1 1

punto di vista dell’urologo Ospedale “San Giovanni Bosco” Categorie di rischio: punto di vista dell’urologo Alessandro Giacobbe Ospedale “San Giovanni Bosco” S.C. Urologia Torino 2 2

“Advanced” PCa

Treatment Options Surgery RT Cryo/Other Multimodal Approach

Treatment Options Surgery RT Cryo/Other Multimodal Approach

Non tutti i t3 c sono alto rischio

10-yr PCSM >80% Non tutti gli alti rischi sono uguali…..

15-yr Radical Prostatectomy Cancer Specific Mortality Gleason score≤6 15-yr Cancer specific Survival ≥99% Gleason score 7(3+4) 15-yr Cancer specific Survival 98% Gleason score 7(4+3) 15-yr Cancer specific Survival 94% Gleason score 8-10 15-yr Cancer specific Survival 65%

15-yr Radical Prostatectomy Cancer Specific Mortality Gleason score≤6 15-yr Cancer specific Survival ≥99% Gleason score 7(3+4) 15-yr Cancer specific Survival 98% Gleason score 7(4+3) 15-yr Cancer specific Survival 94% K prostata hann molto bassa mortatlita mentre questo e un tumore vero attenione duvers Gleason score 8-10 15-yr Cancer specific Survival 65%

Locally Advanced CaP 5 Yr 10 Yr 15 Yr BPFS 45-62% 43-51% 38-49% CSS 90-99% 85-92% 62-84% OS 90-96% 76-77% Gerber, G.S., et al.. Eur Urol, 1997. 32: 385 Hsu, C.Y., et al. Eur Urol, 2007. 51: 121 Joniau, S., et al. Eur Urol, 2015. 67: 319 Xylinas, E., et al. BJU Int, 2009. 103: 1173

Locally Advanced CaP 5 Yr 10 Yr 15 Yr BPFS 45-62% 43-51% 38-49% CSS 90-99% 85-92% 62-84% OS 90-96% 76-77% Gerber, G.S., et al.. Eur Urol, 1997. 32: 385 Hsu, C.Y., et al. Eur Urol, 2007. 51: 121 Joniau, S., et al. Eur Urol, 2015. 67: 319 Xylinas, E., et al. BJU Int, 2009. 103: 1173

Locally Advanced CaP 5 Yr 10 Yr 15 Yr BPFS 45-62% 43-51% 38-49% CSS 90-99% 85-92% 62-84% OS 90-96% 76-77% Gerber, G.S., et al.. Eur Urol, 1997. 32: 385 Hsu, C.Y., et al. Eur Urol, 2007. 51: 121 Joniau, S., et al. Eur Urol, 2015. 67: 319 Xylinas, E., et al. BJU Int, 2009. 103: 1173

Treatment Options Surgery RT Cryo/Other Multimodal Approach

2.5 fold increased risk of metastasis

Treatment Options Surgery RT Cryo/Other Multimodal Approach

Treatment Options Surgery RT Cryo/Other Multimodal Approach

Adjuvant RT recommended for pT3 pts

Our Clinical Practice Age <70, Gleason ≤ 6, PSA < 10 Nerve sparing prostatectomy Active Surveillance (1-2 pos core/12 or more) Gleason score 7 or PSA >10 Age <70 Rad Prostatectomy and PLND Age >70 Radiotherapy Gleason score ≥8 Surgery + Radiotherapy + ADT (intermittent)