Presentations and CPD questions from a BAUS satellite symposium sponsored by Takeda 'Unanswered questions in the management of high-risk prostate cancer' held on 22 June in Liverpool.

CPD Questions

Complete a series of questions relating to the presentations here. You can download a certificate on successful completion of the test.

Select the correct answer (or answers) to the following statements (there may be more than one correct response to each question).

(Dr Chris Parker)

What proportion of men with locally advanced prostate cancer, managed by hormones alone, will die from prostate cancer within 10 years?

Which treatments have been proven to improve overall survival in locally advanced prostate cancer?

Only surgery
Only radiotherapy
Only hormones
Only radiotherapy and hormones
All three treatments

In men with locally advanced disease, what proportion of deaths from prostate cancer is prevented by the addition of radiotherapy to hormones?

In men with locally advanced disease, what proportion of deaths from prostate cancer is prevented by immediate rather than deferred hormones?

(Professor Howard Kynaston)

What are the most important outcome measures when considering treatment for high-risk localised prostate cancer?

PSA changes
Cancer-specific survival
Local control
Metastases-free survival
Adverse pT category after radical prostatectomy

Name one of the most frequently used risk stratification criteria in localisedprostate cancer

RTOG
MRC
D'Amico
Briganti
Da Vinci

What proportion of patients with clinically organ-confined prostate cancer is upstaged after radical prostatectomy?

Which trial demonstrates an improvement in overall survival with adjuvant radiotherapy after radical prostatectomy in high-risk prostate cancer?

EORTC 30041
SWOG 8794
SPCG-7
SWOG S9921
EORTC 22961

What is the current open NCRI prostate cancer trial examining the role of adjuvant versus salvage radiotherapy in high-risk prostate cancer?

PATCH Trial
STAMPEDE
ProtecT
EORTC 30041
RADICALS

(Dr Amit Bahl)

According to D'Amico classification what is the PSA failure rate for high-risk prostate cancer at five years after radical radiotherapy?

<10%
10-25%
26-50%
>50%

All of the following categories high-risk prostate cancer as per the NICE guidelines except

Gleason 8-10
PSA>20
T3/T4
>50% cores involved

Which of the following represents ADJUVANT radiotherapy after radical prostatectomy

Radiotherapy subsequent to radical prostatectomy when the postoperative PSA is undetectable
Radiotherapy subsequent to radical prostatectomy when the postoperative PSA is >0.4
Radiotherapy subsequent to radical prostatectomy after three consecutive rises of PSA but the PSA is still below 1.0
Radiotherapy subsequent to radical prostatectomy after three consecutive rises of PSA and the PSA is above 1.0

Treatment of choice in T3bN0M0 prostate cancer based on current evidence is

Neoadjuvant hormone therapy followed by radical radiotherapy (with or without high-dose-rate boost) and up to three years of adjuvant hormone therapy
Radical prostatectomy
Cryotherapy
High-intensity focused ultrasound

Based on current evidence and guidelines all of the following are considered appropriate management options in high-risk prostate cancer except

Hormone therapy and radiotherapy
Radical prostatectomy with the possibility of subsequent radiotherapy
Watchful waiting
Low-dose-rate brachytherapy

(Professor Malcolm Mason)

For patients with 1-2 pathologically involved lymph nodes following radicalprostatectomy:

The majority develop metastases within 10 years
Randomised trials have demonstrated the benefits of adjuvant radiotherapy
A significant proportion will survive for 10 years
Further staging investigations are mandatory
Retrospective studies support the addition of radiotherapy to adjuvant hormone therapy

Patients receiving radiotherapy to the prostate:

Should have surgical lymph node staging before referral
Are unsuitable for whole pelvis radiotherapy if they have a risk of lymph node involvement of >15%
Should be warned of a substantial risk of long-term complications if the whole pelvis is irradiated
Should be treated with intensity-modulated radiotherapy (IMRT)
May achieve long-term disease control even if they are in a high-risk category
None of the above

The first randomised trial of radiotherapy to prostate only or to prostate plus pelvic nodes (RTOG 77-06):

Included patients in a good risk group
Showed no evidence of benefit to pelvic radiotherapy
Used lower doses of radiotherapy than would be used today
Was conducted in the pre-PSA era
Used comparable planning techniques to those used today

The RTOG 94-13 trial comparing whole pelvic and prostate-only radiotherapy:

Was a 2x2 factorial design also comparing neoadjuvant/concomitant with adjuvant hormone therapy
Was powered to detect differences between the four arms of the study
Indicated that whole pelvic radiotherapy was superior to prostate only radiotherapy
Did not answer the question as to whether whole pelvic radiotherapy was beneficial
Had the advantage that it employed IMRT

In relation to high-risk prostate cancer, the following are true:

Data from a matched pair analysis suggest that adjuvant radiotherapy might be beneficial for patients who are pathologically node positive
Data from randomised trials of adjuvant radiotherapy suggest that adjuvant radiotherapy might be beneficial for patients who are pathologically node positive
Future randomised trials of IMRT to pelvic lymph nodes are already in designbr/>
IMRT will not permit delivery of higher doses of radiation to pelvic nodes compared with conformal radiotherapy
A randomised trial comparing surgery and radiotherapy would be desirable

CPD REVIEWS: Unanswered questions in the management of high-risk prostate cancer

December 2011 PS110828d

Date added to bjui.org: 07/02/2012 (publication information)

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