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Prostate Cancer Treatment: What’s Best for You. Daniel P. Petrylak Professor of Medicine Columbia University Medical Center/NY Presbyterian Hospital. When does a patient see a medical oncologist. Local disease: As “unbiased” opinion for local therapy

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Prostate cancer treatment what s best for you

Prostate Cancer Treatment: What’s Best for You

Daniel P. Petrylak

Professor of Medicine

Columbia University Medical Center/NY Presbyterian Hospital


When does a patient see a medical oncologist
When does a patient see a medical oncologist

  • Local disease: As “unbiased” opinion for local therapy

  • High Risk Disease: Add hormone or chemotherapy to decrease risk of relapse

  • Metastatic disease: Initiation of second line hormones, chemotherapy, radiation therapy


High risk cap the options
High-Risk CAP: The Options

  • Surgery

    – Standard RP, wide/extended resection RP

    – Hormone therapy: NHT, AHT

    – ART

    – Chemotherapy: Neoadjuvant, adjuvant

  • RT

    – EBRT with NHT and/or AHT

    – Dose escalation

    – EBRT with chemohormonal therapy

    – Other RT techniques

  • HT alone

  • New therapies

NHT = neoadjuvant hormone therapy; AHT = adjuvant hormone therapy; ART = adjuvant radiotherapy.

Payne, 2009.


Challenges for the implementation of multimodality therapy
Challenges for the Implementation of Multimodality Therapy

  • High risk local therapy

    • Role of chemotherapy not defined

    • Investigational studies require long follow-up due to the natural history of disease

    • By selecting the highest risk patients, reduce the available patient pool

  • Clinical trial accrual has been poor.


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