1. Bladder Cancer and Prostatic Cancer
CA PROSTAE AND BLDDER
Bladder Cancer and Prostatic Cancer

2. Each cancer will be discussed by three specialists
-Surgeon
-Radiation Oncologist
-Medical Oncologist
Followed by Question

3. Definite Radiotherapy for Prostate Cancer
Localize early prostate cancer
- Very low Risk with life expectancy > 20 years ( Age < 62 )
- Low Risk with life expectancy > 10 years ( Age < 77 )
Locally advance prostate cancer
- Intermediate / high risk / very high risk ( Including pelvic LN metastatic without distant metastasis ) Radiotherapy with LHRH agonist

4. Adjuvant / Salvage Radiotherapy after Radical Prostatectomy
Extra-capsular Extension / Positive margins / Extension to seminal vesicle or
Post-operative case with PSA > 0.2 ng/ml or
มีการเพิ่มของ PSA หลังการผ่าตัดอย่างต่อเนื่องและมีนัยสำคัญ

5. Palliative Radiotherapy in Prostate Cancer
For Pain, Bleeding, Bone mets, Brain Mets, Spinal cord compression, etc. for Advance or Metastases Disease

6. High Dose Rate Radiotherapy
In Intermediate and High risk group as Booster dose to External Radiotherapy
As monotherapy instead of low dose rate radiotherapy in low risk or selected intermediate risk group
In recurrent tumor after radiotherapy

7. Hormonal treatment in combination with Radiotherapy
LHRH Agonist not more than Two cycles:
In Intermediate risk prostate cancer stage cT2B and cT2C and/or Gleason score 7 and/or PSA ng/ml
LHRH agonist not more than Eight cycles:
In High risk group stage cT3A and/or Gleason score and/or PSA >20 ng/ma, or In Very high risk group stage cT3B and cT4

8. Bladder Preservation Therapy ( Maximal TURBT followed by Concurrent Chemo-Radiotherapy )
Indication
Clinical stage T2-4, N any, M0
Single lesion
No hydro-nephrosis is preferred
Tumor size < 5.0 cm is preferred
No extensive TIS

9. Primary Radiotherapy for Bladder Cancer in muscle invasive pT3-4 or pN+
In case of very Old age and Medical contraindication
May consider Concurrent Chemo-Radiotherapy or Radiotherapy alone depending on the patient status

10. Adjuvant Radiotherapy after Cystectomy
In patient who can not tolerate chemotherapy after partial or total cystectomy
May consider in Positive margin or pT3-4 tumor or N +ve or high grade

11. Palliative Radiotherapy
For Pain, Bleeding, Bone mets, Brain Mets, Spinal cord compression, etc. for Advance or Metastases Disease