1. PROSTATE CANCER: RADIATION APPROACHES for advanced disease
ANDREW L. SALNER, MD FACR
DIRECTOR
HELEN & HARRY GRAY CANCER CENTER
HARTFORD HOSPITAL, CT

2. ARS ? ??

3. Advanced Disease Biochemical recurrence after prostatectomy
Metastatic disease
Palliative external RT
Quadramet

4. Salvage Radiation Therapy for Biochemical Recurrence
Recurrence>2years, PSA DT>10 months
Positive margin, extracapsular extension
Should be used early, PSA<1(possibly 0.5)
50-70% DFS in 5 years
IMRT Gy, image guidance daily
acceptable early complications, rare late complications

5. Choo, R-Mayo Clinic 2009 IJROBP

6. Bone Metastasis Pain/loss of function One dominant site Multiple sites
Spinal cord compression>emergency
Hip metastasis causes pain, threatens fracture
One dominant site
Multiple sites

7. Spine radiation
to osteoblastic
lesion

8. Palliative Radiation Bone Metastasis
Highly effective 90% or more for pain relief
Can be repeated
Short course of 2 weeks, occasionally even given in single dose, depending on location
Can be combined with chemo, hormone deprivation, bone stabilization such as vertebroplasty or fusion if needed

9. Quadramet(samarium 153) Bone seeking radioisotope
Systemic dose to “hot” areas
Can combine with external
May lower blood counts
May cause “flare”
Can last 3-6 months
Can be repeated
60-75% response rate
Best for patients with multiple
or migratory painful sites

10. Advanced prostate cancer
Team approach with urologist, medical and radiation oncologist
Systemic therapies and local therapies
Focus on disease control and quality of life
Individually tailored
THANK YOU!

11. Advanced Stage Disease Session Evaluation? ??