Your SlideShare is downloading. ×
0
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer

525

Published on

Presented by Jeffry Twidwell, MD at Men's Health 2010

Presented by Jeffry Twidwell, MD at Men's Health 2010

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
525
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Minimally Invasive Treatment Options for Clinically Localized Prostate Cancer Jeffry Twidwell, MD
  • 2. Prostate Anatomy
  • 3. Prostate Cancer Detection
    • Digital rectal exam – nodule, assymetry, firmness
    • Prostate Specific Antigen (PSA) – normal range, age adjusted, rate of change
    • Prostate Cancer Antigen 3 (PCa3 urine)
  • 4. Prostate Ultrasound and Biopsy
  • 5. Prostate Cancer Staging
    • Bone scan
    • CT scan
    • MRI scan
    • “risk stratification” – multiple factors evaluated to place patients into low, intermediate and high risk groups.
  • 6. Treatment Options for Localized Prostate Cancer
    • Observation
    • Active Surveillence
    • Radical Prostatectomy
    • Radiation Therapy
    • Cryosurgery
    • High Intensity Focused Ultrasound (HIFU)
  • 7. Observation / Active Surveillence
    • Good option for ---
    • Patient with multiple medical issues
    • Elderly
    • “ Low risk” patient
    • Follow patient with psa AND periodic prostate biopsy
    • 15% 10 year cancer specific mortality; 20% risk of metastasis at 10 years
  • 8. Radical Prostatectomy
    • Conventional / Open Radical Prostatectomy
    • Da Vinci Robotic Radical Prostatectomy
  • 9. Radiation Therapy
    • External beam
    • Brachytherapy / seed implant
  • 10. Prostate Cryosurgery
    • Freezes tissue to produce cell death
    • Individual needles placed into tissue
    • Overlapping “iceballs” freeze entire gland
  • 11. Prostate Cryosurgery
    • Procedure performed in operating room with general or regional anesthesia
    • Small needles placed throughout prostate under u/s guidance
    • Argon gas used to freeze; helium gas used to thaw
    • 2 “freeze – thaw” cycles
    • Target /kill temp -40 C
  • 12. Prostate Cryosurgery
  • 13. Prostate Cryosurgery
    • Outpt procedure
    • Catheter 4-5 days post op
    • Side effects---
    • Perineal pain / fullness
    • Erectile dysfunction 80%
    • Incontinence uncommon
    • Great option for older men, ED not an issue
  • 14. High Intensity Focused Ultrasound (HIFU)
    • NOT FDA approved for use in the US
    • Considered “investigational”
    • Phase III trials underway
    • Presently used throughout the world including Europe, Asia, Canada
  • 15. High Intensity Focused Ultrasound
    • Uses focused sound waves to create heat
    • Heat creates a precise lesion to destroy tissue
    • No damage to tissue before or after focal point
  • 16. High Intensity Focused Ultrasound
  • 17. High Intensity Focused Ultrasound
    • Imaging and treatment ultrasound energy delivered through transrectal probe
    • General anesthesia in OR
    • SP catheter until voiding
    • Outpatient
    • Normal activities in 4-5 days
  • 18. High Intensity Focused Ultrasound
  • 19. High Intensity Focused Ultrasound
    • Early data looks encouraging
    • Early studies show psa recurrence rates similar to radical prostatectomy (suarez et al)
    • Long term follow up needed (10, 15 yr data)
    • Favorable side effect profile---
    • ED - <20%
    • Incontinence 1%
    • Improving technology – tissue change monitoring, NVB mapping
  • 20. High Intensity Focused Ultrasound
    • May be FDA approved by 2012 / 2013
    • NOT covered by insurance
    • Expensive
    • US patients presently travel to Mexico, Carribean, Canada for treatment

×