Thomas M Schroeder MD November 14 th 2020 Outline Overview of All Localized Treatments for Prostate Cancer Interesting Important Recent Developments Active Surveillance Radiation or Surgery ID: 1011490
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1. Localized Treatments for Prostate CancerThomas M. Schroeder, MD November 14th, 2020
2. OutlineOverview of All Localized Treatments for Prostate CancerInteresting Important Recent DevelopmentsActive Surveillance, Radiation, or SurgerySpaceOAR DeviceImaging for Cancer after TreatmentTreatment of Prostate Cancer in Metastatic DiseaseQuestions
3. All Localized TreatmentsHistorySurgeryRadiation TherapyCryotherapyHigh Intensity Focused UltrasoundLaser Ablation
4. HistoryHugh Hampton Young (1875-1945)Performed the first radical perineal prostatectomy to treat prostate cancer.11. Ann Surg. 1905 Young Conservative Perineal Prostatectomy2. Ann Surg. 1917 Young Radium and the Punch Operation for Enlarge ProstatePerformed transurethral & transrectal radium brachtherapy for prostate ca.2Dr. Hugh Hampton Young
5. Surgery1. Lancet Oncology 2018 Coughlin et al. RCT: RALP vs ORRP 24 month outcomes, 2. Cancer 2018 Jang et al. Comparative effectiveness RP + XRT vs XRT + ADT in advanced prostate cancerOpen RetropubicLaproscopic Robot-Assisted
6. Radiation for Prostate Cancer
7. Radiation for Prostate CancerBenefitsNon-invasiveReproducibleEffectiveLow toxicity ratesQuick painless treatments DetractorsToo many treatmentsExpensiveFuture – Reduce Number of Treatments
8. Proton Therapy Bragg Peak (allows sparing of superficial tissues)
9.
10. Outcomes
11. Cryotherapy1. J Urology 2012 Chin et al. Extended FU of RCT Cryotherapy vs XRT in Prostate Cancer 2. J Urology 2016 Siddiqui. Long-Term Outcomes of Salvage Cryoablation for Radio-Recurrent Prostate CancerFreeze the prostate glandRequires urethral warming
12. High-Intensity Focused Ultrasound1. Urology 2004 Blana et al. HiFU for the treatment of localized prostate cancer: 5-year experienceHeats the prostate glandUrinary Obstruction
13. Laser Ablation1. J Urology 2012 Chin et al. Extended FU of RCT Cryotherapy vs XRT in Prostate Cancer 2. Cancer 2018 Jang et al. Comparative effectiveness RP + XRT vs XRT + ADT in advanced prostate cancerHeats the prostate cancerPerformed similar to prostate brachytherapy
14. Laser, HiFU, Cryotherapy Repurposed1. J Urology 2011 Turkbey et al. Multiparametric 3T Prostate MR Imaging to Detect Cancer: Histopath CorrelationThermoablative – too much, too fastSolution – don’t treat the whole glandMultiple studies being conducted
15. Critical Study - ProtecT Trial~10%NEJM 2016 Hamdy et al. 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized PCa
16. ProtecT TrialNEJM 2016 Donovan et al. Patient-Reported Outcomes after Monitoring, Surgery, or Radiotherapy for PcaContinued Benefit to Rectal Separation forProstate Radiation Therapy: Final Resultsof a Phase III Tria
17. Interesting Development - SpaceOARIJROBP 2017 Hamstra et al. Continued Benefit to Rectal Separation for Prostate XRT: Final Results of RCT
18. Interesting Development - ImagingPSA RisingAlready had Radiation/SurgeryStart Hormones or …New PET/CT Imaging (Axumin™/Fluciclovine-F18, 68Ga-PSMA-11, 11C-Choline,…)Identify the diseaseTreat with Radiation/SurgeryJCO 2018 Ost et al. Surveillance or Metastasis-Directed Therapy for Oligometastatic Prostate Cancer RecurrenceJCO 2020 Palma et al. Long-Term Results of the SABR-COMET Phase II Randomized Trial
19. Interesting Development - STAMPEDEMetastatic Prostate Ca PatientsHormone (ADT) with/without Chemo (Taxanes)Randomized to Prostate XRT or No Further TxProstate Only XRT - 36Gy/6Fx or 55Gy/20FxLow Metastic Burden Patients (3 or less bone metastases - none outside axial skeleton, no visceral metastases)Lancet 2018 Parker et al. XRT to primary tumor in newly diagnosed metastic prostate cancer (STAMPEDE)
20. Questions