This document provides guidelines for the management of prostate cancer. It discusses the incidence, risk factors, screening guidelines, staging, grading, diagnostic testing, treatment options, and prognosis for prostate cancer. Treatment approaches are stratified based on risk classification as very low, low, intermediate, high, very high risk, metastatic, castration-resistant, and advanced disease. Management involves active surveillance, surgery, radiation therapy, hormone therapy, chemotherapy, immunotherapy, and clinical trials depending on the risk level and stage of the cancer. Prognosis depends on the stage, with 5-year survival rates of nearly 100% for local or regional disease and 28% for distant metastases.
Prostate - Excellent Illustrations / Must Watch & Prevent. ery Useful Information. DO NOT MISS to view and read the attached presentation. Please pass it on to your family & friends. Shared via "Sharifah Khatijah Syed Abdul Rahman Al-Attas" <sh_khatijah@yahoo.com
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Overview and Pharmacotherapy of Prostate Cancer (based on NCCN 2012 guideline...hyunik116
This presentation was the prostate cancer lecture for the oncology therapeutics course (31:725:560) that was presented to the class of 2014 PharmD students at the Ernest Mario School of Pharmacy.
I really enjoyed researching and preparing this lecture for the students, and hope you also will find at least something useful in this presentation.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Prostate - Excellent Illustrations / Must Watch & Prevent. ery Useful Information. DO NOT MISS to view and read the attached presentation. Please pass it on to your family & friends. Shared via "Sharifah Khatijah Syed Abdul Rahman Al-Attas" <sh_khatijah@yahoo.com
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Overview and Pharmacotherapy of Prostate Cancer (based on NCCN 2012 guideline...hyunik116
This presentation was the prostate cancer lecture for the oncology therapeutics course (31:725:560) that was presented to the class of 2014 PharmD students at the Ernest Mario School of Pharmacy.
I really enjoyed researching and preparing this lecture for the students, and hope you also will find at least something useful in this presentation.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
This slide deck is about Prostate cancer. It is amongst the leading cause of cancer deaths in adult males. This slide deck will provide you with necessary information regarding the symptoms, risk, diagnosis, and possible treatment of prostate cancer. I hope the readers find this slide deck useful & informative
diagnosis and outline of management of localized prostate cancer for non-urol...Dr Mayank Mohan Agarwal
a brief introduction of anatomy of prostate, screening of prostate cancer, measures to improve specificity of PSA screening, risk stratification of prostate cancer, treatment options - active surveillance, radical prostatectomy, radical radiotherapy
We urge men and male cancer Survivors to encourage one another to invest in their health through regular self-examinations, getting screened and adopting a balanced lifestyle, in order to reduce their cancer risk or the recurrence of cancer.
CANSA places the focus on Prostate and Testicular Cancer during its Men’s Health Awareness Campaign in November.
Read more: http://www.cansa.org.za/mens-health/
This slide deck is about Prostate cancer. It is amongst the leading cause of cancer deaths in adult males. This slide deck will provide you with necessary information regarding the symptoms, risk, diagnosis, and possible treatment of prostate cancer. I hope the readers find this slide deck useful & informative
diagnosis and outline of management of localized prostate cancer for non-urol...Dr Mayank Mohan Agarwal
a brief introduction of anatomy of prostate, screening of prostate cancer, measures to improve specificity of PSA screening, risk stratification of prostate cancer, treatment options - active surveillance, radical prostatectomy, radical radiotherapy
We urge men and male cancer Survivors to encourage one another to invest in their health through regular self-examinations, getting screened and adopting a balanced lifestyle, in order to reduce their cancer risk or the recurrence of cancer.
CANSA places the focus on Prostate and Testicular Cancer during its Men’s Health Awareness Campaign in November.
Read more: http://www.cansa.org.za/mens-health/
Programul de performare pe care vi-l propunem este rodul a peste 20 de ani de experienta in management si 5 ani de consultanta.
Credem ca la momentul actual ne confruntam, pe langa criza economica, cu una mult mai grava si anume, o criza a managementului.
Si acest lucru nu este datorat unei apetente scazute de a invata a managerilor, ci lipsei unor programe profesioniste care sa ii ajute sa isi puna in valoare potentialul extraordinar de care dispun.
Rolul acestui training personalizat este tocmai de a-i sprijini pe acei manageri care doresc sa-si potenteze capacitatile si sa contribuie la trecerea companiei lor la nivelul urmator.
Cu prietenie,
Sorin Spiridon
Managing Partner
Ca cervix epidemiology,screening and preventionDrAnkitaPatel
CA CERVIX IS PREVENTABLE AND CURABLE IF DETECTED AT EARLY STAGE .VACCINATION, PAP SMEAR AND HPV VACCINATION ARE KEY COMPONENTS FOR PREVENTION AND EARLY DETECTION.
