Clinicians should monitor localized prostate cancer patients post therapy with PSA screening and inform them of their individual risk of recurrence. Survivorship programs should address symptom management and connect patients to support resources.
For patients with rising PSA after treatment, clinicians should interpret levels in light of other clinical factors and consider imaging like MRI to identify local recurrence and determine eligibility for salvage therapy. Biopsy of recurrent lesions may be warranted in select cases.
Post-treatment surveillance for testicular cancer should be individualized based on stage and histology, utilizing history, physicals, imaging and tumor markers selectively rather than routinely. Long-term monitoring for potential late effects is also important
Basic information for discussion with a healthcare professional is provided here together with some background:
• An enlargement or the presence of tumors in the gland below a man’s bladder that produces fluid for semen ie, the prostate, may suggest benign prostatic hyperplasia (BPH) or prostate cancer
o Almost 8% of new cancer cases worldwide are attributed to this highly curable disease (proportion of patients surviving after 5 years = 98.9%)
o In the USA alone, prostate cancer is the most common non-skin cancer, diagnosed more often in African-American (1 in 5 cases) than white men (1 in 6 cases)
o Prostate cancer is strongly correlated with age, starting at about 50 years old and rising over the ensuing decades
o While debates over under- or over-treatment of prostate cancer continue, it is clear that management of the disease costs the USA an aggregate annual loss in productivity of $3.0 billion
o Moreover, prostate cancer is the third-leading cause of cancer-related deaths in the USA, mainly due to advanced or metastatic disease
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
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
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.
Basic information for discussion with a healthcare professional is provided here together with some background:
• An enlargement or the presence of tumors in the gland below a man’s bladder that produces fluid for semen ie, the prostate, may suggest benign prostatic hyperplasia (BPH) or prostate cancer
o Almost 8% of new cancer cases worldwide are attributed to this highly curable disease (proportion of patients surviving after 5 years = 98.9%)
o In the USA alone, prostate cancer is the most common non-skin cancer, diagnosed more often in African-American (1 in 5 cases) than white men (1 in 6 cases)
o Prostate cancer is strongly correlated with age, starting at about 50 years old and rising over the ensuing decades
o While debates over under- or over-treatment of prostate cancer continue, it is clear that management of the disease costs the USA an aggregate annual loss in productivity of $3.0 billion
o Moreover, prostate cancer is the third-leading cause of cancer-related deaths in the USA, mainly due to advanced or metastatic disease
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
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
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.
Presentation is highlighting the integration of different modalities in the management of locally advanced and metastatic prostate cancer pointing to the proven values of adding chemotherapy. A special note has been made to oligometastatic disease.
Changing landscape in the treatment of advanced prostate cancer Alok Gupta
This presentation describes how the treatment of stage 4 prostate cancer has improved over last 100 years. This was presented at URO ONCOLOGY UPDATE meeting of Delhi Urological Society on 18th March 2017
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.
Advances in risk assessment, differential diagnosis between aggressive and non-aggressive tumors, and the development of novel/optimized treatment for advanced disease are discussed.
This slide deck is made available for patients/caregivers. It is not a substitute for seeking medical help. Please check original sources listed in the deck and consult your physician for the latest information and advice.
Presentation is highlighting the integration of different modalities in the management of locally advanced and metastatic prostate cancer pointing to the proven values of adding chemotherapy. A special note has been made to oligometastatic disease.
Changing landscape in the treatment of advanced prostate cancer Alok Gupta
This presentation describes how the treatment of stage 4 prostate cancer has improved over last 100 years. This was presented at URO ONCOLOGY UPDATE meeting of Delhi Urological Society on 18th March 2017
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.
Advances in risk assessment, differential diagnosis between aggressive and non-aggressive tumors, and the development of novel/optimized treatment for advanced disease are discussed.
This slide deck is made available for patients/caregivers. It is not a substitute for seeking medical help. Please check original sources listed in the deck and consult your physician for the latest information and advice.
