GU (new threads)

PSA cut off level

Sun, 01 May 2011 15:48:22 +0000

Hi everyone,
I have lastly seen patients with very high PSA levels and negative staging studies. For example, in a young patient with a PSA of 400, Gleason 8, cT3b cN0 and no mets in staging studies. Can you recommend local treatment?? Do you know any references supporting radical treatment in these patients?

Paradigms Shift Bladder Cancer

Wed, 27 Apr 2011 14:36:49 +0000

Dear all,
You cannot miss this paper "International Phase III Trial Assessing Neoadjuvant Cisplatin, Methotrexate, and Vinblastine Chemotherapy for Muscle-Invasive Bladder Cancer: Long-Term Results of the BA06 30894 Trial"

http://www.ncbi.nlm.nih.gov/pubmed?term=International%20Phase%20III%20Trial%20Assessing%20Neoadjuvant%20Cisplatin%2C%20Methotrexate%2C%20and%20Vinblastine%20Chemotherapy%20for%20Muscle-Invasive%20Bladder%20Cancer%3A%20Long-Term%20Results%20of%20the%20BA06%2030894%20Trial

Pediatric RMS Badder n Prostate

Wed, 27 Apr 2011 05:56:01 +0000

the pt 6 yr old boy, with RMS of urinary bladder n prostate,,, at presentation he had large B/L iliac LAP along with huge primary tumor. He responded very well to chemotherapy with disappearance of nodes n residual thickening in bladder bt quite a volume of dis in prostate, but is still inop (as per our surgeons). Hence the kid is being planned for RT, we managed to get him funded for IMRT, but am facing quite a few problems while contouring n planning for this chap.
1. Do we have separate set of constraints for this age gp of pts for organs like rest of bladder, rectum, testes n small bowel.
2.Do we need to treat PA nodes also in this pt.
3. Wat would be constraints for bones in this pt, as most of them are unossified.

Adjuvant RTin Ca penis

Fri, 22 Apr 2011 09:38:29 +0000

42/M
Partial Penectomy + Bilateral INguinal LND
HPR
Basaloid Squmuas Ca
pT3.5*2.7
DEpth 1.5 cm
Corpora and urethra free
LVE+, PNI+
Shaft c/m 3 cm free
Skin c/m 8 cm free
Right superfacial ing LN 1/10 involved with extensive necrosis & PNE
Left superfacial ing LN 3/8 involved with extensive necrosis & PNE. 4 Left deep ing LN free

Stage pT1pN2

Ideally his bilteral pelvic LND should have been done.
Not possible now for logistics reasons.

Role of RT i believe is to prevent LN relapse. Hence I need to treat bilateral Inguinofemoral and pelvic LN to a dose of 50-60 Gy (60 Gy for lt groin)

I need opinion of house

Salvage radiotherapy after Radical prostatectomy

Sun, 27 Feb 2011 09:32:35 +0000

Hi everybody,
Would like to know how are you treating in your hospitals this clinical situation.
Standard will be RT (66-68Gy) no ADT.
There is some evidence about dose escalation (King 2008 ijrobp and Bernard 2010 ijrobp) there is also evidence about ADT (Choo 2009 ijrobp). Most of the ongoing phase III clinical trials (RTOG 0543, RADICALS, JCOG 0401…) are investigating the combination of RT and ADT.
Are you using this combination? Which dose are you administering?

Thanks

Intermediate and high risk Ca Prostate

Wed, 16 Feb 2011 18:05:40 +0000

Is there any benefit of adding Whole pelvic RT to Intermediate & high risk Ca prostate in comparison to Localized RT ?
Current recommendation still favoring whole pelvic RT despite at least 2 prospective randomized trials showing no benefit in 5 year PFS ?

First post in Isocentre (need opinions)

Mon, 14 Feb 2011 22:13:40 +0000

65y man.
Gleason 8 (4+4), iPSA 24ng/ml.
Bone scan negative. CT scan: 2 common iliac positive nodes.
KPS: 90%.
For sure ADT, but… what about EBRT?. If yes, which dose to prostate, and nodes?
I was thinking in 46Gy to Whole pelvis, boost to positive nodes to 60Gy, and prostate/seminal vesicles to 74-76. Does it make any sense to escalate doses to prostate?
Another concern, important obstructive symptoms, IPSS:25.

I'd really appreciate comments on this.