CA CERVIX, DR ANKITA PATEL , APEX HOSPITAL ,SYMPTOMS, DIAGNOSIS,STAGING, NCCN GUIDELINES FOR THE MANAGEMENT, SURVIVAL , MULTIMODALITY APPROACH , CHEMOTHERAPY , RADIOTHERAPY , SURGERY
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. GUIDELINES FOR
MANAGEMENT
Dr ANKITA SINGH PATEL
MBBS,MD(KGMU)
CONSULTANT
Apex Hospital Cancer Institute
TRAINING AND FELLOWSHIP
Fortis Research Institute ,New Delhi
Tata Memorial Hospital,MUMBAI
Mob. 8765845035,9305421547
Email: dr.ankitapatel.onco@gmail.com
3. INCIDENCE
Prostate cancer (PCa) is the second most common
cause of cancer and the sixth leading cause of cancer
death among men worldwide.
RISK FACTORS: Age ,Race , Family history/age of onset
, Diet / fat , Cadmium, cigarette
4. PROSTATE CANCER
Tumor distribution
% of
glandular
tissue in
prostate
% of cancers
in zone
10% 25% 65%
5-10% 70%20%
Oesterling J, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;1322-1386.
Transition zone Central zone Peripheral zone
14. GLEASON SCORE
PRIMARY GRADE – Most predominant pattern.
SECONDARY GRADE – Highest grade in all the samples.
When these two grades are added together, the total is called the Gleason score.
EXAMPLE if the biopsy samples show that:
most of the cancer seen is grade 3
the highest grade of any other cancer seen is grade 4, then
the Gleason score will be 7 (3+4).
A Gleason score of 4+3 shows that the cancer is slightly more aggressive than a
score of 3+4, as there is more grade 4 cancer.
19. American Society Prostate
Cancer Screening
Guidelines
Average risk: annually beginning age 50 years with 10+
year life expectancy
Age 45 if high risk: High risk includes African-American
men or those with first-degree relative with prostate cancer
<65 years of age
Age 40 if very high risk: Very high risk includes multiple
family members with prostate cancer at early age
If testing performed, PSA with or without DRE
2009 guidelines reaffirmed in 2013
20. PSA
Cutpoints for
Biopsy
Recommendations
PSA RANGE RECOMMENDATION
0-3.9ng/mL
“normal “ range;
biopsy not generally recommended
4-9 ng/mL
Biopsy recommended ;
probability of detecting cancer ranges from 25% to
30%.
>10 ng/mL
Biopsy recommended ;
high probability of detecting cancer (>=50%)
22. PROSTATE CANCER SUSPECTED(PSA/Screening)
COMPLETE HISTORY AND PHYSICAL EXAMINATION INCLUDING DRE
TRUS GUIDED BIOPSY
Life expectancy <=5 yrs and
Asymptomatic
No further workup or treatment
until symptomatic except in
high or very high risk group.
Life expectancy >5 yrs OR
symptomatic
Risk classification
WORK UP depends on Risk Classification
BONE SCAN IF
1. T1 and PSA>20
2. T2 and PSA>10
3. Gleason score >=8
4. T3,T4
5. Symptomatic
1. T3,T4
2. T1-T2 and normogram indicated
probability of lymph node
involvment>10%
Pelvic CT or MRI or PETCT
23. VERY LOW RISK GROUP
EXPECTED SURVIVAL INITIAL THERAPY ADJUVANT
THERAPY
ACTIVE SURVEILLANCE
•PSA 6 monthly and SOS
•DRE 12 monthly and SOS
•repeat prostate biopgy 12 monthly and SOS
>=20yrs EBRT OR Brachytherapy
Radical Prostatectomy(RP)+PLND if
predicted probability of LN mets is >=2%
Roach formula
LN metastasis (%) = 2/3 PSA + 10×
(Gleason-6)
ADVERSE FEATURES
(Detectable PSA,positive
margin,seminal vesicle
invasion,ECE)
EBRT
LYMPH NODE
METASTASIS
ADT+EBRT
10-20YRS ACTIVE SURVEILLANCE
<10 YRS OBSERVATION
•T1c
•Gleason score<=6
•PSA<10 ng/ML
•Fewer than 3 prostate biopsy cores
positive,<=50% cancer in each core
24. LOW RISK
EXPECTED SURVIVAL INITIAL THERAPY ADJUVANT THERAPY
>=10YRS ACTIVE SURVEILLANCE
EBRT OR Brachytherapy
RADICAL
PROSTATECTOMY(RP)+PLN
D if predicted probability of LN
mets is >=2%
ADVERSE FEATURES (Detectable
PSA, positive margin, seminal
vesicle invasion, ECE)
EBRT
LYMPH NODE METASTASIS
ADT+EBRT
<10YRS OBSERVATION
•T1-T2a
•Gleason score<=6
•PSA<10 ng/ML
25. INTERMEDIATE RISK
