PROSTATE CANCER: RADIATION APPROACHES for advanced disease ANDREW L. SALNER, MD FACR DIRECTOR HELEN & HARRY GRAY CANCER CENTER HARTFORD HOSPITAL, CT

ARS ? ??

Advanced Disease Biochemical recurrence after prostatectomy Metastatic disease Palliative external RT Quadramet

Salvage Radiation Therapy for Biochemical Recurrence Recurrence>2years, PSA DT>10 months Positive margin, extracapsular extension Should be used early, PSA<1(possibly 0.5) 50-70% DFS in 5 years IMRT 60-70 Gy, image guidance daily acceptable early complications, rare late complications

Choo, R-Mayo Clinic 2009 IJROBP

Bone Metastasis Pain/loss of function One dominant site Multiple sites Spinal cord compression>emergency Hip metastasis causes pain, threatens fracture One dominant site Multiple sites

Spine radiation to osteoblastic lesion

Palliative Radiation Bone Metastasis Highly effective 90% or more for pain relief Can be repeated Short course of 2 weeks, occasionally even given in single dose, depending on location Can be combined with chemo, hormone deprivation, bone stabilization such as vertebroplasty or fusion if needed

Quadramet(samarium 153) Bone seeking radioisotope Systemic dose to “hot” areas Can combine with external May lower blood counts May cause “flare” Can last 3-6 months Can be repeated 60-75% response rate Best for patients with multiple or migratory painful sites

Advanced prostate cancer Team approach with urologist, medical and radiation oncologist Systemic therapies and local therapies Focus on disease control and quality of life Individually tailored THANK YOU!

Advanced Stage Disease Session Evaluation ? ??