Identifying Risks and Treatment Options for Advanced Prostate Cancer - a Continuing Eduction Program from LearningProstate.com

DR. SCHELLHAMMER:
"...I would like to discuss now a patient who presents with those high-risk features Dr. Sartor mentioned.... The biopsy revealed Gleason sum 4+3 and seven of the 12 cores obtained were positive for cancer and the cancer was bilateral. His PSA at time of biopsy was 10; one year ago it was 4. A bone scan was performed which was negative for Metastatic disease."

PRESENTATION

60 Year Old Healthy Male

No Comorbidities

T2c, Gleason 4+3

7/12 Cores Positive (Bilateral)

PSA=10, PSA 1yr ago=4

Bone Scan = NEG

DR. SCHELLHAMMER:
"...the patient really has to choose the treatment that's best for him as he listens to these discussions since there really is no best form of therapy, as we've outlined. But he did decide to have surgery and the surgery was performed successfully, without complications."

TREATMENT

RRP with Bilateral LND Performed.

Pathology:
   Gleason 4+4, ECE Present
   Margins, SV & Nodes are Negative.

Stage pT3a N-

DR. SCHELLHAMMER:
"...the patient then decided to pursue a program of surveillance after his radical prostatectomy rather than embark on any anjuvant therapies. At 12 months his PSA was 0.1. However at 15 months it was 0.2; three months later, 18 months, it was 0.4... So he returns to you, Dr. Sandler, for your opinion about salvage radiation therapy."

SURVEILLANCE

PSA values
   @ 12Mo. post R.P.=0.1

   @ 15Mo. post R.P.=0.2

   @ 18Mo. post R.P.=0.4

   @ 21Mo. post R.P.=0.8