HDR Monotherapy for Prostate Cancer

Sun, 13 Feb 2011 22:42:57 +0000

As the life expectancy of Indian men increase, we will be seeing more of prostate cancer in near future. Availability of Iodine or Palladium Seeds can be an issue for permanent implantation. Here a solution where you can use your existing HDR setup to treat these cases. This paper is by one of the most famous brachytherapist Dr.Martinez group. He was the one who designed the HDR MUPIT (Martinez Universal Perineal Template) for gynecological implants in 1970's.

http://www.ncbi.nlm.nih.gov/pubmed/21310546

CTV for Stage I Seminoma

Mon, 07 Feb 2011 13:08:43 +0000

I understand from my reading that the standard treatment for Stage I seminoma (after orchidectomy) is radiotherapy to the para-aortic (retroperitoneal) nodes of the abdomen.
Typically this uses a parallel opposed pair with margins of:

Superiorly T_10-11 disc
Inferiorly L₅-S₁ disc
Laterally the tips of the transverse processes (except for left sided tumours where the field extends to the left renal hilum)

Given the spread of volume based planning I am trying to determine what volumes I should contour for a seminoma treatment. When the surgeons do a retroperitoneal dissection they only take tissue out below the renal arteries; with radiotherapy the field is extended a significant distance above this.
Is there a good reference that discusses the rationale for placing the fields as we do?

(PS. My first post! Thanks for the help!)

When can we omit a histological diagnosis of prostate cancer?

Mon, 07 Feb 2011 08:17:26 +0000

70/M
PSA 100
Bone scan shows multiple areas of avidity
What are the policies that you follow regarding histological diagnosis before starting hormonal treatment?

SBRT Prostate - Cyber Knife and other technologies

Sun, 16 Jan 2011 02:35:15 +0000

Cyberknife SBRT, is it safe to try in Prostate ? Any data? Dose Fractionation?
How does it compare to Rapidarc+CBCT based SBRT?

Can you anyone discuss the issue and through some insight.

High Risk Ca Prostate

Tue, 04 Jan 2011 17:38:31 +0000

62/Male,
Pretreatment PSA=160,
Metastatic work up negative.
Biopsy: Gleason 7(3+4), 6/6 cores.
Neo adjuvant hormones followed by Radical Retropubic prostatectomy+PLND
Final Path: Gleason 7 (3+4), margin postive, extra prostatic extension=present, positive LVI, seminalvesical invasion (pT3b), 1/9 plevic lymp node postive (pN1).

What should be the treatment now? Hormones for sure. Is there any role of radiation, if yes prostate bed alone or pelvic+prostate bed ?

Seminoma

Sat, 04 Dec 2010 20:05:02 +0000

32/Male, Caucasian, married, no kids, Classical Seminoma Stage 1, had surgery in July 2009, 8cms tumors, no adverse features. Patient refused adjuvant RT then and went on surveillance.
Now Nov 2010 has a 1.3 cms left peri-renal lymph node and another one right beside it measuring 1.0 cm.

What should be the treatment? If RT what portals and dose ?

Salvage treatment for Prostate cancer

Tue, 02 Nov 2010 02:48:10 +0000

72/Male, previous RT to prostate only 70Gy/35#'s.
Now has recurrence in left base, GS=3+4=7. rest of the metastatic work up negative. PSA (Oct 2010) 3.41. The reason why biopsy was done becoz over 2 years the PSA has been gradually going up.
Now the patient wants to know what Salvage curative options are available. Does not want hormones.

low-risk ca prostate (postTURP)

Wed, 06 Oct 2010 10:58:45 +0000

60 year hypertensive male underwent angioplasty 3 mnths back
c/o urgency, nocturia, more of dysuria x 1year
PSA <10
USG pelvis- normal volume, no hypoechoic foci
Had acute retention of urine, catheterization attempted, difficult, dilation and manipulation in small town
Underwent TURP with diagnosis of BPH by urologist with impression of false passage from bulbous urethra to veru-montenum
HPE: adenocarcinoma foci in <10% of tissue, gleason 3+3

Diagnosis: Low risk (? T stage) ca prostate
Planned for 3 mnthly PSA and pelvic MRI at 6 weeks postop

Issues:

1. Active surveillance vs adjuvant treatment (in view of inadequate surgery)
2. In view of dilation and manipulation chances of local spread and stage migration
3. How to arrive at life expectancy in this case?

Role of Radiation in Renal Cell Carcinoma

Wed, 22 Sep 2010 07:22:52 +0000

RCC is relatively rare; but indications for post operative XRT vary from "positive margins", to capsular invasion and nodal metastasis. While I was reading about it, I was struck that much of the "evidence" comes in from retrospective studies and few poorly designed prospective studies where loco-regional recurrence rates was not the end point of the study design. In addition to that, there have been few number of patients and literature quotes that this is "radio-resistant" tumor (http://www.ncbi.nlm.nih.gov/pubmed/12118559?dopt=Abstract).

