Prostate Cancer

Int. 洪 毓 謙

Prostate cancer is the Second leading cause of death from cancer in the United States

American male, the lifetime risk of:1. Developing prostate cancer is 17%2. Dying of prostate cancer is only 3%

Autopsy - small prostatic carcinomas:64% of 60 to 70 years of age

Screening:1. Digital rectal examination2. PSA level(< 4.0 ng/Ml) if abnormal →Transrectal ultrasonography to guide Prostate biopsy

Prostate cancer screening has been a controversial issue because the effectiveness of screening remains uncertain. No studies have yet proven a survival benefit with screening

Gleason Score→ assigns a grade to each of the two largest areas of cancer in the tissue samples.

→ The two grades are then added together to produce a Gleason score

2 to 4 ~ low grade 5 to 7 ~ intermediate grade8 to 10 ~ high grade

Early prostate cancer Treatment

Radical Prostatectomy Radiation therapy

External beamBrachytherapy - can be considered a standard

therapeutic option for men with low-risk disease Watchful waiting

Hormone therapy

RADIATION THERAPY (External Beam)

Does not require hospitalization and normal activity can usually be maintained during the course of therapy.

Cure rates appear to be comparable with Radical Prostatectomy(RP), at least for the first five to eight years

Late recurrences can occur. As a result, ten years or more after treatment, the outcome with RT may not be as favorable as with RP. However, the available data on this issue using modern radiotherapy techniques are limited.

Brachytherapy

Permanent seeds implantation :requires only a one-time insertion in an outpatient setting. Radiation exposure to physicians, nursing personnel, and family members is negligible.

Brachytherapy

High dose rate (HDR) temporary brachytherapy: A computer-controlled machine pushes a single highly radioactive iridium seed into the catheters one by one. Because the computer can control how long this single seed remains in each of the catheters, we are able to control the radiation dose in different regions of the prostate.

Watchful waiting or Radical Prostatectomy ??

Death from Prostate Cancer

Watchful waiting or Radical Prostatectomy ??

Distant Metastasis

Watchful waiting or Radical Prostatectomy

Cumulative Probability of Death

Watchful waiting or Radical Prostatectomy

A statistically significant difference in the risk of death due to prostate cancer after radical prostatectomy as compared with watchful waiting, yet there was no significant difference between the two groups in the overall survival rate.

Life quality

Hormone therapy

In randomized trials (N Engl J Med 1997 Jul 31;337(5):295-300 ) in men with locally advanced prostate cancer: Neoadjuvant hormone therapy (androgen deprivation therapy) significantly improves disease-free survival, time to the development of progressive disease and overall survival

Advanced prostate cancer Treatment

Second-line hormone therapy Chemotherapy

1. In early trials, objective response rates were 10 to 20 percent, and median survival did not exceed 12 months. 2. Newer regimens, particularly those that include docetaxel, a significant prolongation in median survival, approaching 20 months.

Sr 89can release 60 ~ 80% symptoms of bone metastasis

Re186-HEDPAggregate in sites of bone metastasis, release 80% of pain