This document discusses different treatment options for prostate cancer depending on risk level. For low risk prostate cancer, options include active surveillance, radiation therapy, or radical prostatectomy. For locally advanced or high risk prostate cancer, options discussed include radical prostatectomy plus pelvic lymph node dissection or radiation therapy combined with androgen deprivation therapy. Several studies are referenced that compare outcomes of different treatments, such as for cancer-specific mortality and time to distant metastasis.

1. CA DE PRÓSTATA- MANEJO:
LOCALIZADO- ALTO RIESGO/
LOCALMENTE AVANZADO
MR YESENIA HUERTA COLLADO
ONCOLOGIA MÉDICA

5. BAJO RIESGO- INTERMEDIO RIESGO
• VIGILANCIA ACTIVA
• PROSTATECTOMIA RADICAL
• RT

10. Pelvic lymph node dissection
• pelvic lymph node dissection (PLND) during
RP failed to improveoncological outcomes,
including survival.
• However, it is generally accepted that
extended pelvic LN dissection (eLND)
provides important information for staging
and prognosis
• preoperative tolos:
• A risk of nodal metastases over 5%
• Briganti nomogram
• Roach formula

11. • INCONTINENCIA
• 12M:
• RALP, 21.3%
• RRP 20.2%
• The adjusted OR was 1.08 (95% CI: 0.87-1.34).
• Erectile dysfunction
• RALP : 70.4%
• RRP : 74.7
• The adjusted OR was 0.81 (95% CI: 0.66-0.98)

12. ESTUDIO PIVOT

13. ESTUDIO PIVOT
PROSTATECTOMIA RADICAL VS OBSERVACIÓN --- MORTALIDAD A 12 AÑOS

14. ESTUDIO PIVOT

15. ESTUDIO PIVOT : ACTUALIZACIÓN
CIRUGIA: > EVENTOS ADVERSOS
CIRUGIA: < PROGRESION DE ENFERMEDAD
CIRUGIA: POTENCIAL BENEFICIO EN RIESGO INTERMEDIO

17. RADIOTERAPIA

18. BAJO RIESGO
 VIGILACIA ACTIVA
 RT
 PR

19. • Dosis de Rt externa debe de ser mínimo 74gY, engloando toda la rosa
base de las vesículas seminales
• No hay beneficio de asocioacn con bloqueo hormonal
• No hay benefcio de asociación de rt

24. PR VS (RT+ADT)

28. Among patients with Gleason score 9-10 prostate cancer,
treatment
with EBRT+BT with androgen deprivation therapy was associated
with significantly better prostate cancer–specific mortality and
longer time to distant metastasis compared with EBRT with
androgen deprivation therapy or with radical prostatectomy.

31. It is POSSIBLE!!!
All boils down to expertise

35. RT + ADT

37. In summary, we found that dose-
escalated EBRT was associated with
improved survival for men with
intermediate- and
high-risk, but not low-risk, prostate
cancer.
CONVENTIONAL FRACTIONS
 Low-risk cancers : A dose of 75.6 to 79.2 Gy.
 Intermediate-risk and high-risk: up to 81.0 Gy

38. freedom from biochemical
failure.
Cancer-Specific–Survival (%)

41. estudio DURACION
BRAZOS
N SOBREVIDA
ESPECIFICA -CANCER
SG

44. Neoadjuvant docetaxel for M0 disease

45. primary endpoint was relapse-free survival

46. follow-up of 12 years showed :
clinical RFS (metastases, local relapse or death) was also
improved with docetaxel (median cRFS 13.9 years versus
12.5 years; HR 0.75; 95% CI 0.56-1.00; P= 0.0491)
HR 0.71; 95% CI 0.54-0.94,
P=0.017).

47. • RTOG 0521:
 Tested RT plus 2 years ADT with or without 6 cycles of docetaxel
 reported a borderline improved RFS [HR 0.76;(95% CI 0.57-1.00); P=0.05].
 OS did not reach significance.
• STAMPEDE :
- A subset of men randomised had high-risk locali sed disease (and/or pelvic enlarged lymph nodes)
- RFS was improved in men randomised to receive docetaxel (HR 0.60; 95% CI 0.45-0.80; P= 0.283 x10-3)
Based on the available data, offering docetaxel
based ChT may be a reasonable option for younger,
fit men with multiple risk factors for recurrence.

48. RT - POST PR

49. Adverse laboratory/pathologic
features include:
 positive margin(s);
 seminal vesicle invasion;
 extracapsular extensión
 detectable PSA.
SWOG-8794
EORTC-22911
ARO-96-02
Finn Prostate Group Study

52. 2.151 pacientes

54. PR- compromiso linfático

56. April 2018

57. BJU Int 123:252, 2019].
recibieron tratamiento combinado tuvieron
Gleason más alto
T más alto
márgenes positivos
mayor número de GL afectados.
mejor supervivencia en comparación con
*los individuos que permanecieron en observación
(HR = 0,77; IC del 95%: 0,64-0,94; p = 0,008)
*aquellos que recibieron ADT
(HR = 0,76 ; IC del 95%: 0,63-0,93; p = 0,007)
Patients with LNM after RP were identified
using the National Cancer Database
(2004–2013).
Exclusion criteria included any
 radiation therapy
 ADT before RP
 clinical M1 disease

58. patients with node-positive disease represent a heterogeneous population
Patients with the most adverse pathological features demonstrated the greatest benefit
from adjuvant ADT + EBRT.