Techniques for Inguinal/Groin IrradiationAjeet Gandhi
Inguinal radiotherapy delivery is many a times a complex dosimetric uncertainty and we need to judiciously choose the technique for best patient outcome
Incorporating data for management of breast cancerAjeet Gandhi
The guidelines are mostly western and in many scenarios, it is difficult to apply them to Indian population. We need to take in to consideration many factors while applying the data
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
Role of radiotherapy in recurrent carcinoma cervixAjeet Gandhi
While the role of radiation therapy in carcinoma cervix management is undauntable for all stages. Recurrent carcinoma cervix need a lot of personalisation
Controversies in the management of rectal cancersAjeet Gandhi
Management of rectal cancers have undergone a huge paradigm shift over the last decade. One the one hand, it has opened up new avenues; it also has thrown up new challenges and controversies
T4 Larynx cancer can be treated with ChemoradiotherapyAjeet Gandhi
Traditionally, T4 larynx cancers are recommended to undergo surgery as the primary modality of treatment. However, a select group of patients may be treated with CTRT
Advances in radiation oncology:Cancer careAjeet Gandhi
Radiation therapy has tremendous capacity for cancer cure. Advancement in last few decades have further enhanced its outcome. Global access would save many lives
A novel technique of radiation delivery with ultrahigh dose rate radiation therapy delivered in milisecond of time. Although, still in investigational phase
Management of Anemia in cancer patientsAjeet Gandhi
Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Post treatment surveillance for Genitourinary Cancers
1. Dr Ajeet Kumar Gandhi
MD (AIIMS), DNB (Gold Medalist), UICCF (MSKCC,USA)
Assistant professor, Radiation oncology
Dr RMLIMS, Lucknow
Post treatment surveillance in GU
(Prostate and Testis) cancers
2. Prostate cancer: Management
Risk Category Management
Low Active Surveillance
Radical Prostatectomy ± Pelvic LN dissection
Brachytherapy
Radical EBRT
Intermediate Radical EBRT + Short term ADT
EBRT + Brachytherapy boost + Short term ADT
Radical Prostatectomy ± Pelvic LN dissection
Brachytherapy
High Radical EBRT + long term ADT
EBRT + Brachytherapy boost + long term ADT
Radical Prostatectomy + Post op RT
4. Ideal post treatment surveillance
program
Goals of therapy: shared decision making
Predictions for future natural course of disease
Discussions about salvage treatment available
Survivorship program
5. Post-treatment tool kit for surveillance:
Prostate Cancer
Serum PSA
Digital Rectal Examination (Low specificity)
Imaging
TRUS :Poor specificity
MRI
Prostate specific PET imaging
Post treatment prostate biopsies
6. Biochemical failure
10-40 % of patients with recurrent PSA will develop
systemic progression*
PSA relapse precedes clinical failure by a number of
years
PSA rise indicates recurrence but does not distinguish
between local and distant relapse
5 year survival after post RT PSA recurrence: 60-70%
*Boorjian et al. Eur Urol. 2011;59:893–
9
7. Predictive factors for BCF
Positive surgical margins
PSA recurrence <2 years, Gleason 8-10 and PSADT <10
months
PSA-DT of <12 months and an interval of <12 months
from end of radiotherapy to PSA rise as significant
independent predictors of distant failure
*Perez and Brady, 6th edition
8. PSA in post treatment setting:
What is normal
After RP: Levels should be undetectable. Wait for 6-8 weeks
(ACS)
After Radical RT: PSA less than 0.5 ng/ml or Undetectable
Disease recurrence likely:
Doubles in less than six months
Rises within 12 months of any form of treatment
*AUA policy report on PSA monitoring
9. PSA in post treatment setting:
What is normal
ASTRO: Three consecutive rise in serum PSA above nadir. Not
more than 3-6 months interval. Applicable only to patients treated
with EBRT with or without short term hormonal therapy. Sensitivity
64% & Specificity 78%
Metastatic prostate cancer:
Undetectable PSA or PSA decrease by more than 90% at 3-6
months predict PFS
>50% decrease in PSA at 8 weeks after secondary therapy
PSA trigger for bone scan (following initial treatment of localized
prostate cancer): 40-45 ng/ml
*AUA policy report on PSA monitoring
10. PSA: After hormonal therapy
ADT can decrease the serum level of PSA
independent of tumour response
Reduction of PSA to undetectable levels (duration of
PFS)
Decreases in PSA of less than 80% may not be very
predictive
Clinical criteria should also be followed
11. Post treatment surveillance: PSA
PSA Bounce:
Def (IJROBP 2006:64;512-517): Increased PSA >0.2ng/ml
from nadir & subsequent fall
Median time: 18-26 months (occurs sooner than true
PSA relapse; 22-30 months)
Fluctuation range: 0.11-15.8 ng/ml
More common with EBRT plus Brachytherapy (30-40%)
EBRT alone (12-30%)
Prognostic value: Superior (Rosser et al. J Urol
2002;168:2001-05)
12. Post treatment surveillance: PSA
Post treatment PSA doubling time (PSADT)
After RP: <10 months (development of metastatic
disease)JAMA 1999; 281:1591-7
After EBRT (Zelefsky et al. J Clin Onc 2005;23:826-
831)
The PSADT for favorable-, intermediate-, and
unfavorable-risk patients who developed a
biochemical failure was 20.0, 13.2, and 8.2
months, respectively (p < .001).
