1 / 37

Guide Lines for Management of Genitourinary Malignancy. 2. Prostate Cancer.

Guide Lines for Management of Genitourinary Malignancy. 2. Prostate Cancer. Mohamed S. Zaghloul Hussein Khaled Moneir Aboul Ella. Diagnosis. Prostatic symptoms + transrectal ultrasound (TRUS) and biopsies from all lobes of the prostate.

collice
Download Presentation

Guide Lines for Management of Genitourinary Malignancy. 2. Prostate Cancer.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Guide Lines for Management of Genitourinary Malignancy.2. Prostate Cancer. Mohamed S. Zaghloul Hussein Khaled Moneir Aboul Ella

  2. Diagnosis • Prostatic symptoms + transrectal ultrasound (TRUS) and biopsies from all lobes of the prostate. • Pathologic exam should include. - Tumor grade (WHO). - Gleason's score 1-5 + 1-5

  3. Work up • Laboratory • CBC • S. Creatinine • PSA (total &free) • LFTS • Imaging • Chest x-ray • CT abdomen and pelvis • Bone scan (if PSA is more than 10,high S. alkaline phosphatase , tender or painful bony symptoms ) • MRI pelvis (optional). Staging: according toTNM classification system

  4. Treatment Stage I&II : with intact prostatic capsule: Either • nerve sparing radical prostatectomy or • radical radiotherapy with, at least, conformal radiotherapy (70-80 Gy).

  5. PORT Indications of PORT after radical prostatectomy: i. Capsular infiltration. ii. Seminal vesicle infiltration. iii. Positive safety margin.

  6. Treatment Stage III: • Neoadjuvant hormonal manipulation by LHRH agonist (with antiandrogen for the first 2 weeks)(Goserelin “Zoladex” or Leuproline “Leuporon” , for 2 months before and 2 months during radiotherapy) 70 Gy radical radiotherapy whole pelvis for 50 Gy and 20 Gy boost to the prostate. Maintenance LHRH agonist for 6-24 months (for high risk patients).

  7. Treatment Stage IV (metastatic): • Bilateral subcapsular orchiectomy ± flutamide daily orally or androcure 250 mg/day. • Second line hormonal therapy: Bicalutamide (Casodex) 50-100 mg daily orally • Palliative radiotherapy to bone metastasis • Hormone refractory or resistant patients - Mitoxantrone (Novantron) 12 mg/m2 every 3 wks + prednisone 10 mg daily. - 2nd line: Docetaxil (Taxotere) 75 mg/m2 every 3 weeks.

  8. Treatment • Management of biochemical failure after radical treatment: (Biochemical failure is defined as serum prostate specific antigen levels of 0.4 ng/ml following surgery, 0.5 ng/ml following radiotherapy and/or 2 consecutive rising prostate specific antigen values 3 months apart). Patients with biochemical failure need to be investigated for local or systemic recurrences.

  9. Follow-up every 3 months for the first 3 years, every 6 months thereafter.

  10. 3.Renal Carcinoma & Renal pelvis carcinoma Mohamed S. Zaghloul Hussein Khaled Moneir Aboul Ella

  11. Work up • * Laboratory • CBC • S. Creatinine • LFTS • * Radiologic • Chest x-ray • CT abdomen and pelvis (or IVU + abdominopelvic US) • Bone scan (optional)

  12. Treatment 1.Renal cell Ca. • Resectable cases: Radical nephrectomy: complete removal of Gerota’s fascia and its content including the adrenal gland, kidney and perinephric fat. It may include resection of hilar LN or even regional LN.

  13. Post operative radiotherapy may be added in the following : • 1. Invasion of the capsule • 2. Positive LN. • 3. Positive safety margin or residual tumors.

  14. Metastatic Renal Cell Ca • i. Metastatectomy in pulmonary or brain metastases (maximum 3 separate metastases). • ii.Palliative nephrectomy and/or removal of metastatic foci in the following conditions. • No central nervous system, bone or liver metastases. • Adequate pulmonary and cardiac functions. • Good performance status. • Predominantoly clear cell histology. • Severe renal symptoms eg repeated hemorrhages, tumor pain or significant paraneoplastic syndrome.

