Less than 10 years to live

11
Options

• Treatment options are equal based
• On patients followed
• No randomized clinical trials

12
Medical team

• Urologist
• Radiation oncologist
• Medical oncologist
• Nephrologist
• Nursing
• Physical therapy

13
Choice

• The choice is yours !!!

14
Prostate Cancer

• You are in charge
• Empower patients
• Educate patients
• Stimulate interest in participation in clinical
  trials

15
Thank You

• Questions ?