The 3-year incidence of DM for patients with
PSADT of 0 to 3, 3 to 6, 6 to12, and >12 months
was 49%, 41%, 20%, and 7%, respectively (p <
.001)
14. Role of MRI in recurrent prostate cancer
T2 weighted imaging: sensitivity 84.1-88%, specificity
52-82%
T2 combined with dynamic imaging: Sensitivity 84.1-
88%; Specificity 89.3-100%
Dynamic MRI with spectroscopy: Sensitivity 87%;
Specificity 94%
15. Prostate cancer specific PET
radiotracers
pcPET radiotracers in the setting of biochemical
recurrence:
Carbon 11/fludeoxyglucose 18(F-18) choline
Gallium 68/F-18 prostate specific membrane antigen
(PSMA)
F-18 fluciclovine
PSMA PET more useful:
Median 51.5% of patients when PSA level is <1.0 ng/mL
74%of patients when PSA level is 1.0 to 2.0 ng/mL
90.5% of patients when PSA level is >2.0 ng/mL
16. Prostate biopsy after RT
20-80% biopsy positivity rate in T1-T3 prostate cancers*
Associated with higher nadir PSA, higher rate of local
recurrence
6 year BFFS 95% vs. 70% in biopsy positive versus negative
after definitive RT**
Biopsy time: 24-36 months after RT***
Rising PSA without systemic disease but with positive
biopsy: Potential candidates for salvage therapy
*Hammer P et al. European Urology 2002; 83-88
**Stoyanova et al. IJROBP 2012:84 (3): S60
*** Juniata crook et al. IJROBP 2000;48(2):355-367
17. Clinicians should monitor localized prostate cancer patients
post therapy with PSA, even though not all PSA recurrences are
associated with metastatic disease and prostate cancer specific
death.
Clinicians should inform localized prostate cancer patients of
their individualized risk-based estimates of post-treatment
prostate cancer recurrence.
Clinicians should support localized prostate cancer patients
who have survivorship or outcome concerns by facilitating
symptom management and encouraging engagement with
professional or community based resources.
18.
19. Prostate cancer recurrence: PSA every 6-12 months for 5
years and then annually (more frequently in high risk
individuals). Annual DRE
Health promotion: 150 mins of physical activity, 600 IU of
vitamin D per day, calcium (<1200mg/day), limit alcohol and
tobacco
Screening for second primary cancers: bladder and
colorectal cancer
For patients with ADT: Anemia, Osteoporosis, Sugar, Lipids,
CVS, Vasomotor symptoms
Sexual dysfunction, intimacy, urinary dysfunction, anxiety
and distress
20. Routine DRE after local therapy is not required for
asymptomatic patients while the PSA remains controlled
Biopsy of the prostate after RT should only be carried out in
men with prostate cancer who are being considered for
salvage local therapy
Men on long-term ADT should be monitored for side-effects
including osteoporosis (using bone densitometry) and
metabolic Syndrome
In patients with CRPC on systemic treatment, regular
imaging studies should be done to monitor disease
response/progression
21. Rising PSA after radical
treatment
Def of PSA recurrence
Exclude PSA bounce
Look for other clinical factors, PSADT
Prior treatment received
Clinically significant PSA
recurrence
Imaging: MRI/ PET
Biopsy of local recurrent
lesion
Local recurrence
Patient suitable for salvage therapy
22. Conclusion I: Prostate
Serum PSA every 6-12 months (may be individualized
in selected cases)
Rising PSA should be interpreted keeping in account
other clinical factors
DRE every year
TRUS (unreliable), multi-parametric MRI/Prostate
specific PET useful in certain scenarios but not for
routine surveillance
Prostate biopsy/ biopsy of locally recurrent disease
in selected patients
24. Issues in testicular cancer
survivorship
Detection of relapse
High cure rates
Effective salvage therapies (almost >50% cured)
Relapses evident through rise in tumor
markers/radiological imaging
Tumor markers elevated in 2/3rd of NSGCT and 1/3rd of
Seminoma: Value in isolation questionable
25. Issues in testicular cancer
survivorship
Impairment in spermatogenesis:
Transient effect (6-12 months)
Recovery in most with testicular doses (9-50 cGY)
Second primary Cancers:
Risk in 10 year survivors: Almost twice
Increased risk of lung, esophagus, colon and pleura, leukemia
Increased risk of cardiac death
Chemotherapy induced long term side effects:
High tone hearing loss
Neurotoxicity, Reynaud's phenomenon, hypertension, renal
dysfunction
26.
27.
28.
29.
30.
31. Conclusion II-Testicular tumors
Post treatment surveillance: Individualized based on
stage and histology
History and physical examination, abdominal/pelvic CT,
Chest X-ray at varying intervals
Routine use of tumor markers/testicular USG is not
recommended
Focus on late effects mandatory
The predictors of metastasis are Gleason score of 8–10, pathological stage T3b-4, nodal invasion and prostate-specific antigen (PSA) doubling time.
Biochemical evidence of failure on the basis of elevated or slowly rising PSA alone, therefore, may not be sufficient to initiate additional treatment
For example, in a retrospective analysis of nearly 2,000 men who had undergone radical prostatectomy with curative intent and who were followed for a mean of 5.3 years, 315 men (15%) demonstrated an abnormal PSA of 0.2 ng/mL or higher, which is considered evidence of biochemical recurrence. Among these 315 men, 103 (34%) developed clinical evidence of recurrence. The median time to the development of clinical metastasis after biochemical recurrence was 8 years. After the men developed metastatic disease, the median time to death was an additional 5 years