 | |
Information You Should Read
Stanford Univ. video on PCa
The Prostate - What, Where
The Prostate Biopsy
How To Tell a "Physician Artist"
The Doctors Appointment
Insignificant Cancer
Vocabulary, Glossary, etc.
Tables, Tests, Markers etc.
Gleason Info and Partin Tables
PSA - What it is and means
Locally Advanced Cancer
BPH
Prostatitis
Other Diagnostic Tools
Veterans Information
|
 Optimal management of locally advanced prostate cancer remains undefined. Standard treatment options include RP, external-beam radiotherapy, or hormonal ablation therapy, alone or in combination. New approaches being tested include improved methods for delivering radiation or combining hormonal ablation with surgery or radiation. It is possible that other forms of systemic therapy, including chemotherapy, may become important components of multimodality treatment. Clinical trials designed to test this hypothesis are ongoing. Table of Contents for this page: Patient information: Advanced prostate cancer Locally advanced (high-risk) prostate cancer. Management strategies for locally advanced prostate cancer. Management of Locally Advanced Prostate Cancer Greater BMI Linked to Increasing Locally Advanced Prostate Cancer Mortality Treatment of Locally Advanced Prostate Cancer
Patient information: Advanced prostate cancer Following is part of a very excellent article by Nancy A Dawson and Diane MF Savarese and published by "Up to Date Information". You can read the complete article by clicking here. TREATMENT FOR LOCALLY ADVANCED CANCERS — Experts are not in complete agreement about the best way to manage locally advanced prostate cancer (most often T3 tumors; T4 disease is rare); treatment options include: External beam radiation treatment (EBRT) with or without brachytherapy (see "Radiation therapy" below). Transurethral resection of the prostate (TURP), a conservative type of surgery that aims only to relieve obstruction to the urine flow that is caused by the tumor Radical prostatectomy, in which the entire prostate gland is removed surgically in an attempt to provide a cure Hormone therapy that eliminates the effect of male hormones (androgens such as testosterone) on the growth of the prostate cancer cells. The term "hormone therapy" refers to any treatment that decreases the amount of androgens in a man's body or prevents the body (particularly the prostate cells) from responding to them. More commonly used terms for this type of therapy are androgen ablation or androgen deprivation therapy (ADT). . . . . . . Locally advanced (high-risk) prostate cancer. "Locally advanced" prostate cancer before the advent of PSA testing typically referred to patients whose prostate tumor on clinical exam or post-prostatectomy histologic examination had disease extend outside the prostatic capsule (T3) or invade adjacent structures (T4). Treatment of these patients with EBRT produced actuarial local control, disease-free, and overall survival rates of 75%, 40%, and 27%, respectively. The most important pretreatment prognostic factors in the pre-PSA era were Gleason score and T-stage. The definition of a "high-risk" patient has evolved over the past decade with the adoption of widespread PSA testing. Pretreatment PSA has joined Gleason score and T-stage as an important independent prognostic factor. Extensive stage migration has occurred with the advent of PSA screening such that the most frequent presenting stage is now clinically nonpalpable (and presumably low-volume) T1c disease. The combined prognostic value of PSA, clinical T-stage, and Gleason score is superior to that of any one of these factors alone and has led to the ability to stratify patients based on pretreatment clinical risk group classifications. . . . . To read this interesting and well done paper click "here". Drugs Aging. 2006;23(2):119-29.Links Management strategies for locally advanced prostate cancer. Jani AB. Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA. ABSTRACT Locally advanced prostate cancer represents a subpopulation of prostate cancer diagnosed in patients who are either untouched by screening efforts or whose disease has an unusually rapidly progressive natural history. The diagnostic work-up for the locally advanced patient is distinct from that of early stage disease in several respects in that it is related principally to ruling out metastases. The typical metastatic work-up consists of a serum alkaline phosphatase, bone scan, CT of the abdomen/pelvis, and chest x-ray. Once metastatic disease has been ruled out, individual components of the management of locally advanced prostate cancer patients may include surgery (palliative or curative), external beam radiation therapy (with photons or particles) or brachytherapy (with low-dose rate/permanent or high-dose rate/temporary radiation sources), and hormone therapy. Unlike in early stage disease, observation/watchful waiting is typically not a treatment option in locally advanced prostate cancer. Of the curative local control modalities, the one most commonly used, and the one which has emerged as the clinical standard, is