PROSTATE CANCER:
RADIATION APPROACHES
for advanced disease
ANDREW L. SALNER, MD FACR
DIRECTOR
HELEN & HARRY GRAY CANCER CENTER
HARTFORD HOSPITAL, CT
ARS
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Advanced Disease
 Biochemical
recurrence after
prostatectomy
 Metastatic disease
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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
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)
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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