I am linking to meta-analysis published in recent issue of Annals of Oncology here: http://www.scribd.com/doc/37912346/Need-for-a-New-Trial-to-Evaluate-Postoperative-Radiotherapy-in-Renal-Cell-Carcinoma-a-Meta-Analysis-of-Randomized-Controlled-Trials. Please feel free to download it. (PMID: 20139152).

At the same time, it led me to think that since this is "radio-resistant" tumor, can hypofractionation (with conformal techniques) be really helpful?

A Pubmed search lead me to following articles:
http://www.scribd.com/doc/37912667/Do-Patients-Receiving-Whole-Brain-Radiotherapy-for-Brain-Metastases-From-Renal-Cell-Carcinoma-Benefit-From-Escalation-of-the-Radiation-Dose

What is the opinion of the forum to push for Radiation in Renal Cell Carcinoma? It's time that overt reliance on targeted therapy be discarded in favor or perhaps stereotactic/ conformal hypofractionated regimens and/or under the ambit of a well designed prospective clinical trial.

@Santam: Am on Linux Mint (9) now and realized that Ubuntu's installer is best in Linux world at present. Maybe perhaps in near future (when I have better bandwidth), I'd shift to a rolling release distro; most likely debian only.

Brachytherapy for Intermediate Risk Prostate Cancer

Sun, 01 Aug 2010 05:36:00 +0000

Dear all,
I would like to know your thoughts about Brachytherapy alone for good Intermediate Risk Prostate Cancer patients. Anyone of you using brachy alone for these patients. Iam aware of RTOG 0232 study http://rtog.org/members/protocols/0232/0232.pdf which is looking at this question.
Your comments are welcome
Nikhilesh

Penile Cancer

Sat, 24 Jul 2010 00:53:35 +0000

Guys I need your opinion on this case
72/Male,
Previous Intermediate risk ca. prostate treated with hormones + RT in 2006, now PSA undetectable.
January 2010 patient noticed a small superficial growth on dorsal surface of glans.
Excision biopsy March 2010: Specimen size 1x1x0.8 cm superficial invasive squamous cell cancer, margin not commented.
History of phimosis since birth, circumcision done during childhood.
July 2010 has a 5-6 mm clinical recc just beside the biopsy site, its very close to the coronal sulcus on the right later side, urethral meatus normal, no pain/bleeding or urinary complaints. No groin nodes palpable. CT pelvis is scheduled to be done in few weeks time.
Patient does not want surgery.
What are the treatment options? If Radiation then dose fractionation ?
Nikhilesh

Hormone Refractory Prostate Ca

Fri, 11 Jun 2010 15:16:47 +0000

60yr/ M, generalised bodyache since a week, treated with analgesics, went to USA, had severe constipation, hence admitted. On investigations found to have extensive bone mets & hypercacemia, Ba enema showed nothing-probably the costipation was due to hypercacemia. PSA-3900. Prostate not enlarged, no LN pathy, Prostate Bx-Adeno ca (gleason's score 5+4). Treated with Leuprolide (2 # of 3 mthly inj) & Zoledronic acid 6 #. symptomatic relief & PSA came down to 17. Came back to India. PSA rising, hence received 3 # of monthly leuprolide with Idrophos Tabs. Severe bodyache with rising PSA- Hence labelled as HRPC and treated with Docetaxel 2 # with Idrophos tabs & analgesics. Good symptomatic relief. But PSA is continuously rising, now PSA is 1900. CT abdo- bone mets only. No urinary symptoms.
Sr. Testosterone level-2 (castrated level).
I could not digest that Pt is symptomaticlly better & PSA rising; so PSA repeated at another lab-same reading. I came to the conclusion that Docetaxel is not working.
What next?

Dr. Girish Bedre

ca prostate post op

Sat, 29 May 2010 12:30:35 +0000

68/M
No comorbidities
LUTS
PSA Apr 6 ng/ml
Gleasons 4+3=7
RP done
HPR
adenoca GS 4+7
involves both lobes
Mainly periphral zone
Extensive PNI. Although no direct extraprostatic spread noted, tumour cells in perineural spaces in fat and around ganglion on left side indicative of extracapsular spread
base involved
P urethra uninvolved
apex,circumpherential and distal margin free

seminal vesicles free
Rt pelvic LN 0/12
Lt pelvic LN 4/4 involved

What should be the volume on dose of RT?
Any guidelines on contouring tumour bed?