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Prostate Cancer Updates: Screening Treatment and Survivorship PowerPoint Presentation

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Description : This medical presentation on cancer titled "Prostate Cancer Updates: Screening, Treatment and Survivorship" provides us important information on PSA screening, treatment of prostate cancer, and survivorship.

Tags : Cancer, Prostate Cancer, Updates, Screening, Treatment, Survivorship, PSA screening, treatment, Surgery, radical prostatectomy, Radiation Therapy, Brachytherapy, seeds, External Beam, Hormone Therapy, Metastatic, Chemotherapy, Robotic surgery, Image guided radiation therapy

Published on : May 03, 2021 | Views : 1801 | Downloads : 5

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Prostate Cancer Updates: Screening, Treatment and Survivorship Nataniel Lester-Coll, MD Assistant Professor of Radiation Oncology
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Outline PSA Screening Treatment of Prostate Cancer Survivorship 2
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Epidemiology 3
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PSA Screening Why is PSA screening controversial? What’s new? 4
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PSA Screening
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PSA Screening 6
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PSA Screening 2009: 2 large screening studies were published European study: PSA test reduced prostate cancer deaths American study: PSA test did not reduce prostate cancer deaths 2012: US Preventative Task Force recommended against routine PSA screening for all men 2017: Publication of combined analysis of European + American study (238,000 men) with more results PSA test reduced prostate cancer deaths 2018: Publication of British study (400,000 men) Getting a single PSA test did not reduce prostate cancer deaths 7
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PSA Screening 2018: US Preventative Task Force recommends PSA screening “For men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician.” “Shared Decision Making” 8
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PSA Screening 9
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PSA Screening 10
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PSA Screening What is our approach today? At UVM? Modern Approach to Prostate Cancer Screening (MAPS) Grant supported collaboration led by Dr. Alison Landrey (primary care) and James Wallace (radiation oncology) Shared decision making Individual, risk adjusted, individualized approach that incorporates race, family history, and a baseline PSA to maximize the benefits of screening and minimize harms 11
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Outline PSA Screening Treatment of Prostate Cancer Survivorship 12
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Treatment of Prostate Cancer How do we approach treating prostate cancer? It depends “Risk Group” + Patient Preferences 13
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Treatment of Prostate Cancer 14 Gleason Score + PSA + Exam/Imaging Findings
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Treatment of Prostate Cancer Low risk Active Surveillance or Treatment Intermediate – High risk Surgery (radical prostatectomy) Radiation Therapy Brachytherapy (seeds) External Beam +/- Hormone Therapy Metastatic Hormone Therapy, Chemotherapy, Radiation Therapy 15
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Treatment of Prostate Cancer For localized prostate cancer, treatment decisions based on cancer risk and shared decision making Incorporate patient preferences Logistics, side effects Consultations with specialists to discuss the pros/cons of different treatments 16
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Treatment of Prostate Cancer 17
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Treatment of Prostate Cancer 18
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Treatment of Prostate Cancer 19
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Treatment of Prostate Cancer What’s new? What’s being done at UVM? Low risk Genomic Prostate Score MRI 20
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Treatment of Prostate Cancer What’s new? What’s being done at UVM? Intermediate – High risk Robotic surgery Image guided radiation therapy Shorter courses of radiation therapy 21
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Treatment of Prostate Cancer 22 Radiosurgery (5 Treatments) Shorter Radiation (28 Treatments) Intermediate-Risk Prostate Cancer Clinical Trials
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Treatment of Prostate Cancer What’s new? What’s being done at UVM? Metastatic Hormone therapy: Lupron, Abiretarone, Enzalutamide Chemotherapy: Docetaxel, Cabazitaxel Vaccine: Sipuleucel-T Radium 223 Emerging: PARP Inhibitors, Immunotherapy 23
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Treatment of Prostate Cancer What’s new? What’s being done at UVM? Metastatic 24 Advanced imaging: Axumin Scan Radiosurgery
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Treatment of Prostate Cancer What if prostate cancer recurs after treatment? Where did it recur? In the “prostate bed” after surgery? Radiation therapy In the prostate after radiation therapy? Cryoablation, surgery, brachytherapy 25
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Treatment of Prostate Cancer What if prostate cancer recurs after treatment? Where did it recur? In the lymph nodes after surgery or radiation therapy? Surgery or radiation therapy +/- hormone therapy In the bones or elsewhere in the body Hormone/systemic therapies +/- radiation therapy 26
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Outline PSA Screening Treatment of Prostate Cancer Survivorship 27
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Survivorship 28
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Survivorship Health promotion Maintain a healthy weight by limiting consumption of high-calorie foods and beverages and promoting increased physical activity Diet rich in fruits vegetables and whole grains and low in saturated fat Calcium / Vitamin D Referral to dietitian for nutrition-related challenges (e.g, bowel problems that affect nutrient absorption) Limit alcohol consumption Avoid tobacco products 29
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Survivorship Surveillance for recurrence PSA every 6 to 12 months Yearly digital rectal exam 30
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Survivorship Screen for second cancers Follow screening guidelines Prostate cancer survivors who have undergone radiation therapy may have slightly higher risk of bladder and colorectal cancers 31
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Survivorship Bowel dysfunction Discuss and manage bowel function and symptoms (e.g, rectal bleeding) 32
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Survivorship Heart disease and diabetes Screening for heart disease risk factors, blood pressure monitoring, cholesterol, and glucose 33
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Survivorship Distress, Depression, and PSA Anxiety Assess for distress, depression, and anxiety over PSA tests Referrals for counselors when appropriate 34
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Survivorship Fracture risk, Osteoporosis Calculate a fracture risk score and prescribe osteoporosis treatment if risk is high 35
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Survivorship Sexual dysfunction and body image Discuss sexual function, monitor erectile dysfunction over time Refer patients with persistent sexual dysfunction to a urologist, sexual health specialist, or psychotherapist to review treatment and counseling options. 36
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Survivorship Urinary dysfunction Discuss urinary function (e.g, urinary stream, difficulty emptying the bladder) and incontinence Prescribe medications and refer for physical therapy / kegel exercises 37
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Survivorship Vasomotor symptoms (“hot flashes”) Consider medications for symptomatic patients 38
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Survivorship Survivorship at UVM 3 month survivorship visit, with detailed paperwork on: Care team, including primary care, urology, radiation oncology, medical oncology Diagnosis and treatment details (pathology, staging, dates, dose) Genetic assessment / referral Detailed list of potential late side effects Follow up plan 39
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Questions?