Tx on advanced, relapsing and castration resistance

PCEU 59(2011)572-583

Updated literature review from 2007-2010

Hormone TX

• LHRH: standard care Less physical and emotional stress Less cardiotoxicity compared with DES

• LHRH antagonist Degarelix, not inferior to Leuprin Better PSA progression, better PC-related death Efficacy still need to proven

Antiandrogen

• BAD monotherapy compared with castration

• LHRH agonist + antiandrogen VS LHRH agonist

little benefit but high cost and side effects Still use in debates

• IAD(intermittent) is not inferior to continous

Immediate versus deferred HT

• Immediate HT make no survival benefit

Locally advanced: no survival benefit S/P RP, PSA↑ vs meta proof: no survival benefit Instead of survival, PFS benefit was noted in immediate HT

• locally advanced pt>>deferred HT • metastatic pt>> immediate HT

Follow up in PC pts

• ADT pts BMD test, T score<-1.0 / 2yrs BMD test, T score -1.0~-2.5 / 1yr

• On LHRH, routine test: PSA, testosterone• 使用 LHRH agonist在前 6個月要評估抗賀爾蒙藥物是否有效，以及考慮是否改用其他藥物以及 CRPC的可能

• Evaluate the side effects of ADT, insulin resistance or lipid profile abnormality

How to diagnosis of the relapse after curative Tx

• S/P RP, PSA >0.2ng/ml(連續兩次 )Systemic failure sp RP, PSA↑<1yr,

PSA doubleing time 4-6m, Gleason score 8-10

• S/P RT, >+2ng/ml PSA

適合用其他工具判斷復發嗎 ?

• 除非 PSA velocity>2ng/ml 或>20ng/ml

>>建議進行 CT• No CT/BONE SCAN/PET: no role in

relapse diagnosis

Recurrence treatment

• S/P RP but relapse, salvage RT would bebetter choice

• S/P RT but relapse, considerSalvage RP in low comorbidity,

life>10yr…Cryo: less comorbidity, same result

as RP

CHEMOTHERAPY INDICATION

• 75mg/m2 in 3wk interval• Indication: symptomatic metastasis• Asymptomatic metastasis:???• High PSA, PSA double time<6m \

early start

• Second line: cabazitaxel

Bone related complications

• Zometa: 4mg /4wksDecrease fx events, decreased pain

• DenusomabDecreased fx events as zometa

• Beware of spinal cord compression complications