State Of The Art Urology
Despite the high 5- and 10 year survival rates prostate cancer mortality is estimated to be 29.000 cases with 238.000 newly diagnosed cases for 2013 . To identify and treat those patients, who have a tumor, which will cause severe symptoms or will be lethal is the persisting challenge in the daily routine of urologists and oncologists. At the same time unnecessary invasive diagnostic procedures or treatments have to be minimized .
Once a tumor has been diagnosed and validated in histological biopsies several treatment options especially for the organ-confined tumor are available. To prospectively compare the different regimens available, prospective multicenter trials such as the German PREFERE Study are required. In this four arm preference based study, surgery , radiation and active surveillance will be compared in terms of effectiveness and side effects in a multicenter randomized trial including over 7000 men.
Focus in the future has to be on additional diagnostic parameters to clearly identify low risk tumors, which will not need treatment and separate them from high risk tumors, which do need aggressive treatment. It is believed that the heterogeneous outcome of prostate tumors is based on different tumor subtypes, which could be defined by certain molecular properties. Currently, several national and international institutions have set up large efforts to further delineate the molecular heterogeneity of prostate tumors.
How Much Does Prostate Cancer Treatment Cost In India
Prostate cancer treatment recommendations depend upon level of PSA, Gleason score, Grade, co-morbid conditions of the patient. Average cost ofprostate cancer treatment in Indiawould vary fromRs. 4,50,000 to Rs. 7,50,000. Prostate cancer treatment cost in India vary in different hospitals at different cities. These are different surgical treatment options and their cost:
- Radical Laparoscopic Prostatectomy cost in India – Rs. 4,80,000 to Rs. 5,50,000
- Robot-assisted laparoscopic radical prostatectomy cost in India – Rs. 7,00,000 to Rs. 7,50,000
- Open radical prostatectomy cost in India – Rs. 3,00,000 to Rs. 4,00,000
Mri Thermometry For Thermal Ablation
One of the major advantages associated with MRI guidance of thermal ablations is the MRI thermometry and subsequent dose estimations, which are performed in near real-time and allow for adjustments of treatment parameters and tumour targeting. The thermometry to monitor local temperatures most commonly is accomplished using the known linear dependence of proton resonance frequency as a function of temperature. During delivery of ablative energy (generated by ultrasound transducer or laser
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Treatment Option Overview For Prostate Cancer
In This Section
Local treatment modalities are associated with prolonged disease-free survival for many patients with localized prostate cancer but are rarely curative in patients with locally extensive tumors. Because of clinical understaging using current diagnostic techniques, even when the cancer appears clinically localized to the prostate gland, some patients develop disseminated tumors after local therapy with surgery or radiation.
Treatment options for each stage of prostate cancer are presented in Table 6.
| Stage | Standard Treatment Options |
|---|---|
| EBRT = external-beam radiation therapy LH-RH = luteinizing hormone-releasing hormone PARP = poly polymerase TURP = transurethral resection of the prostate. | |
| Stage I Prostate Cancer | |
| PARP inhibitors for men with prostate cancer and BRCA1, BRCA2, and/or ATM mutations |
Radiation Therapy And Radiopharmaceutical Therapy
External-beam radiation therapy
Candidates for definitive radiation therapy must have a confirmed pathologic diagnosis of cancer that is clinically confined to the prostate and/or surrounding tissues . Staging laparotomy and lymph node dissection are not required.
Radiation therapy may be a good option for patients who are considered poor medical candidates for radical prostatectomy. These patients can be treated with an acceptably low complication rate if care is given to the delivery technique.
Long-term results with radiation therapy are dependent on stage and are associated with dosimetry of the radiation.
Evidence :
Evidence :
Brachytherapy
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How Effective Is Hormone Treatment For Prostate Cancer
Hormone therapy or androgen suppression therapy is used for reducing levels of male hormones ), in the body, or to stop them from stimulating prostate cancer cells. Hormone therapy is effective in slowing down the cancer growth or shrink them.
Hormone therapy does not cure alone the prostate cancer, it can be used:
- If the prostate cancer has spread too far and surgery or radiation cant be used
- If the prostate cancer comes back or remains after radiation therapy or surgery
- To make radiation therapy more effective
Conversations With Peter T Scardino Md Facs And Howard M Sandler Md Ms Fastro
Peter T. Scardino, MD, FACS
Howard M. Sandler, MD, MS, FASTRO
Over the next 2 years, one might expect a substantial increase in the use of stereotactic body radiotherapy for prostate cancer, given the convenience of the five-fraction approach compared with longer treatment strategies.Howard M. Sandler, MD, MS, FASTRO
The 2014 Genitourinary Cancers Symposium, held in San Francisco from January 29 to February 1, brought together more than 3,100 participants from around the world involved in the care of patients with genitourinary malignancies. The abstract presentations and plenary discussions offered the latest clinical and basic science data that will affect patient management immediately and well into the future.
