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Prostate Cancer Treatment: What’s Best for You. Daniel P. Petrylak Professor of Medicine Columbia University Medical Center/NY Presbyterian Hospital. When does a patient see a medical oncologist. Local disease: As “unbiased” opinion for local therapy
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Prostate Cancer Treatment: What’s Best for You Daniel P. Petrylak Professor of Medicine Columbia University Medical Center/NY Presbyterian Hospital
When does a patient see a medical oncologist • Local disease: As “unbiased” opinion for local therapy • High Risk Disease: Add hormone or chemotherapy to decrease risk of relapse • Metastatic disease: Initiation of second line hormones, chemotherapy, radiation therapy
High-Risk CAP: The Options • Surgery – Standard RP, wide/extended resection RP – Hormone therapy: NHT, AHT – ART – Chemotherapy: Neoadjuvant, adjuvant • RT – EBRT with NHT and/or AHT – Dose escalation – EBRT with chemohormonal therapy – Other RT techniques • HT alone • New therapies NHT = neoadjuvant hormone therapy; AHT = adjuvant hormone therapy; ART = adjuvant radiotherapy. Payne, 2009.
Challenges for the Implementation of Multimodality Therapy • High risk local therapy • Role of chemotherapy not defined • Investigational studies require long follow-up due to the natural history of disease • By selecting the highest risk patients, reduce the available patient pool • Clinical trial accrual has been poor.
