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Prostate Cancer: Treatment choices

Prostate Cancer: Treatment choices. Winston W Tan MD FACP Senior Consultant Genitourinary Oncology Mayo Clinic Florida. Incidence. 230,000 cases each year 30,000 deaths each year Indolent Aggressive disease Jemal et al 2009.

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Prostate Cancer: Treatment choices

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  1. Prostate Cancer: Treatment choices Winston W Tan MD FACP Senior Consultant Genitourinary Oncology Mayo Clinic Florida

  2. Incidence • 230,000 cases each year • 30,000 deaths each year • Indolent • Aggressive disease • Jemal et al 2009

  3. Biopsy • Sextant biopsy • Template biopsy • Importance for diagnosis • PSA of 50 and above

  4. Diagnosis • PSA • Gleason Score • Stage • Metastasis or not

  5. Gleason score • Microscopic appearance • 1 well differentiated • 5 poorly differentiated • Maximum score of each site:5 • Add score of 2 sites

  6. Treatment Options • Radical Prostatectomy • External beam radiation • Brachytherapy( interstitial seed implant) • Combination of external beam radiation and seed implant • Observation

  7. Radical prostatectomy • Full evaluation of pathology • Risk of anesthesia • Impotence • Urinary incontinence • Morbidity from surgery

  8. External beam radiation • Treat more area if there is extracapsular involvement • Gastrointestinal complications • Radiation cystitis • Radiation proctitis • Urinary incontinence

  9. Brachytherapy • Not for everybody • Low risk • More radiation cystitis • Inadequate cure of cancer

  10. Observation • Scandinavian studies • Low gleason score :6 and below • Elderly patients • Less than 10 years to live

  11. Options • Treatment options are equal based On patients followed No randomized clinical trials

  12. Medical team • Urologist • Radiation oncologist • Medical oncologist • Nephrologist • Nursing • Physical therapy

  13. Choice The choice is yours !!!

  14. Prostate Cancer • You are in charge • Empower patients • Educate patients • Stimulate interest in participation in clinical trials

  15. Thank You Questions ?

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