prostate%20cancer
PROSTATE CANCER
Treatment Guideline Chart

Prostate cancer is the cancer that occurs in the male's prostate.

It is the most common cancer in men >50 years of age.

Signs and symptoms include weak urinary stream, polyuria, nocturia, hematuria, erectile dysfunction, pelvic pain, back pain, chest pain, lower extremity weakness or numbness and loss of bowel or bladder control.

Surgical Intervention

Radical Prostatectomy

  • Removal of the prostate gland as a whole, including the seminal vesicles, ampulla of the vas deferens, and lymph nodes with preservation of function (continence, potency)
  • First-line treatment for patients with tumors confined to the prostate gland, with very low- to intermediate-risk disease, and life expectancy of ≥10 years
    • Treatment option for patients with high- to very high-risk disease and a salvage therapy option for patients with biochemical recurrence after external beam radiation therapy (EBRT), brachytherapy or cryotherapy if with no metastases, ISUP grade 4-5 or PSA >20 ng/mL
  • High cure rate for patients with purely localized disease

Pelvic Lymph Node Dissection (PLND)

  • Recommended for patients with high-risk or locally advanced disease with nodal metastases, done concurrently with radical prostatectomy
  • Extended pelvic lymph node dissection, which involves the removal of the lymph nodes in the area of the external iliac artery and vein, veins within the obturator fossa, and medial and lateral nodes of the internal iliac artery, is preferred due to its completeness of disease staging and is therapeutically more advantageous in patients with microscopic metastases compared to PLND alone
    • May be done in patients with intermediate risk with >5% estimated risk of lymph node involvement

Orchiectomy

  • Surgical option of androgen deprivation therapy (ADT) (Please refer to the discussion of orchiectomy in the ADT section)

Cryosurgery (Cryotherapy/Cryoablation)

  • Minimally invasive surgical procedure that involves freezing and destruction of tumor tissues
  • Treatment option for patients with high-risk prostate cancer following radiation therapy and as initial treatment for patients with low- to intermediate-risk localized or locally advanced stages
    • High-risk prostate cancer following radiation therapy
    • Low- to intermediate-risk prostate cancer not a candidate for prostatectomy due to comorbidities
    • Relative contraindications to radiotherapy
  • Prostate volume should be <40 mL at the time of therapy
  • Lower risk of damage to nearby structures and complication secondary to radical treatment
  • Studies reported a range of 52%-92% biochemical disease-free survival within 5-7 years, depending on criteria used
    • Discussion with patient should be made regarding the lack of long-term efficacy comparative outcome data

Other Ablative Techniques

  • Eg high-intensity focused ultrasound (HIFU), radiofrequency ablation and electroporation
  • HIFU is a minimally invasive procedure that uses focused ultrasound waves emitted from a transducer to cause thermal damage to malignant tissues
    • Alternative treatment to localized prostate cancer with disease recurrence after radiotherapy 
    • May be applicable for low- to intermediate-risk patients but further studies are needed to conclude use
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