EXPECTED SURVIVAL INITIAL THERAPY ADJUVANT THERAPY
>=10 Year
RADICAL
PROSTATECTOMY(RP)+P
LND if predicted probability
of LN mets is >=2%
ADVERSE FEATURES
(Detectable PSA, positive margin,
seminal vesicle invasion, ECE)
EBRT
LYMPH NODE METASTASIS
ADT+EBRT
EBRT +- ADT(4-6 month) OR
Brachytherapy alone
<10 yr EBRT +- ADT(4-6 month) OR
Brachytherapy alone
Observation
•T2b-T2c or
•Gleason score 7 or
•PSA 10-20ng/mL
26. HIGH RISK
INITIAL THERAPY ADJUVANT THERAPY
EBRT + ADT (2-3 YRS)
or
EBRT + + brachytherapy +ADT (2-3 YRS)
or
RP +PLND ADVERSE FEATURES (Detectable PSA, positive
margin, seminal vesicle invasion, ECE)
EBRT
LYMPH NODE METASTASIS
ADT+EBRT
•T3a or
•Gleason score 8-10 or
•PSA>20 ng/mL
27. VERY HIGH GRADE
INITIAL THERAPY ADJUVANT THERAPY
EBRT + ADT (2-3 YRS)
or
EBRT + + brachytherapy +ADT (2-3 YRS)
or
RP +PLND ADVERSE FEATURES (Detectable PSA, positive
margin, seminal vesicle invasion, ECE)
EBRT
LYMPH NODE METASTASIS
ADT+EBRT
ADT in select patient
•T3b-T4 or
•Primary Gleason pattern 5 or
•>4 cores with Gleason score 8-10
28. METASTATIC
Any T , N1 ADT or
EBRT +ADT(2-3 YRS)
Any T , Any N , M1 ADT + EBRT to site of metastasis ,if in
weight bearing bones , or symptomatic
•Any T,N1 or
•Any T,Any N , M1
29. MONITERING AFTER INITIAL
MANAGEMENT
PSA every 6-12 months for 5 yr , then every year.
DRE every year, but may be omitted if PSA undetectable
N1 ,M1 - Physical examination +PSA every 3-6 month
POST RP Failure of PSA to fall to undetectable levels (PSA
PERSISTENCE)
RADICAL
PROSTATECTOMY
BIOCHEMICAL FAILUREUndetectable PSA after RP with a subsequent
detectable PSA that increases on 2 or more
determination (PSA RECURRENCE)
POST EBRT Biochemical failure (PSA increase by 2ng/mL or more
above nadir)
Or
Positive DRE
RADIATION THERAPY
RECURRENCE
30. RADICAL PROSTATECTOMY
BIOCHEMICAL FAILURE
PSADT
+- CT/MRI TRUS
+- Bone Scan
+-PET CT
+-Prostate bed
biopsy (especially if
imaging suggests
local recurrence)
Studies negative
for distant
metastasis
EBRT +- ADT
OR
Observation
Studies positive
for distant
metastasis
ADT + EBRT to site of metastasis ,if in
weight bearing bones , or symptomatic
31. RADIATION THERAPY
RECURRENCE
Candidate for
LOCAL
THERAPY
•PSADT
•TRUS
Biopsy
• Bone Scan
•PET
CT/CT/MRI
•+Prostate
MRI
TRUS Biopsy
+ metastatic
-
•Observation or
•RP or
•Cryosurgery or
•Brachytherapy
•ADVANCED
DISEASE
TRUS Biopsy -
metastatic
-
•Observation or
•ADT or
•Clinical trial or
•More aggressive
workup for local
recurrence
ADVANCED
DISEASE
metastatic
+
•ADVANCED
DISEASE
Not a candidate
for LOCAL
THERAPY
ADT
Or
observation
ADVANCED
DISEASE
32. ADVANCED DISEASE
:SYSTEMIC THERAPY
•Orchidectomy or PROGRESSION
•LHRH agonist +- antiandrogen >= 7 days to prevent
testosterone flare or
•Castration
•LHRH agonist + antiandrogen or •Resistant
•LHRH antagonist or •Prostate
•Observation(for M0 disease) or •Cancer
•Continous ADT and Docetaxel 75mg/m2 w/o prednisolone for
6 cycles( for castration sensitive high volume M1 only)
33. Definition of Castration Resistant
Prostate Cancer
Serum testosterone <50 ng/Ml
And one or more of the following:
• Rising PSA from nadir on androgen deprivation therapy(ADT)
• Radiographic progression on ADT.
• Clinical progression
34. APPROVED THERAPY FOR CRPC
NAME DRUG TYPE APPROVAL INDICATION
Docetaxel
(Taxotere)+Prednisolone
Chemotherapy FDA,EMA First line
Denosumab(Xygeva) Targeted therapy(
RANKL)
FDA Prevention of SREs in patients
with bone metastasis
Cabazitaxel
(Jevtana+
Prednisolone
Chemotherapy FDA,EMA Second line
Sipuleucel-T
(Provenge)
Immunotherapy FDA First line asymptomatic or
minimally symptomatic mCRPC
Abiraterone
acetate(Zytiga)
Targetederapy(an
ti-androgen)
FDA,EMA First and second line
Enzalatumide
(Xtandi)
Targeted
THerapy(anti-
androgen)
FDA Second line advanced mCRPC