During the course of the meeting, The ASCO Post had the opportunity to speak with several of the worlds leading authorities about the state of the art in screening, diagnosis, and treatment for prostate and kidney cancers. In this first installment of our two-part report on genitourinary malignancies, we talked to Peter T. Scardino, MD, FACS, Chair of Surgery and former Chair of Urology at Memorial Sloan Kettering Cancer Center in New York, and Howard M. Sandler, MD, MS, FASTRO, Chair of Radiation Oncology at Cedars-Sinai Medical Center, and a member in the Cedars-Sinai Samuel Oschin Comprehensive Caner Institute, Los Angeles, about the latest approaches to managing prostate cancer.
A CONVERSATION WITHPETER T. SCARDINO, MD, FACS
PSA Screening
Imaging Studies
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Prostate Cancer Care In Orange County
When you receive a prostate cancer diagnosis, you need the best, most innovative treatments and internationally recognized clinician-scientists by your side.
City of Hope is a National Cancer Institute-designated comprehensive cancer center with multiple Orange County locations ready to treat your prostate cancer.
- Next-generation genetic screening and prevention programs
- Precision medicine and targeted therapies
- Minimally invasive surgical techniques
- Clinical trials of groundbreaking new treatments
- Renowned Physicians and Researchers
- Every year, thousands of people facing prostate cancer, from stage 1 to stage 4, are successfully treated at City of Hope. Our patients five-year survival rate is very close to 100%.
- Our interdisciplinary team works with you to develop an individualized and highly coordinated treatment plan based on your unique needs.
- For more than a decade, U.S. News & World Report has named City of Hope one of the top cancer hospitals in America. Our highly specialized clinicians and scientists are focused solely on cancer, rapidly turning our innovative research into advanced treatments for patients across Orange County and beyond.
Our advanced cancer treatments include:
Prostate cancer is a disease in which cells in the prostate start growing abnormally and uncontrollably. The prostate is a walnut-shaped organ that contributes fluid to semen and helps expel semen during ejaculation.
Focal Thermal Ablative Therapy Options
Once prostate cancer is found, localised, and imaged, it is necessary to determine a potential treatment plan. Standard therapies include radiotherapy, surgery, or androgen deprivation45 however, these therapies have significant risk and morbidity to the patient’s health-related quality of life with potential impact on sexual, urinary, and bowel function.3 Active screening programmes for prostate cancer have enabled earlier identification of low-risk prostate cancer because of related
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Limitations To Mri Visualisation Of Ice Ball Temperature Isotherms
A major limitation for MRI-guided cryoablation is that the ice ball isotherms are not readily visualised. The leading edge of the ice ball is well visualised due to very rapid T2 relaxation of ice protons, but this corresponds to 0°C and may not be lethal. Therefore, it is necessary to carry the edge of the ice beyond the tumour margin by at least 5 mm however, this approach assumes that ice ball lethal isotherms of â40°C are < 5 mm from the leading edge of the ice ball93 and in the presence of
Side Effects Of Hormone Therapy
Hormone therapy may cause side effects associated with low testosterone, such as hot flashes, sweating, weight gain, reduced sexual desire and depression. Some men also may experience swollen breasts, depression, memory loss and heart problems. Eventually, the cancer may become resistant to hormone therapy. If hormone therapy stops working, doctors may switch treatments.
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State Of The Art Radiation Oncology
Radiotherapy has been established as a clear treatment alternative in patients with prostate cancer. This is due to the significant developments over the last decades, continuously increasing precision of dose delivery to the tumor while sparing normal tissue and thus reducing treatment-related side effects.
For further improvement of the therapeutic window, modern radiation machines are coupled with imaging, such as in-room CT-scanners, or radiation and imaging in one machine. Daily imaging prior to treatment is possible, correcting potential positioning errors of the patient. Currently, adaption of dose distribution not only to interfractional movement, but also to intra-fractional changes is possible. This means, dose distribution can follow movement and deformation of organs at risk , of the target volumes or target organs . Research is currently establishing technical advancements such as gating or tracking . Combinations of radiation and imaging in terms of Image Guided Radiotherapy have lead to further increase of dose in prostate cancer treatment, thus further increasing outcome ,,. With these technical developments, also local dose increase to e.g. positive lymph nodes in patients with pelvic nodal disease can be targeted precisely, e.g. based on PSMA-PET-Imaging.
Prostate Cancer Center Of Excellence
The idea of having prostate cancer can be frightening. According to the American Cancer Society, doctors diagnose more than 164,500 new cases of prostate cancer per year. Roughly 1 out of 9 men are diagnosed with prostate cancer in their lifetime. Because there are no symptoms, you could have it right now and not even realize it.
