Tx on advanced, relapsing and castration resistance prostate cancer

1. Tx on advanced, relapsing
and castration resistance PC
EU 59(2011)572-583
Updated literature review from 2007-2010

2. Hormone TX
• LHRH: standard care
 Less physical and emotional stress
 Less cardiotoxicity compared with DES
• LHRH antagonist
 Degarelix, not inferior to Leuprin
 Better PSA progression, better PC-related death
 Efficacy still need to proven

3. Antiandrogen
• BAD monotherapy compared with
castration
• LHRH agonist + antiandrogen VS LHRH
agonist
 little benefit but high cost and side effects
 Still use in debates
• IAD(intermittent) is not inferior to continous

4. Immediate versus deferred HT
• Immediate HT make no survival benefit
 Locally advanced: no survival benefit
 S/P RP, PSA↑ vs meta proof: no survival benefit
 Instead of survival, PFS benefit was noted in immediate HT
• locally advanced pt>>deferred HT
• metastatic pt>> immediate HT

5. Follow up in PC pts
• ADT pts
 BMD test, T score<-1.0 / 2yrs
 BMD test, T score -1.0~-2.5 / 1yr
• On LHRH, routine test: PSA, testosterone
• 使用LHRH agonist在前6個月要評估抗賀爾
蒙藥物是否有效，以及考慮是否改用其他
藥物以及CRPC的可能
• Evaluate the side effects of ADT, insulin
resistance or lipid profile abnormality

6. How to diagnosis of the relapse
after curative Tx

7. • S/P RP, PSA >0.2ng/ml(連續兩次)
Systemic failure sp RP, PSA↑<1yr, PSA
doubleing time 4-6m, Gleason score 8-10
• S/P RT, >+2ng/ml PSA

8. 適合用其他工具判斷復發嗎?
• 除非PSA velocity>2ng/ml 或>20ng/ml
>>建議進行CT
• No CT/BONE SCAN/PET: no role in
relapse diagnosis

9. Recurrence treatment
• S/P RP but relapse, salvage RT would
bebetter choice
• S/P RT but relapse, consider
Salvage RP in low comorbidity,
life>10yr…
Cryo: less comorbidity, same result as RP

10. CHEMOTHERAPY
INDICATION
• 75mg/m2 in 3wk interval
• Indication: symptomatic metastasis
• Asymptomatic metastasis:???
• High PSA, PSA double time<6m early
start
• Second line: cabazitaxel

11. Bone related complications
• Zometa: 4mg /4wks
Decrease fx events, decreased pain
• Denusomab
Decreased fx events as zometa
• Beware of spinal cord compression
complications