1. 1 1

2. 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

3. “Advanced” PCa

4. Treatment Options
Surgery RT
Cryo/Other
Multimodal Approach

5. Treatment Options
Surgery RT
Cryo/Other
Multimodal Approach

6. Non tutti i t3 c sono alto rischio

8. 10-yr PCSM >80%
Non tutti gli alti rischi sono uguali…..

10. 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%

11. 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%

12. 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, : 385
Hsu, C.Y., et al. Eur Urol, : 121
Joniau, S., et al. Eur Urol, : 319
Xylinas, E., et al. BJU Int, : 1173

13. 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, : 385
Hsu, C.Y., et al. Eur Urol, : 121
Joniau, S., et al. Eur Urol, : 319
Xylinas, E., et al. BJU Int, : 1173

14. 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, : 385
Hsu, C.Y., et al. Eur Urol, : 121
Joniau, S., et al. Eur Urol, : 319
Xylinas, E., et al. BJU Int, : 1173

15. Treatment Options
Surgery RT
Cryo/Other
Multimodal Approach

16. 2.5 fold increased risk of metastasis

17. Treatment Options
Surgery RT
Cryo/Other
Multimodal Approach

19. Treatment Options
Surgery RT
Cryo/Other
Multimodal Approach

20. Adjuvant RT recommended for pT3 pts

21. 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)