Systemic treatment for high-risk localized prostate cancer Karim - - PowerPoint PPT Presentation

Systemic treatment for high-risk localized prostate cancer

Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France

Disclosure

Participation in advisory boards or as a speaker for: Amgen, Astellas, Astrazeneca, Bayer, Curevac, Janssen, Orion, Roche, Sanofi-Aventis

Mr Leo, 68 year old

• Systematic serum PSA=

28 ng/mL

• Confirmed twice
• Moderate increase in

night mictions

• Minor erection troubles

in the last year

Mr Leo, 68 year old

• No previous medical

history

• Married, 2 children
• Normal physical

examination (except digital rectal examination)

• Mother (89 year) and

father (91 year) alive

Mr Leo’s dad, 91

He meets a urologist

• Serum PSA= 28 ng/mL
• Likely clinical T3
• Biopsy:

Adenocarcinoma Gleason 8 (4+4)

• 8/12 positive biopsies

Radiologic assessment

Bone scan Normal CT scan thorax/abdomen/pelvis Normal MRI of the prostate T3

Prostate MRI for capsular invasion

• Sensitivity ∼ 60%
• Specificity ∼ 80%

T1 T2

What to do? You should have a prostatectomy! No ! Radiation therapy ! Yes, but they also talk about hormones A patient with high-risk localized prostate cancer

What would you recommend?

Now what if Mr Leo’s CT scan…

• Serum PSA= 28 ng/mL
• Likely clinical T3
• Biopsy:

Adenocarcinoma Gleason 8 (4+4)

• 8/12 positive biopsies

…shows this?