prostat ca – androjenik hormonlar -...
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days
Test
oste
rone
(ng/
dL)
Charles HUGGINS
The effect of castration on advanced carcinoma of the prostate gland.
Arch Surg, 1941
Metastatik PCa – Mevcut Durum
Sistemik tedavi – Androjen Ablasyonu (HT)
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Prostat Ca – Androjenik Hormonlar
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Metastatik PCa - Prognoz
James ND et al. Eur Urol, 2014, http:// dx.doi.org/10.1016/j.eururo.2014.09.032
STAMPEDE ÇalışmasıKontrol kolu917 hasta
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Gundem G et al Nature, doi:10.1038/nature14347
Primer Tümör ve Metastazlar arası Hücresel ve Genetik Etkileşim
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Primer Tümör ve Metastazlar arası Etkileşim
Metastatik Prostat Kanseri
Amaç: Sağkalımı artırmak
Yeni tedavi yaklaşımlarına ihtiyaç var
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Metastatik RCC – TedaviSitoredüktif tedavi önemli bir komponent
EAU Guidelines
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Culp SH et al. Eur Urol, 2014, 65: 1058-1066
SEER Veritabanı – Metastatik PCaRP, RT ve HT ile Genel Sağkalım
5 y Gnl SK (%)
67.452.6
22.5
Median izlem27 ay
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-T4 veya HG hastalık-Yaş > 70 y-PSA> 20 ng/ml-Pelvik LAP
Culp SH et al. Eur Urol, 2014, 65: 1058-1066
Bağımsız risk faktörleri
OS(%)DSS77.3 89.9
53.1 68.7
38.2 50.1
22.5 48.7
5 y
SEER Veri Tabanı – Genel Sağkalım
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Neoadjuvan 6 ay HTPSA < 0.4 ng/ml olursa RP ve genişletilmiş PLNDAdjuvan HT 2 sene
Heidenreich A et al. J Clin Oncol 32, 2014 (suppl 4; abstr 272)
Sitoredüktif Prostatektomi
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RP Control Group
n 18 38
F-u 29 (3-52) mo 44 (21-96) mo
OS 100% 79%
OS time 29 (3-52) mo 38.3 (8-96) mo
bNED 83.3%
PFS 21.5 (4-52) mo 15.6 (9-73) mo
Time to CRPC 21.5 (4-52) mo 22.5 (14-82) mo
Heidenreich A et al. J Clin Oncol 32, 2014 (suppl 4; abstr 272)
Sonuçlar
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Heidenreich A et al. J Urol, 193: 2015Epub September 2014
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Conclusion:CRP might improve overall and cancer specific survival in a well selected cohort ofpatients based on the individual PSA response toneoadjuvant ADT. CRP effectively prevents complications of the lower and upper urinary tract.
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Gratzke C et al. Munich Cancer Registry Eur Urol, 2014
5 y OS
RP: 55%
No RP: 21%
Munich Cancer Registry – Genel Sağkalım
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Satkunasivam R et al J Urol, 2015, 194: 378-385
Metastatik PCa – SEER Database
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Satkunasivam R et al J Urol, 2015, 194: 378-385
Metastatik PCa – SEER Database
HT, komorbidite ve kemiklere RT değişkenlerine göre düzeltme ile RP ve IMRT ile sağkalımdaartışKonformal RT etkili değil
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Yeni tanı almış metastatik prostat kanseri (M1)106 hasta
Metastatik PCa - RP
Sooriakumaran P et al. Eur Urol, 2016, 69: 788-794
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Sooriakumaran P et al. Eur Urol, 2016, 69: 788-794
Metastatik PCa – RP - Sağkalım
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Sitoredüktif RP seçilmiş hastalarda sağkalımı artırabilir
Standart hormonal tedaviye kemoterapinin eklenmesi sağkalımı önemli oranda artırmaktadır
Lokal tedavi olarak RP’nin multimodaltedavi kapsamında ilave edilmesi
sağkalımı daha da uzatabilirEn uygun hasta grubunu belirlemek için ilave çalışmalara ihtiyaç vardır
Metastatik Prostat Kanseri Birinci Basamak Tedavisinde Yeni Bir Kavram
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Metastatik PCa – EAU Kılavuzu 2016