PROSTATE CANCER:PROSTATE CANCER:RADIATION APPROACHESRADIATION APPROACHES

for advanced diseasefor advanced disease

ANDREW L. SALNER, MD FACRANDREW L. SALNER, MD FACRDIRECTORDIRECTOR

HELEN & HARRY GRAY CANCER CENTERHELEN & HARRY GRAY CANCER CENTERHARTFORD HOSPITAL, CTHARTFORD HOSPITAL, CT

ARS

???

Advanced DiseaseAdvanced Disease

Biochemical recurrence after Biochemical recurrence after prostatectomyprostatectomy

Metastatic diseaseMetastatic disease Palliative external RTPalliative external RT QuadrametQuadramet

Salvage Radiation Therapy for Salvage Radiation Therapy for Biochemical RecurrenceBiochemical Recurrence

Recurrence>2years, PSA DT>10 monthsRecurrence>2years, PSA DT>10 months Positive margin, extracapsular extensionPositive margin, extracapsular extension Should be used early, PSA<1(possibly Should be used early, PSA<1(possibly

0.5)0.5) 50-70% DFS in 5 years50-70% DFS in 5 years IMRT 60-70 Gy, image guidance dailyIMRT 60-70 Gy, image guidance daily acceptable early complications, rare late acceptable early complications, rare late

complicationscomplications

Choo, R-Mayo Clinic 2009 IJROBP

Bone MetastasisBone Metastasis

Pain/loss of functionPain/loss of function Spinal cord compression>emergencySpinal cord compression>emergency Hip metastasis causes pain, threatens Hip metastasis causes pain, threatens

fracturefracture One dominant siteOne dominant site Multiple sitesMultiple sites

Spine radiation to osteoblastic lesion

Palliative RadiationPalliative RadiationBone MetastasisBone Metastasis

Highly effective 90% or more for pain reliefHighly effective 90% or more for pain relief Can be repeatedCan be repeated Short course of 2 weeks, occasionally Short course of 2 weeks, occasionally

even given in single dose, depending on even given in single dose, depending on locationlocation

Can be combined with chemo, hormone Can be combined with chemo, hormone deprivation, bone stabilization such as deprivation, bone stabilization such as vertebroplasty or fusion if neededvertebroplasty or fusion if needed

Quadramet(samarium 153)Quadramet(samarium 153) Bone seeking radioisotopeBone seeking radioisotope Systemic dose to “hot” areasSystemic dose to “hot” areas Can combine with externalCan combine with external May lower blood countsMay lower blood counts May cause “flare”May cause “flare” Can last 3-6 monthsCan last 3-6 months Can be repeatedCan be repeated 60-75% response rate60-75% response rate Best for patients with multipleBest for patients with multiple

or migratory painful sitesor migratory painful sites

Advanced prostate cancerAdvanced prostate cancer

Team approach with urologist, medical Team approach with urologist, medical and radiation oncologistand radiation oncologist

Systemic therapies and local therapiesSystemic therapies and local therapies Focus on disease control and quality of lifeFocus on disease control and quality of life Individually tailoredIndividually tailored THANK YOU!THANK YOU!

Advanced Stage DiseaseSession Evaluation

???