14. Radiologic assessment Bone scan? Yes : high risk of bone metastases CT scan of the abdomen/pelvis? Yes : Lymph nodes MRI of the prostate? To be discussed if changes treatment decision
28. SPCG-7— Endocrine Therapy Alone Versus Endocrine Therapy Plus Radiotherapy HR: 0.44 (0.3 – 0.6) P < .001 HR: 0.68 (0.5 – 0.9) P < .001 Widmark et al. Lancet 2009; 373: 274-6 Death from prostate cancer Overall mortality
29. NCIC CTG PR.3/ MRC PR07/ SWOG JPR3: OS Warde ASCO 2010 320 Deaths, 175 ADT alone, 145 RT+ADT HR=0.77 (95% C.I. 0.61-0.98) P=0.0331 # at Risk ADT ADT+RT ADT ADT+RT Percentage 0 20 40 60 80 100 0 3 6 9 602 603 509 512 Time (Years) 213 232 51 60 7 yr OS 74% 7 yr OS 66%
40. High risk prostate cancer GETUG 12 trial ADT (3 years) + RXT Docetaxel + Estramustine (4 cycles) RANDOMI ZE Primary endpoint: Progression-free survival n = 413/400 pts Stratification - Gleason 8 - PSA>20 - T3 - pN+ / pN- ADT (3 years) + RXT
41. Phase III trials of Docetaxel in localized prostate cancer Ongoing 636 RP Montgomery (USA) VA # 553 CAP Early enrolment termination 228 /1700 RP M. Eisenberger (USA) TAX 3501 Accrual completed 600 XRT H. Sandler (USA) RTOG 0521 Ongoing 396 RP Ahlgren (Sweden) AdPro Accrual completed 413 / 400 XRT K. Fizazi (France) GETUG 12 Ongoing 350 XRT A. D’Amico (USA) DOCET-L-02357 Ongoing 750 RP Eastham (USA) CALGB 90203 Ongoing 924 XRT Kellokumpu-Lehtinen (Fin) AdRad Status # patients ( enrolled /planned) Local treatment PI Study name
42. Mr Leo tolerated well his treatment… … but he’s getting upset … with treatment-induced erectile dysfunction … and his wife as well. Coming back to our patient