Radiotherapy for Prostate cancer

Radiation oncologist Lasha Goginashvili

 Anatomy

https://www.saintlukeskc.org/health-library/prostate-anatomy; https://radiopaedia.org/cases/prostate-anatomy
 Statistics

https://novosanis.com/infographics/5-facts-about-prostate-cancer
 Statistics

https://www.uicc.org/news/globocan-2020-new-global-cancer-data
 Risk factors

Perez and Brady`s Principles and Practice of Radiation Oncology) 7th Edition. pg 4872
 Screening
Age >50

• DRE - Digital Rectal Examination

• PSA - Prostate-Specific Antigen

 Imaging
Local Spread

• Rectal Ultrasonography • CT

• MRI • Bone scintigraphy

• PSMA - Ga68 - PET/CT

 Staging

TNM

Tumor Node Metastasis

 Staging

Clinical staging - is an estimate of the extent of the cancer based on results

of physical exams, imaging tests

Pathological staging - is based on histological examination of tissue

specimens obtained with the aid of biopsy or surgery. It combines the results of
both the clinical staging with the surgical results.
 Staging

American Joint Committee on Cáncer •2017 pg 692 - 696

 Staging

American Joint Committee on Cáncer •2017 pg 6092 - 696

 Staging

American Joint Committee on Cáncer •2017 pg 6092 - 696

 Staging

American Joint Committee on Cáncer •2017 pg 6092 - 696

American Joint Committee on Cáncer •2017 pg 6092 - 696
 Staging
High Risk

Intermediate Risk

Low Risk
 Staging

https://www.researchgate.net/publication/363058076_Prostate_Cancer_Risk_Factors_and_Outcome_Indicators/figures?lo=1&utm_source=google&utm_medium=organic
 Staging

ersion 4.2023, 09/07/23 © 2023 National Comprehensive Cancer Network® (NCCN®), All rights reserved. NCCN Guidelines® and this illustration may not be reproduced in any form without the express written permission of NCCN
 Monotherapy
Favorable
Low Risk Intermediate Risk

o cT1-2a, PSA - 10 -20 ng/ml,

o cT1/cT2a, PSA
G`s 6 (3+3);
≤ 10 ng/ml;
o cT1-2a, PSA < 10 ng/ml,
G`s ≤ 6 (3+3) G`s 7 (3+4);
 Combination
High Risk
Unfavorable
Intermediate Risk
 cT3, PSA > 20 ng/ml, G`s ≥ 8
o cT2b, PSA < 10 ng/ml, G`s
7 (3+4);

o cT1 - 2c, PSA - 10 -20

ng/ml, G`s 7 (3+4);

o cT1 - 2c, PSA - 10 -20

ng/ml, G`s 7 (4+3);
 Treatment

• Surgery

• Systemic therapy

• Radiation therapy

Combination
 Treatment

Surgery

• Radical Prostatectomy + pelvis lymphodisection

 Treatment
Radiotherapy

• Radical

• Post-operative
 Treatment
Radiotherapy

• EBRT

• Brachytherapy

• EBRT + Brachytherapy ADT

Simulation
Conturing

source : National Centre of surgery

Conturing

source : National Centre of surgery

Planning

source : National Centre of surgery

Planning

source : National Centre of surgery

 Brachytherapy

Brachytherapy is radiation treatment that is given directly into

your body. It is placed in to the tumor or as close to the cancer
as possible. The radiation is given using tiny devices such as
wires, seeds, or rods filled with radioactive materials

29
Brachytherapy

30