D de Jong, Prostate cancer brachytherapy
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D de Jong, Prostate cancer brachytherapy
- 1. Prostate Cancer Brachytherapy: Effects on Quality of Life & Sexual Function Dennis de Jong, Helen M Conaglen Leanne Tyrie, & John V Conaglen Sexual Health Research Unit Waikato Clinical School, Hamilton
- 4. Stages Treatments T1a Low grade cancer - active surveillance, radiation or prostatectomy T1b Aggressive treatment, radiation or prostatectomy T1c Depends on age, general health, and grade of cancer T2a/b Prostatectomy, radiation, hormone therapy an option for older men T3a/b/c Larger cancers - radiation, surgery, hormone treatment, or a combination of these T4a/b Usually spread beyond the prostate and to the lymph nodes. Treatment depends on health and age, but no known cure
- 5. Stages Treatments T1a Low grade cancer - active surveillance, radiation or prostatectomy T1b Aggressive treatment, radiation or prostatectomy T1c Depends on age, general health, and grade of cancer T2a/b Prostatectomy, radiation, hormone therapy an option for older men T3a/b/c Larger cancers - radiation, surgery, hormone treatment, or a combination of these T4a/b Usually spread beyond the prostate and to the lymph nodes. Treatment depends on health and age, but no known cure
- 13. Study Sample Participants 161 men aged 48-84 years [Mean 66.4 yrs, SD 6.9] Cancer Grades T1c to T3c, with a mode of T3a Gleason Scores Range: 6 to 10 [Mean 7, SD 0.9] PSA Range: 2.2 to 230 [Mean 17.1, SD 21.8] Brachytherapy without ADT 89 men Brachytherapy with ADT 72 men Short-term effects sub-group (0-3 months) 48 men with age, grades, Gleason Scores, & PSA similar to men above
- 17. EORTC-30: However, all NZ levels significantly better than general EORTC norms taken across all treatment options Scale Main Effect Post hoc General QoL Time, p <.05 Sig worse at two years than baseline, p <.05 Physical Function Time, p <.01 Sig worse at two years than baseline, p <.05 Role Function Time, p <.05 Sig worse at two years than baseline, p <.05 Social Function Time, p <.01 Sig worse at mid-point than baseline, p <. 05, and two years than baseline, p <. 001
- 25. Effect of Time & ADT on IIEF-5 Sig effect of time: F(2, 60)=10.888, p =.00009 No effect of ADT, nor interaction.
- 26. IIEF-5 sub-scales over Time
- 27. Short or Long Term Effects? Sig change from baseline to 3 months: t (15) = 2.96, p < .01
Notes de l'éditeur
- The most commonly registered cancer in 2008 was prostate cancer, which accounted for 14 percent of registrations. Equates to 2500 new cases this year Treatments for various stages: Surgery Radiation therapy Androgen deprivation therapy (ADT) Active surveillance High dose rate Brachytherapy in combination with EBRT ( external-beam radiation therapy used for intermediate & high risk Used with and without ADT)
- Low grade, normal except for a few key points. High grade, cells look nothing like original tissue. Adenocarcinoma, cancer made up of cells that surround the gland, epithelial cells
- T describes the cancer itself, with different numbers explaining how large the cancer is. N stands for nodes and tells us if the cancer has spread to the lymph nodes. M tells if the cancer has spread, or become metastatic.
- the cancer has started to grow outside of the gland, but with no spread to bones or lymph nodes. It can be seen growing into the fat that surrounds the prostate, or into the seminal vesicles or even into the base of the bladder.
- Called interstitial radiotherapy, or brachytherapy , these improved methods offer the promise of a quick, minimally invasive treatment option, with good control in men with cancer confined to the prostate. Originally, gold or iodine seeds were placed surgically, but men continued to have problems with the return and spread of cancer. Newer seeds were developed, including iodine, iridium, palladium and more recently cesium . Each of these types of radioactive pellets gives off a calculated amount of radiation. Different seeds give off different levels of radiation Need to make the point that the radiation that we are looking at deals with effects of both beam and brachytherapy radiation Most often they are inserted through the skin of the perineum, just under the scrotum and in front of the anus. Because this procedure would otherwise be painful, it is done under anesthesia. This could be either general anesthesia where you are put to sleep, or a spinal or epidural anesthesia where just the area below the waist is anesthetized. Each seed is carefully placed in a predetermined location and depth as follows: A specially designed plastic template steers the preloaded needles into correct position. The position is confirmed with rectal ultrasound that is used to monitor the seed placement. The radioactive seeds are then inserted through these needles. external-beam radiation therapy (EBRT)? This is the term for a specific radiation technique used to treat many types of cancers in the body. Beams of high-energy radiation are focused from outside the body (hence external-beam ) onto the target area. 3-D conformal and IMRT (intensity modulated radiation therapy) therapy
- When the hormone is eliminated from the body, the cancer generally stops growing and may actually go into a dormant phase, like going into hibernation.
- QoL stuff: Note, possibly due to cancer as well as treatment Bowel symptoms might include irritation and blood in stools Likely that the QoL falls are down to IPSS, IIEF and other issues related to cancer.
- Cesaretti, says that EF probably has also got to do with age as well as the prostate cancer
- high dose rate brachytherapy
- Cancer occupying one side and growing outside of the capsule, Fibrous outer lining of the prostate.
- C30-Quality of life, measure designed to look at QoL in general for those suffering from cancer. QoL, PF, RF, SF, PA etc IPSS-Looks specifically at urinary function - 7 Questions, incomplete emptying, frequency, intermittency, urgency, weak stream, straining, nocturia PR25-Prostate cancer module. Looks at measures directly related to prostate cancer and its treatment. Urinary, incontinence, Bowel related, Treatment related, and sexual function Looks at androgen deprivation, in this case, looked to see whether hormone therapy interacted with the measures above EORTC stands for European Organisation for Research and Treatment of Cancer The IIEF is the International Index of Erectile Function, a 15 item scale, but we used the short form or IIEF-5 for this study.
- These results will be spoken about when they appear to show a trend that actually started prior to the 6-18 month period. As groups were different, a t-test was done at baseline to test for comparability.
- AGE GROUP INTERACTIONS NOT SIGNIFICANT WHEN EXAMINED FURTHER Of 83% with symptoms at baseline, 49% mild, 23% moderate and 1% severe. At 6-18 months, 37% mild, 28% moderate, 2% severe. At 22-27 months, 30% mild, 16% moderate, 3% severe. Here is the IPSS scoring guide. 0-7 Mildly symptomatic; 8-19 moderately symptomatic; 20-35 severely symptomatic
- Tells a nice overall story Also a short term effect going on here. In short term [1] young men sig worse at 3/12 than baseline [2] mid men sig worse at 3/12 than the young men at baseline [3] mid men sig worse at 3/12 than baseline
- Bowel 74.52% with no symptoms, 44.35% at 6-18 months and 57.14% at 22-27 months
- Treatment is based on issues surrounding side effects, a lot to do with maleness (e.g. Enlarged breasts or soreness etc) Also a short term effect happening:
- Note also a significant fall here. And a short term effect happening also 4.08% functioning at 100% this fell to 0% from baseline
- Again, a significant fall in these symptoms early on after treatment 16% reported 100% sexual function, fell to 0% at 22-27 months
- All these findings are regardless of percentage affected.
- All these findings are regardless of percentage affected.