Aymen's Test Page

• Adenocarcinoma, Clinically Localized Disease, Low Risk, Surveillance Candidate:

Notes: PSA every 3-6 months, DRE every 6-12 months and rebiopsy (12 core) every 12-24 months. May rebiopsy if indicated by new DRE finding or PSA increase. Institute definitive therapy at disease progression.

Surveillance Notes Post Definitive Treatment Surveillance: Q3 months x 1-2 years exam with PSA. Then, if no PSA-recurrence*, q6 months x 5 years. Then, if no PSA-recurrence*, yearly. No imaging required. *PSA recurrent defined as 2 ng/mL above nadir.

Citations: 1. Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N. Engl. J. Med. 2011;364(18):1708-1717. 2. Gore JL, Kwan L, Lee SP, Reiter RE, Litwin MS. Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer. J. Natl. Cancer Inst. 2009;101(12):888-892. 3. Johansson J-E, Andrén O, Andersson S-O, et al. Natural history of early, localized prostate cancer. JAMA 2004;291(22):2713-2719. 4. Klotz L, Zhang L, Lam A, Nam R, Mamedov A, Loblaw A. Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J. Clin. Oncol. 2010;28(1):126-131.

5. Tosoian JJ, Trock BJ, Landis P, et al. Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J. Clin. Oncol. 2011;29(16):2185-2190.

Aymen Elfiky MD, MA, MPH, MSc

• Adenocarcinoma, Clinically Localized Disease, Intermediate Risk, Radiation Candidate:

Level 1 evidence supports radiation + ADT. If a patient or physician feels ADT is not the preferred option, radiation alone with dose escalation can be considered.

Standard overview example: •Radiation + Neoadjuvant/Concurrent/Adjuvant LHRH Agonist Starting 2 - 4 Months Prior to Starting Radiation and Continuing for a Total of 6 Months (+/- Nonsteroidal Antiandrogen During XRT)

A cycle is every 12 weeks: •Leuprolide acetate depot 22.5 mg - every 12 weeks - intramuscularly every 12 weeks Daily: •Bicalutamide 50 mg - once a day - orally once a day

Citations: 1.D’Amico AV, Chen M-H, Renshaw AA, Loffredo M, Kantoff PW. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA. 2008;299(3):289-295. 2.Denham JW, Steigler A, Lamb DS, et al. Short-term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial. Lancet Oncol. 2011;12(5):451-459. 3.Jones CU, Hunt D, McGowan DG, et al. Radiotherapy and short-term androgen deprivation for localized prostate cancer. N Engl J Med. 2011;365(2):107-118.

• Adenocarcinoma, Clinically Localized Disease, High Risk, Radiation Candidate

Standard overview Example: •Radiation + Neoadjuvant/Concurrent/Adjuvant LHRH Agonist Starting 2-4 Months Prior to Radiation for a Total of 18-36 Months (+/- Nonsteroidal Antiandrogen During XRT)

Citations: 1.Bolla M, de Reijke TM, Van Tienhoven G, et al. Duration of androgen suppression in the treatment of prostate cancer. N Engl J Med. 2009;360(24):2516-2527. 2.Horwitz EM, Bae K, Hanks GE, et al. Ten-year follow-up of radiation therapy oncology group protocol 92-02: a phase III trial of the duration of elective androgen deprivation in locally advanced prostate cancer. J Clin Oncol. 2008;26(15):2497-2504. 3.Souhami L, Bae K, Pilepich M, Sandler H. Impact of the duration of adjuvant hormonal therapy in patients with locally advanced prostate cancer treated with radiotherapy: a secondary analysis of RTOG 85-31. J Clin Oncol. 2009;27(13):2137-2143.

• Adenocarcinoma, Post-Prostatectomy, Node Positive, 1 - 3 Nodes / 4 or More Nodes

Note risk factors for local recurrence Citations: 1. Messing EM, Manola J, Yao J, et al. Immediate versus deferred androgen deprivation treatment in patients with node- positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol. 2006;7(6):472-479.

• Adenocarcinoma, Post-Prostatectomy, Pathologic T3

Citations: 1.D’Amico AV, Chen M-H, Renshaw AA, Loffredo M, Kantoff PW. Androgen suppression and radiation vs radiation alone for prostate cancer: a randomized trial. JAMA. 2008;299(3):289-295. 2.Thompson IM, Tangen CM, Paradelo J, et al. Adjuvant radiotherapy for pathological T3N0M0 prostate cancer significantly reduces risk of metastases and improves survival: long-term followup of a randomized clinical trial. J Urol. 2009;181(3):956-962.