CHI Memorials Prostate Center of Excellence is a state-of-the-art treatment center dedicated entirely to treating prostate cancer. Our physicians, surgeons and radiologists work together to offer you the most effective multidisciplinary prostate cancer treatments available, improving your quality of life while minimizing debilitating side effects.
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These Technologies Could Change Your Life For The Better
The da Vinci® Surgical Robot assists with laparoscopic prostatectomies and represents the most advanced prostate cancer treatment available today. The da Vinci® provides superior 3D visualization, as surgeons use its robotic arms to perform prostate surgeries through keyhole – sized incisions. The actual surgical instruments are the size of match heads, ensuring precise control that results in:
Stage I Prostate Cancer Treatment
In This Section
Vascular-targeted photodynamic therapy using a photosensitizing agent has been tested in men with low-risk prostate cancer. In the CLIN1001 PCM301 randomized trial, 413 men with low-risk cancer were randomly assigned in an open-label trial to receive either the photosensitizing agent, padeliporfin , or active surveillance. Median time to local disease progression was 28.3 months for patients receiving padeliporfin and 14.1 months for patients who were assigned to active surveillance . However, the appropriate population for photodynamic therapy may be quite narrow, as it may overtreat men with very low-risk disease and undertreat men with higher-risk disease.
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Stage Ii Prostate Cancer Treatment
In This Section
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent. .
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radical prostatectomy may be difficult after a transurethral resection of the prostate .
Evidence :
Evidence :
Evidence :
Ajcc Stage Groupings And Tnm Definitions
The AJCC has designated staging by TNM classification.
| Grade Group | Gleason Score | Gleason Pattern |
|---|---|---|
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | ||
| 1 | ||
| 4+4, 3+5, or 5+3 | ||
| 5 | 4+5, 5+4, or 5+5 |
| Stage | Gleason Score Gleason Pattern g | Illustration | |
|---|---|---|---|
| T = primary tumor N = regional lymph nodes M = distant metastasis cT = clinical T PSA = prostate-specific antigen pT = pathological T. | |||
| aAdapted from AJCC: Prostate. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer, 2017, pp. 71526. | |||
| The explanations for superscripts b through g are at the end of Table 5. | |||
| I | cT1ac, cT2a, N0, M0 | cT1 = Clinically inapparent tumor that is not palpable. | < 10 |
| cT1a = Tumor incidental histologic finding in 5% of tissue resected. | |||
| cT1b = Tumor incidental histologic finding in > 5% of tissue resected. | |||
| cT1c = Tumor identified by needle biopsy found in one or both sides, but not palpable. | |||
| cT2 = Tumor is palpable and confined within prostate. | |||
| cT2a = Tumor involves 1/2 of one side or less. | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. | |||
| Gleason Score, 6 Gleason Pattern, 3+3 . | |||
| N0 = No positive regional nodes. | |||
| M0 = No distant metastasis. |
References
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What Lies Ahead: Leading The Way With Alpha Therapies
The coming years will see even more powerful forms of radioactive therapy. The MSK laboratory of radiochemist Jason Lewis and other researchers are investigating the use of alpha particles, which have a much higher energy hundreds of times more potent than the photons used in conventional radiation or beta particles. Not only do alpha particles cause more damage when they slam into cancer cells but their path of destruction is more tightly focused, sparing normal cells.
MSK is building one of the nations first dedicated alpha particle GMP labs at a U.S. academic institution.
These radiopharmaceuticals that we are creating translate very well from bench to bedside, says Dr. Lewis, Chief of the Radiochemistry and Imaging Sciences Service and Director of the Radiochemistry and Molecular Imaging Probe Core Facility. When you see these striking responses to treatment, it brings real hope for the future and our patients.
Advances in radiotheranostics are supported by The Tow Foundation, long-time contributors to MSKs mission.
- A new FDA-approved drug could be an effective treatment against prostate cancer that has spread.
- The treatment uses a molecule that seeks out and attaches to a specific protein on the cancer cell surface called PSMA
- The technology delivers radiation that damages DNA and destroys the cancer cell..
A Team Approach To Prostate Cancer Care
A major reason for the success of our Prostate Cancer Center is its multidisciplinary approach to cancer treatment. Every case is under the care of a team of specialists that meets regularly to determine and implement the optimal treatment. This team consists of urologists, medical oncologists, radiation oncologists, and other cancer specialists. As a result of this multidisciplinary approach, men suffering from prostate cancer or other genitourinary malignancies can meet with several specialists during just one visit. Patients also have the satisfaction of knowing that an entire team of experts is working together to apply the latest breakthroughs in cancer detection, diagnosis, and treatment to their specific case.
Another important aspect of our prostate cancer program is the use of a nurse coordinator. This dedicated, caring professional facilitates treatment and educates patients about their condition. Additional support is available from genetic, nutritional and psychological counselors, as well as social workers. All of these experts understand the special problems and concerns of men confronting genitourinary malignancies and are committed to addressing these issues in a dignified, compassionate way.
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