photon external beam radiotherapy (EBRT). Numerous randomised studies have shown that androgen ablation has an established role in conjunction with radiotherapy for locally advanced disease--the current standard of care is thus photon EBRT plus neoadjuvant and adjuvant androgen ablation. Long-term androgen ablation appears to be better than short-term ablation, even when hormone complications are considered. EBRT is typically delivered to the prostate, seminal vesicles and pelvic lymph nodes, although in some circumstances local fields to the prostate and seminal vesicles may be adequate. New treatment planning and delivery techniques, such as intensity-modulated radiotherapy and organ motion tracking, are being developed to reduce the morbidity of radiotherapy while permitting a higher delivered dose. Further work is necessary to determine the precise sequencing and duration of hormone therapy in conjunction with radiotherapy and the optimum radiotherapy treatment volume. Additional work is also needed to determine the precise groups benefiting from other local control modalities such as surgery and brachytherapy. Finally, novel investigational strategies such as chemotherapy and gene therapy are being applied in an attempt to improve outcomes of locally advanced prostate cancer patients. PMID: 16536635 [PubMed - indexed for MEDLINE] Management of Locally Advanced Prostate Cancer T3 Disease A national Patterns of Care survey by the American College of Surgeons found that of patients diagnosed in 1990, 15% presented with clinical T3 disease.260 What is the natural history of clinical T3 prostate cancer? Because of the biologic heterogeneity inherent in all prostate cancers regardless of stage, this remains a difficult question to answer. In addition, patients have been staged differently and treated with a variety of therapies. The longest study of untreated T3 prostate cancer was reported recently in a large prospective, population-based study of 642 patients from Sweden. One hundred eighty-three patients with clinical T3 or T4 disease and no evidence of distant metastases were observed without initial local therapy.261 The grade of disease was not specifically noted for the group of T3 or T4 patients, but in the overall group of T1–T4 patients, most had either moderately (47%) or poorly differentiated (19%) cancers. At 15 years, progression-free survival was 46.6% and disease-specific survival was 56.5%. Notable from these results are the surprisingly high disease-specific survival rates in this cohort in both localized and locally advanced categories of disease. . . . . . Click "here" to read the complete paper. Greater BMI Linked to Increasing Locally Advanced Prostate Cancer Mortality The association between obesity and prostate cancer has gained credibility by a finding reported here that a higher body mass index predicts an increased risk of mortality from locally advanced disease. Men with locally advanced prostate cancer were twice as likely to die of the disease if they had a BMI of 25 or higher compared with men who had lower BMI values, Matthew R. Smith, M.D., Ph.D., of Massachusetts General Hospital and Harvard, and colleagues, reported in the November issue of Cancer. . . . . . . Read the complete paper by clicking "here". Treatment of Locally Advanced Prostate Cancer
Treatment of Locally Advanced Prostate Cancer Rationale and Treatment Techniques for EBRT for Stage T3 or Greater Prostate Cancers At diagnosis, approximately 10%-15% of prostate cancer cases clinically found on digital rectal examination extend beyond the confines of the prostate capsule (AJCC clinical stage T3-T4), [2] with no evidence of regional nodal or distant metastatic spread. Fortunately, the widespread use of PSA as a screening tool has increased the detection of prostate cancers even before the first abnormalities are evident on digital rectal examination. EBRT treatment has long been considered the treatment of choice for management of locally advanced prostate cancers since surgical resection would usually result in pathologically positive margins and thus would require adjuvant postoperative radiotherapy to achieve local control and potential cure. The mid to late 1990s saw a strong surgical interest in "downstaging" locally advanced prostate cancers with neoadjuvant antiandrogen and then proceeding with radical prostatectomy. Although androgen ablation produced significant tumor responses and pathologically negative margins were often achieved at resection, PSA recurrence was the norm once androgen ablation therapy was discontinued, indicating the presence of residual tumor. To read this complete paper click "here".
|
Tell a Friend Site Map - This site is updated regularly, and every effort is made to ensure that the information is correct. In order to continue this web site I accept donations - click "here" for how to donate. I do not accept any responsibility for errors or omissions that may occur. If you find errors please notify us by clicking "here" and sending us the information. Fair Use Notice and Warning ©Copyright 1998 - 2008
| |
