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How would you treat a patient with Gleason 8 or 9 prostate cancer, pretreatment PSA 15-24, with retroperitoneal adenopathy?
Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as castrate sensitive metastatic disease without biopsy confirmation?
Answer from: Radiation Oncologist at Community Practice
Patient meets STAMPEDE criteria (about 9% with non regional nodal Mets) and optimal ADT with prostate only RT is also an option especially if nodal burden is to the entire paraaortic region.
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Answer from: Medical Oncologist at Community Practice
I would typically use a curative-intent paradigm with ADT + Abiraterone, plus prostate-directed radiotherapy with a radiotherapy boost (if possible) to the pelvic and RP nodes. If PSA remains undetectable after 2 years of systemic therapy, I would consider stopping the ADT + Abi and watching careful...
Comments
Radiation Oncologist at Mallory Radiotherapy, PLLC
Agree. I would boost the node up to the same dose ...
Agree. I would boost the node up to the same dose ...
Medical Oncologist at Saint Vincent Cancer and Wellness Center
Thank you.
Thank you.
Answer from: Radiation Oncologist at Academic Institution
I would offer a similar approach to that described nicely by @Emmanuel S. Antonarakis and @Matthew L. Mallory: definitive RT+ADT+abiraterone, with SIB to the grossly positive nodes. My caveats and additions are:
I start with a frank discussion with the patient re: evidence for various scenar...
Answer from: Radiation Oncologist at Community Practice
I don’t see the logic in treating only the prostate when u have similar disease in the node. If u radiate, radiate all gross disease area if it can be encompassed in a reasonable volume. With the same dose to gross disease as prostrate, do ADT and arbiter one for 2 to 3 yrs and then follow and...