Systemic treatment for high-risk localized prostate cancer Karim Fizazi, MD, PhD Institut Gustave Roussy Villejuif, France
Disclosure Participation in advisory boards or as a speaker for: Amgen, Astellas, Astrazeneca, Bayer, Curevac, Janssen, Orion, Roche, Sanofi-Aventis
Mr Leo, 68 year old • Systematic serum PSA= 28 ng/mL • Confirmed twice • Moderate increase in night mictions • Minor erection troubles in the last year
Mr Leo, 68 year old • No previous medical Mr Leo’s dad, 91 history • Married, 2 children • Normal physical examination (except digital rectal examination) • Mother (89 year) and father (91 year) alive
He meets a urologist • Serum PSA= 28 ng/mL • Likely clinical T3 • Biopsy: Adenocarcinoma Gleason 8 (4+4) • 8/12 positive biopsies
Radiologic assessment Normal Bone scan Normal CT scan thorax/abdomen/pelvis MRI of the prostate T3
Prostate MRI for capsular invasion • Sensitivity ∼ 60% T2 • Specificity ∼ 80% T1
A patient with high-risk localized prostate cancer Yes, but they also You should No ! talk about What to have a Radiation hormones do? prostatectomy! therapy !
What would you recommend?
Now what if Mr Leo’s CT scan… • Serum PSA= 28 ng/mL • Likely clinical T3 • Biopsy: Adenocarcinoma Gleason 8 (4+4) • 8/12 positive biopsies
…shows this?
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