  15. Metastatic Renal Cell Ca • iii. Cytoreductive maneuvers : embolization , chemoembolization, …. • iv. Palliative radiotherapy or chemotherapy and biologic therapy - (Interferon 3 million units every other day and Vinblatine 0.1 mg/kg body weight every 3 weeks then reevaluation).

  16. Ca. of Renal pelvis a. Resectable cases • Radical nephrouretrectomy with removal of a bladder cuff. • Adjuvant PORT is added in: 1. Large tumors invading the renal capsule or Gerota's fascia. 2. high grades.

  17. b. Inoperable cases : are palliated by palliative radiotherapy or as metastatic cases c. Metastatic renal pelvis Ca. • Palliative radiotherapy or chemotherapy using • Gemcitabine 1000 mg/m2 D1 & D8 • Cisplatin 70 mg/m2 D2 Every 3 weeks.

  18. Testicular cancer Mohamed S. Zaghloul Hussein Khaled Moneir Aboul Ella

  19. Diagnosis Any solid testicular mass should be diagnosed by scrotal US followed by inguinal high orchiectomy (no direct testicular or fine needle aspiration biopsy). CT-guided biopsy is recommended for diagnosis of tumour on top of abdominal undescended testis.

  20. Work up • Laboratory • CBC • LFTS, S. Creatinine • AFP, βHCG, LDH • Radiologic • Chest x-ray (CT in retroperitoneal positive lymphadenopathy). • Abdominopelvic CT (or IVU & bipedal lymphangiography).

  21. Treatment • Inguinal high orchiectomy and biopsy of the other testis. • Active treatment according to the stage.

  22. Observation is recommended only for stage IA compliant patients. • Pelviabdominal CT every 2 months during the first year & every 4 months thereafter.

  23. Treatment of relapsed cases • a. relapsed stage I cases who did not receive radiotherapy : • i) Non bulky (< 5 cm) are treated with radiotherapy 35- 40 Gy. • ii) Bulky (≥ 5 cm) ,received radiotherapy or having visceral or pulmonary disease are treated with chemotherapy as mentioned above (as stages IIc and III). • b. relapsed stage II & III are treated with second line chemotherapy.

  24. Response Evaluation, further management & follow up: • CT scan has to be done 1-2 months post treatment. If normal follow up to be performed every 2 months during the first year and every 4 months thereafter. If abnormal and the mass is ≥ 3 cm either resect the mass or radiotherapy (if no previous radiotherapy given). If the mass is < 3 cm observe till the mass progress treat as above. • NB: If PET scan is available it will be of great help in detecting residual disease.

  25. Non- Seminoma • Nerve- sparing retroperitoneal lymph node dissection (RPLND) : 1. If LN are negative : Observation. 2. If LN are positive either observe or give chemotherapy in non-compliant patients or if there are extensive nodal involvement.

  26. Stage IB • there are 2 options: • i. RPLND. • ii. Chemotherapy 2 courses of BEP. • Stage IS : Chemotherapy in the form of 4 cycles of EP or 3 cycles of BEP. • Stage II (A or B): i) If Tumor markers are not elevated patients are treated by either RPLND + adjuvant 2 courses of chemotherapy OR 4 courses of EP or 3 courses of BEP. ii) If markers are elevated give chemotherapy.

  27. Stage IIC & III and extragonadal primary sites (Mediastinum or retroperitoneim Primary Chemotherapy according to risk status. • i) Good risk : either 4 cycles of EP or 3 cycles of PEB. • ii) Intermediate or poor risk : 4 cycles of PEB.

  28. Incompletely responded or relapsed patients treated with surgical salvage if presented in a single site. • Resistant cases are treated with third line (high-dose) chemotherapy. • Third line chemotherapy consisted of 2 cycles of high dose carboplatin and etoposide ± cyclophosphamide (or ifosphamide).

  29. Follow-up • Every 3 months in the first years & every 6 months thereafter. • CXR and CT abdomen to be performed every year

More Related