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What adjuvant treatment would you offer a patient who underwent cystoprostatectomy for a muscle invasive bladder cancer and discovered to also have prostate cancer?
How would your approach be affected by bladder and/or prostate cancer stage, margin status, and lymph node positivity?
Answer from: Radiation Oncologist at Community Practice
Complex case. If they have an indication for prostate RT (major: positive LN, persistent PSA, +SVI, minor: + margins, +ECE), I would consider treating the prostate fossa +/- LNs. As far as the bladder, we don't have the answer yet, but high-risk patients are being studied on the BART study...
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Answer from: Radiation Oncologist at Academic Institution
Currently, the indications for adjuvant RT for bladder cancer would be pT3/4 tumor with positive margins and/or positive nodes, but the data supporting the use of RT in this setting are not high level. This situation may be complicated by possible indications for adjuvant chemotherapy and/or immunot...
Answer from: Radiation Oncologist at Academic Institution
Agreed these are tough cases. In general, I'd rely on the modern early salvage data to just watch if PSA <0.2 even if the initial surgical intent wasn't definitive prostatectomy for prostate cancer. Caveats of the ARTISTIC trials being low rates of higher risk features (e.g. GS 8-10 an...