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 ?