Bladder Cancer and Prostatic Cancer CA PROSTAE AND BLDDER Bladder Cancer and Prostatic Cancer

Each cancer will be discussed by three specialists -Surgeon -Radiation Oncologist -Medical Oncologist Followed by Question

Definite Radiotherapy for Prostate Cancer Localize early prostate cancer - Very low Risk with life expectancy > 20 years ( Age < 62 ) - Low Risk with life expectancy > 10 years ( Age < 77 ) Locally advance prostate cancer - Intermediate / high risk / very high risk ( Including pelvic LN metastatic without distant metastasis ) Radiotherapy with LHRH agonist

Adjuvant / Salvage Radiotherapy after Radical Prostatectomy Extra-capsular Extension / Positive margins / Extension to seminal vesicle or Post-operative case with PSA > 0.2 ng/ml or มีการเพิ่มของ PSA หลังการผ่าตัดอย่างต่อเนื่องและมีนัยสำคัญ

Palliative Radiotherapy in Prostate Cancer For Pain, Bleeding, Bone mets, Brain Mets, Spinal cord compression, etc. for Advance or Metastases Disease

High Dose Rate Radiotherapy In Intermediate and High risk group as Booster dose to External Radiotherapy As monotherapy instead of low dose rate radiotherapy in low risk or selected intermediate risk group In recurrent tumor after radiotherapy

Hormonal treatment in combination with Radiotherapy LHRH Agonist not more than Two cycles: In Intermediate risk prostate cancer stage cT2B and cT2C and/or Gleason score 7 and/or PSA 10-20 ng/ml LHRH agonist not more than Eight cycles: In High risk group stage cT3A and/or Gleason score 7-10 and/or PSA >20 ng/ma, or In Very high risk group stage cT3B and cT4

Bladder Preservation Therapy ( Maximal TURBT followed by Concurrent Chemo-Radiotherapy ) Indication Clinical stage T2-4, N any, M0 Single lesion No hydro-nephrosis is preferred Tumor size < 5.0 cm is preferred No extensive TIS

Primary Radiotherapy for Bladder Cancer in muscle invasive pT3-4 or pN+ In case of very Old age and Medical contraindication May consider Concurrent Chemo-Radiotherapy or Radiotherapy alone depending on the patient status

Adjuvant Radiotherapy after Cystectomy In patient who can not tolerate chemotherapy after partial or total cystectomy May consider in Positive margin or pT3-4 tumor or N +ve or high grade

Palliative Radiotherapy For Pain, Bleeding, Bone mets, Brain Mets, Spinal cord compression, etc. for Advance or Metastases Disease