Hdl Handle:
http://hdl.handle.net/10147/189981
Title:
Management of localised prostatic adenocarcinoma
Authors:
Rangaswamy, G; Azmi, A.; Ibrahim, N; Thirion, P
Affiliation:
Department of Radiation Oncology, St. Luke's Hospital, Dublin, Ireland.
Citation:
Mangement of localised prostatic adenocarcinoma. 2011, 2 (23):33 Medical Independent
Journal:
Medical Independent
Issue Date:
Nov-2011
URI:
http://hdl.handle.net/10147/189981
Item Type:
Article
Description:
Mr NC is a 76-year-old patient with no significant past medical history referred by his GP with a PSA of 17ng/ml following opportunistic screening. Rectal examination showed an area of firmness in the left lobe of the prostate measuring about 1cm without clinical features of extra-capsular extension. He underwent transrectal prostatic biopsies of his prostate gland which showed prostatic adenocarcinoma with a Gleason Score of 4+4=8 involving three out of six cores taken from the left lobe in 70 per cent of tissue submitted and a Gleason Score of 3+4=7 in four out of six cores in 60 per cent of tissue submitted from the right lobe. A staging bone scan showed no evidence of metastatic disease and a MRI of the pelvis suggested extra-capsular extension on the left side with no seminal vesicle involvement and no pelvic adenopathy. His final diagnosis was prostatic adenocarcinoma Gleason 8 (4+4) T3aN0M0 with a presenting PSA of 17ng/ml, entering the RTOG high risk localised category. Following a discussion at the multidisciplinary conference, the patient was referred to the Radiation Oncology Department at St Luke’s Hospital in Rathgar for further management. In keeping with European Organisation for Research and Treatment of Cancer (EORTC) and Research and Treatment of Cancer (RTOG) guidelines, the patient was prescribed a combination of long-term hormonal therapy for three years and radical radiotherapy. In our institution, patients are treated with pre-radiotherapy induction maximum androgen blockade therapy for two to four months with a view to achieving pre-radiotherapy prostatic gland and tumour shrinkage. The patient was commenced on neoadjuvant maximum androgen blockade therapy using a combination of three-monthly leuprorelin acetate injection and daily bicalutamide orally. The treatment was tolerated well with no significant side effects. An assessment at three months showed a complete clinical and biochemical response with no abnormality detected in his prostate on rectal examination and an undetectable PSA. He subsequently embarked on radiotherapy and completed a course of localised 3D conformal radiotherapy to the prostate and seminal vesicles at a dose of 74 Gray in 37 daily fractions with omission of elective nodal irradiation. Following the completion of his radiotherapy the patient was commenced on adjuvant LH-RH agonist therapy using six-monthly leuprorelin acetate. Presently the patient is still on adjuvant LH-RH therapy and is in complete clinical and biochemical remission 18 months from diagnosis. He continues to tolerate the hormonal therapy well with no significant side effects.
Keywords:
PROSTATE CANCER

Full metadata record

DC FieldValue Language
dc.contributor.authorRangaswamy, Gen
dc.contributor.authorAzmi, A.en
dc.contributor.authorIbrahim, Nen
dc.contributor.authorThirion, Pen
dc.date.accessioned2011-11-18T15:31:43Z-
dc.date.available2011-11-18T15:31:43Z-
dc.date.issued2011-11-
dc.identifier.citationMangement of localised prostatic adenocarcinoma. 2011, 2 (23):33 Medical Independenten
dc.identifier.urihttp://hdl.handle.net/10147/189981-
dc.descriptionMr NC is a 76-year-old patient with no significant past medical history referred by his GP with a PSA of 17ng/ml following opportunistic screening. Rectal examination showed an area of firmness in the left lobe of the prostate measuring about 1cm without clinical features of extra-capsular extension. He underwent transrectal prostatic biopsies of his prostate gland which showed prostatic adenocarcinoma with a Gleason Score of 4+4=8 involving three out of six cores taken from the left lobe in 70 per cent of tissue submitted and a Gleason Score of 3+4=7 in four out of six cores in 60 per cent of tissue submitted from the right lobe. A staging bone scan showed no evidence of metastatic disease and a MRI of the pelvis suggested extra-capsular extension on the left side with no seminal vesicle involvement and no pelvic adenopathy. His final diagnosis was prostatic adenocarcinoma Gleason 8 (4+4) T3aN0M0 with a presenting PSA of 17ng/ml, entering the RTOG high risk localised category. Following a discussion at the multidisciplinary conference, the patient was referred to the Radiation Oncology Department at St Luke’s Hospital in Rathgar for further management. In keeping with European Organisation for Research and Treatment of Cancer (EORTC) and Research and Treatment of Cancer (RTOG) guidelines, the patient was prescribed a combination of long-term hormonal therapy for three years and radical radiotherapy. In our institution, patients are treated with pre-radiotherapy induction maximum androgen blockade therapy for two to four months with a view to achieving pre-radiotherapy prostatic gland and tumour shrinkage. The patient was commenced on neoadjuvant maximum androgen blockade therapy using a combination of three-monthly leuprorelin acetate injection and daily bicalutamide orally. The treatment was tolerated well with no significant side effects. An assessment at three months showed a complete clinical and biochemical response with no abnormality detected in his prostate on rectal examination and an undetectable PSA. He subsequently embarked on radiotherapy and completed a course of localised 3D conformal radiotherapy to the prostate and seminal vesicles at a dose of 74 Gray in 37 daily fractions with omission of elective nodal irradiation. Following the completion of his radiotherapy the patient was commenced on adjuvant LH-RH agonist therapy using six-monthly leuprorelin acetate. Presently the patient is still on adjuvant LH-RH therapy and is in complete clinical and biochemical remission 18 months from diagnosis. He continues to tolerate the hormonal therapy well with no significant side effects.en
dc.subjectPROSTATE CANCERen
dc.titleManagement of localised prostatic adenocarcinomaen
dc.typeArticleen
dc.contributor.departmentDepartment of Radiation Oncology, St. Luke's Hospital, Dublin, Ireland.en
dc.identifier.journalMedical Independenten
dc.description.provinceLeinster-
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