Review Note
Last Update: 02/18/2024 05:30 AM
Current Deck: Part 2::6. High Yield Questions::Genitourinary
PublishedCurrently Published Content
Front
80-year-old man with
a past history of prostatectomy presents with an elevated PSA. Restaging with
PSMA PET shows 2 asymptomatic bone metastases with no visceral disease. List
the treatment options and then discuss factors that you would take into account
when deciding on the optimal treatment for this patient. 3 marks
Back
Treatment options:
- Surveillance
- Androgen deprivation therapy, intermittent or continuous approach
- Additional systemic agents: anti-androgens
- External beam radiotherapy – stereotactic approach (e.g. 24Gy/2#) has been shown to delay ADT, or more palliative approach (e.g 8Gy/1# or 20Gy/5#) may be undertaken (if concern regarding future complications, even if currently asymptomatic)
Patient:
- Age
- Co-morbidities – particularly cardiovascular and metabolic if considering ADT
- Performance status
- Prognosis
- Contraindications to radiotherapy – e.g connective tissue or hypersensitivity condition
- Patient’s wishes
Tumour:
- Original Gleason score
- PSA score, doubling time
- Disease-free interval
- Location of bony metastases, associated risk of fracture or other complication/s
Treatment:
- Local resources and expertise
- Previous radiotherapy
- Previous systemic agents – ADT, docetaxel – and tolerance of these
Further information, not for memorising (no card)
Exam
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