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Medical specialist, Dr. Saima Mushtaq has discussed benign and malignant diseases of prostate in the previous sqadia.com medical video lecture. Now, the cornerstone of this lecture is treatment of prostate cancer in which she describes the various treatment techniques including single-modality therapy, radiation therapy, neoadjuvant hormone therapy. In this lecture students will get to know about radical prostatectomy, through which complete removal of cancer is possible. Also, information about brachytherapy and active surveillance along with non-castrate and castrate metastatic disease is given.
Clinically Localized Prostate Cancer
These cancers can be treated by carrying out single-modality therapy, PSA relapse-free survival, radical surgery. According to the TNM classification system, T1 lesions, T1c type stage, and T3 tumors requires different curative method. After that, an important aspect in assessing the risk of cancer is discussed which is a nomogram. Nomograms assist in predicting clinically significant prostate cancer, extent of the disease, and probability of success of treatment. Another treatment modality is the radical prostatectomy.
Radiation and Hormone Therapy
Radiation therapy is carried out through the use of external beam and radioactive sources implanted into the gland. However, both of these methods can be used in consolidation. Intensity modulated radiation therapy enables the delivery of higher doses to the prostate and reduces the tissue exposure of other organs. Characteristic features of pre-radiotherapy neoadjuvant hormone therapy comprise decrease size of prostate, Increases local control rates, reduces exposure of normal tissues to full-dose radiation.
Brachytherapy and Active Surveillance
A treatment approach in which radioactive sources are implanted directly into the prostate is called as brachytherapy. Following this, Dr. Saima Mushtaq sheds light on complications of brachytherapy. A policy which aims to monitor the illness at fixed intervals with DREs, PSA measurements, and repeat prostate biopsies is named as active surveillance. Moving onward, medical educator elaborates that rise in prostate specific antigen after surgery/radiation therapy indicate micrometastasis.
Noncastrate Metastatic Disease
Noncastrate metastatic prostate cancer includes men with metastases visible on an imaging study and noncastrate levels of testosterone. Standard treatment follows depletion/lowering of androgens by medical or surgical means, block androgen binding to AR with antiandrogens, surgical orchiectomy. Testosterone-lowering agents are contraindicated in men with significant obstructive symptoms. First-generation nonsteroidal antiandrogens such as flutamide, bicalutamide, and nilutamide block ligand binding to the AR.
Castrate Metastatic Disease
Castration-resistant prostate cancer (CRPC) is defined as disease that progresses despite androgen suppression by medical or surgical therapies where the measured levels of testosterone are 50 ng/ mL or lower. Majority of CRPC cases are not hormone refractory. Chemotherapy and new agents include docetaxel, next-generation antiandrogen i.e. enzalutamide, CYP17 inhibitor abiraterone acetate which lowers androgen levels, bone-targeted agents (bisphosphonates, RANK ligand inhibitor (denosumab).