Combination Therapy for the Teal Stage of Prostate Cancer | Prostate Cancer Staging Guide

Описание: PCRI’s Executive Director, Mark Scholz, MD, talks about combination therapy as a treatment for men with the Teal stage of prostate cancer. He covers the treatments that constitute combination treatment and describes the situations where it is appropriate to use.

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0:33 Combination therapy for prostate cancer consists of a radioactive seed implant (brachytherapy) a short course of hormone therapy (also known as testosterone inactivating pharmaceuticals, testosterone blockade, and androgen deprivation), and IMRT or similar external beam radiation treatment.

1:05 Combination therapy is for men with High Teal. Men with lower substages of Teal (Low or Basic) are less concerned about cure rates since a monotherapy or even active surveillance can be used to manage the disease successfully. High Teal, on the other hand, requires a more aggressive treatment strategy, and combination therapy shows the best cure rates.

1:35 The radioactive seed implant is the backbone of combination therapy. It delivers up to 2/3rds of the radiation dose. IMRT is given in addition. Especially if the lymph nodes are involved, IMRT is a necessary addition, since it is more difficult to get enough radiation to the pelvic lymph nodes with seeds alone.

2:15 The Yale formula. This formula can show a percentage likelihood that the lymph nodes are involved with prostate cancer. An online calculator can show this percentage based on numbers like Gleason score, PSA, etc. If there is greater than a 15% chance of involvement, IMRT is necessary.

3:04 The hormone therapy aspect of combination therapy. IMRT, when used by itself, shows better results when combined with a short course of hormone therapy. Typically, hormone therapy is started for a few months before radiation is delivered, and continues through the course of radiation. Depending on your results from the Yale formula, it is possible to forego hormone therapy and IMRT. Even if you have High Teal.

4:08 Combination therapy for men with Teal, is only for men with High Teal. For men with High Teal and greater than 15% chance that the pelvic lymph nodes are involved, combination therapy is required. But for men with High Teal and less than a 15% chance of involvement, can consider a seed implant alone without IMRT or TIP. This is a new development that is still being debated by experts. The current standard is combination therapy for everyone with High Teal.

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