Treatment of Prostatic cancer - Localized , Metastatic ( Castrate , Non-Castrate)

1. Treatment Of Prostatic Cancer
Dr.Jaber Samer

2. TNM CLASSIFICATION

3. T Stage Of Prostate Cancer

4. Localized Prostatic Cancer
1- Radical Prostatectomy
2- Radiation Therapy
 External Beam Radiation
Therapy
 Brachytherapy
3- Active Surveillance

5. Metastatic Disease : Non-
Castrate
The state of noncastrate
metastatic prostate cancer
includes men with metastases
visible on an imaging study and
noncastrate level of testosterone
> 150ng/dl.

6. Metastatic Disease : Non-
Castrate
Medical And Surgical , Surgical
orchiectomy is “gold standard”
but is rarely used due to effective
medical therapy.
Teststerone-Lowering Agent –
GNRH AgonistAntagonist -
Agonist such as Leuprolide
Acetate And Goserelin Acetate.

7. Metastatic Disease : Non-
Castrate
Initially Produce Rise In LH and
FSH , Followed By Down-
Regulation of receptors in the
pituitary gland which effect as
chemical castration.

8. Metastatic Disease : Non-
Castrate
GNRH Antagonists – Degarelix ,
achieve castrate level of
testosterone within 48H ,
without leading to flares as
GNRH Agonist .

9. Metastatic Disease : Non-
Castrate
Anti-Androgen Therapy – Blocks
Ligands Binding to AR Receptor ,
Ex. Flutamide , Bicalutamide ,
nilutamide , Block disease flares
when GNRH agonist therapy are
used (2 – 4 weeks).

10. Metastatic Disease : Non-
Castrate
Intermittent androgen
deprivation therapy (IADT) –
to decrease chance of castrate-
resistance cancer cell.
ON&OFF Approach .

11. Metastatic Disease : CASTRATE
Castration-Resistant Prostate
Cancer (CRPC) , defined as the
disease that progresses despite
androgen suppression by medical
or surgical therapies , where the
measured level of testosterone
are 50ng/ml or lower.

12. Metastatic Disease : CASTRATE
Docetaxel , Cabazitaxel – Taxane
Chemotherapy
Sipuleucel-T – studied in
asymptomatic or minimally
symptomatic men with
metastasis

13. Metastatic Disease : CASTRATE
Abiraterone Acetate And
Enzalutamide – CYP 17 Inh. , high
binding to AR receptor , but
uniquely inhibits nuclear location
and DNA binding of the receptor
complex . Approved to Post
Chemo , An Abiraterone to Pre-
Chemo too.

14. Metastatic Disease : CASTRATE
Alpharadin (Radium-223
Chloride) – alpha emitting bone
seeking radio-isotope , has been
shown to prolong life in patient
with symptoms related to
ossoeous disease (Extensive
bone metastasis without Visceral
Metastasis)

15. Metastatic Disease : CASTRATE
Other Bone trageted agent –
Bisphophonates And Rank-ligand
Inhibitor Denosumab (Superior
to zoledronic acid )

16. Metastatic Disease : CASTRATE
PAIN management And palliation
– Threating or all ready effect
spinal cord or skull base ,
external beam radiation .
Bone Meta. – Alpharadin in
addition to
Abiraterone,docetaxel.