prostate cancer: treatment choices prostate cancer: treatment choices winston w tan md facp winston...
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Prostate Cancer: Treatment choicesProstate Cancer: Treatment choices
Winston W Tan MD FACPWinston W Tan MD FACP
Senior Consultant Senior Consultant
Genitourinary OncologyGenitourinary Oncology
Mayo Clinic FloridaMayo Clinic Florida
IncidenceIncidence• 230,000 cases each year230,000 cases each year
• 30,000 deaths each year30,000 deaths each year
• IndolentIndolent
• Aggressive diseaseAggressive disease
• Jemal et al 2009Jemal et al 2009
BiopsyBiopsy• Sextant biopsySextant biopsy
• Template biopsyTemplate biopsy
• Importance for diagnosisImportance for diagnosis
• PSA of 50 and abovePSA of 50 and above
DiagnosisDiagnosis• PSAPSA
• Gleason ScoreGleason Score
• StageStage
• Metastasis or notMetastasis or not
Gleason scoreGleason score• Microscopic appearanceMicroscopic appearance
• 1 well differentiated1 well differentiated
• 5 poorly differentiated5 poorly differentiated
• Maximum score of each site:5Maximum score of each site:5
• Add score of 2 sitesAdd score of 2 sites
Treatment OptionsTreatment Options• Radical ProstatectomyRadical Prostatectomy
• External beam radiationExternal beam radiation
• Brachytherapy( interstitial seed Brachytherapy( interstitial seed implant)implant)
• Combination of external beam Combination of external beam radiation and seed implantradiation and seed implant
• ObservationObservation
Radical prostatectomyRadical prostatectomy• Full evaluation of pathologyFull evaluation of pathology
• Risk of anesthesiaRisk of anesthesia
• ImpotenceImpotence
• Urinary incontinenceUrinary incontinence
• Morbidity from surgeryMorbidity from surgery
External beam radiationExternal beam radiation• Treat more area if there is Treat more area if there is
extracapsular involvementextracapsular involvement
• Gastrointestinal complicationsGastrointestinal complications
• Radiation cystitisRadiation cystitis
• Radiation proctitisRadiation proctitis
• Urinary incontinenceUrinary incontinence
BrachytherapyBrachytherapy• Not for everybodyNot for everybody
• Low riskLow risk
• More radiation cystitisMore radiation cystitis
• Inadequate cure of cancer Inadequate cure of cancer
ObservationObservation• Scandinavian studiesScandinavian studies
• Low gleason score :6 and belowLow gleason score :6 and below
• Elderly patientsElderly patients
• Less than 10 years to liveLess than 10 years to live
OptionsOptions• Treatment options are equal basedTreatment options are equal based
On patients followedOn patients followed
No randomized clinical trialsNo randomized clinical trials
Medical teamMedical team• UrologistUrologist
• Radiation oncologistRadiation oncologist
• Medical oncologistMedical oncologist
• NephrologistNephrologist
• NursingNursing
• Physical therapyPhysical therapy
ChoiceChoice
The choice is yours !!!The choice is yours !!!
Prostate CancerProstate Cancer• You are in chargeYou are in charge
• Empower patientsEmpower patients
• Educate patientsEducate patients
• Stimulate interest in participation in Stimulate interest in participation in clinical trialsclinical trials
Thank YouThank You
Questions ?Questions ?