Radiation Therapy in the Management of Low and Intermediate Risk Prostate Cancer in the Geriatric Population - #49Take Quiz
Understand the course of treatment for patients with low and intermediate risk prostate cancer.
Treatment decisions for men who present with low to intermediate risk prostate cancer need to consider risk of morbidity and mortality of the disease, morbidity of treatment, and patient life expectancy based on co-morbid conditions and geriatric assessments.
- Intermediate risk disease and life expectancy greater than 10 years, treatment with either
- Prostatectomy or
- Definitive radiation therapy with either external beam irradiation or brachytherapy as the preferred treatment
Primary androgen depravation therapy in this patient population is discouraged.
- Low and intermediate risk disease and a life expectancy of less than 10 years, the preferred treatment is active surveillance or observation
- One algorithm for active surveillance suggests PSA and digital rectal exam every 3 months for the first two years, then every 6 months if the PSA is stable.
- Biopsy should be repeated 12 months after diagnosis, and then every 3-5 years until age 80.
- Transition to definitive therapy include detection of Gleason 7 disease or higher
- increased volume of disease based on greater number of biopsy cores involved or greater percentage of tissue involvement, or PSA doubling time <3 years.
Prostate cancer risk increases with age and balancing the risks of treatment with the risks of disease progression presents challenges for providers treating patients with this disease.
Determine best course of treatment for patients with low and intermediate risk prostate cancer
Increasing age is a risk for the development of prostate cancer. Most cases occur in men over age 65 and prostate cancer deaths occur disproportionately in the elderly, owing to the long natural history of the disease.
Describe the role of radiation therapy in the management of Low and Intermediate risk prostate cancer for geriatric patients
Review of Systems (ROS)
Ries, LAG, Melbert, D, Krapcho, M, et al. SEER Cancer Statistics Review, 1975–2005. Bethesda, MD: National Cancer Institute, 2008. Available at: http://seer.cancer.gov/csr/1975-2005/
NCCN guidelines on prostate cancer, version 2.2014
Klotz L Semin Radiat Oncol 2008 19:2-6
Thompson I, Thrasher JB, Aus G, et.al. J of Urol 2007 177:2106-2131
Albertsen PC, Hanley JA, Fine J. JAMA 2005 293(17): 2095-2101
Daskivich TJ, Fan KH, Koyama T, et.al. Ann Intern Med 2013;158(10):709-718
Droz JP, Balducci L, Bolla M, et.al. Brit J of Urol International 2010 106:462-469
Kundu SD, Roehl KA, Eggener SE J Urol 2004 172:2227-2231
Mohamad BA, Marszalek M, Brossner C Eur Urol 2007:684-689
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