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Published in Advanced Prostate Cancer

Expert Opinion / Cases · July 15, 2015

Healthy 56 Year-Old Man With High-Volume Gleason Score 8 Prostate Cancer

Written by
Jeffrey J. Tosoian MD, MPH

 

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Jeffrey Tosoian MD, MPH

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  • Lester Krawitt

    Jul 21, 2015

    I think there is little doubt that he has ECE. A radical which some would advocate is likely to be met by PSM and require salvage RT. If staging imaging is negative, I would advise combined radiation (ERT+Brachy). In the past I'd add ADT, but at his age SE would be considerable, and Neal Stone's articles stress that ADT is not needed if the delivered radiation dose is sufficient. Lastly, MRI might help with staging, but I would be comfortable proceeding without it.

  • Vedantham Srinivasan, MD

    Jul 21, 2015

    I would give hormonal therapy as neo ad juvant and recommend radical prostatectomy

  • Nelson Stone

    Jul 21, 2015

    While RCT demonstrate an advantage with the addition of HT to external beam irradiation, improvements in survival have not been demonstrated when higher doses of radiation are utilized. The combination of ERT+Brachy provides a substantially higher radiation dose (25-30%) than ERT alone. HT given for longer than 6 months is associated with a decrease in all cause survival when used in the neoadjuvant setting (J Urol. 2014 Sep;192(3):754-9). The Japanese TRIP study, which randomized high risk prostate cancer patients to ERT+Brachy and either 6 months of NHT vs. 6 months plus 2 years (BMC Cancer. 2012 Mar 22;12:110) may help answer the question of optimal length of NHT.

  • John Desouza

    Jul 22, 2015

    I disagree he needs multi modality treatment with surgery plus or minus radiotherapy in that order if he is fit enough and if adverse features are confirmed after surgery

  • zakaria ibrahim

    Jul 22, 2015

    I am with radical prostatectomy and external beam radiation therapy and f.u pas

  • Nelson Stone

    Jul 22, 2015

    Cause specific survival with combined modality therapy (EBRT+Brachy+HT) for high risk is 85% at 15 years (J Urol. 2014 Sep;192(3):754-9). Data with RP is no better.

  • Houssein Elhajj

    Aug 16, 2015

    this is obviously a case of high risk prostate cancer, i would recommend abd-pelvic CT scan, bone scan .mp-MRI could also be used for local staging. i think that radical prostatectomy with extended LND as part of multimodal therapy would be the most appropriate next step if the metastatic workup is negative ( even if 
there is suspicious pelvic L.N ) and the patient fit to surgery.

  • Apichart Panichevaluk

    Aug 17, 2015

    This is a non- metastatic high risk localized prostate cancer so I will start with neoadjuvant hormonal treatment and followed with EBRT+ HDR brachytherapy and after that adjuvant hormonal treatment should be considered for 2 years.

  • marilyn kirkley

    Nov 18, 2017

    I think this is a case that shows how outdated and antiquated Prostate Ca screening and diagnostic methods are. Surely, he had prostate ca in 9/12. It was either missed by bx., or misread by pathology. I wonder if he had a second opinion reading of his 9/2012 bx pathology. Why is the random prostate bx still being used? As much as developing treatments for advanced PC, finding it in the first place should be the goal.

  • Apr 23, 2024

    Pending Moderator approval.
    Delete

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