Prostate Cancer: Treatment choices Prostate Cancer: Treatment choices Winston W Tan MD FACP Winston...
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Transcript of Prostate Cancer: Treatment choices Prostate Cancer: Treatment choices Winston W Tan MD FACP Winston...
![Page 1: Prostate Cancer: Treatment choices Prostate Cancer: Treatment choices Winston W Tan MD FACP Winston W Tan MD FACP Senior Consultant Senior Consultant Genitourinary.](https://reader035.fdocuments.in/reader035/viewer/2022070403/56649f335503460f94c4f2ac/html5/thumbnails/1.jpg)
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
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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
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BiopsyBiopsy• Sextant biopsySextant biopsy
• Template biopsyTemplate biopsy
• Importance for diagnosisImportance for diagnosis
• PSA of 50 and abovePSA of 50 and above
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DiagnosisDiagnosis• PSAPSA
• Gleason ScoreGleason Score
• StageStage
• Metastasis or notMetastasis or not
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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
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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
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Radical prostatectomyRadical prostatectomy• Full evaluation of pathologyFull evaluation of pathology
• Risk of anesthesiaRisk of anesthesia
• ImpotenceImpotence
• Urinary incontinenceUrinary incontinence
• Morbidity from surgeryMorbidity from surgery
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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
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BrachytherapyBrachytherapy• Not for everybodyNot for everybody
• Low riskLow risk
• More radiation cystitisMore radiation cystitis
• Inadequate cure of cancer Inadequate cure of cancer
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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
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OptionsOptions• Treatment options are equal basedTreatment options are equal based
On patients followedOn patients followed
No randomized clinical trialsNo randomized clinical trials
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Medical teamMedical team• UrologistUrologist
• Radiation oncologistRadiation oncologist
• Medical oncologistMedical oncologist
• NephrologistNephrologist
• NursingNursing
• Physical therapyPhysical therapy
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ChoiceChoice
The choice is yours !!!The choice is yours !!!
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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
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Thank YouThank You
Questions ?Questions ?