What’s new in PCA...

1. What’s new in PCA... EAU Guidelines 2010 update Steven Joniau University Hospitals Leuven, Belgium

2. PCA Guideline Panel Axel Heidenreich (Chairman) Urology Germany Joacqim Bellmunt Medical Oncology Spain Michel Bolla Radiation Oncology France Steven Joniau Urology Belgium Theodor van der Kwast Pathology Canada Malcom Mason Radiation Oncology UK Veseled Matveev Urology Russia Nicolas Mottet Urology France Hans Peter Schmid Urology Switzerland Thomas Wiegel Radiation Oncology Germany Francesco Zattoni Urology Italy

3. Screening Schröder et al. New Engl J Med 2009 Andriole et al. New Engl J Med 2009 Risk reduction 27% Numbers needed to screen 1410 Numbers needed to treat 48 No significant difference

4. Screening Risk adapted early detection

5. Active Surveillance • Active Surveillance • close follow-up examinations under strict rules of guidelines • Purpose: Identification & treatment of significant PCA, curative intent • Watchful Waiting • withhold treatment until development of disease-specific symptoms • Purpose: symptom-based therapy, palliative intent

6. Active Surveillance: why? Because it • avoids overtreatment with insignificant or slowly proliferating prostate cancer • avoids unnecessary impairment of quality of life • Is a viable alternative for elderly and co morbid patients who harbour a higher mortality risk from non-cancer specific causes

7. Active Surveillance Inclusion Criteria • PSA ≤ 10 ng/ml • Biopsy Gleason Score ≤ 6 • ≤ 2 positive biopsies • ≤ 50% cancer per biopsy • cT1c – cT2a • Intervention required • Biopsy Gleason Score > 6 • PSA-DT < 3 years • cancer volume  • patient’s preference

8. Adjuvant Radiation Therapy • Bolla et al. • EORTC 22911: 60 Gy vs Wait-and-See • pT3a, pT3b, pTxpR1 independent on postop. PSA • Wiegel et al. • ARO 96-02: 60 Gy vs Wait-and-See • pT3a-bpN0, PSA negative ! • Swanson et al. • SWOG 8794: 60-64 Gy vs Wait-and-See • pT3a, pT3b, pTxpR1 independent on postop. PSA

9. Adjuvant Radiation Therapy EORTC 22911

10. Adjuvant Radiation Therapy ARO/AUO – German Study 72% 54%

11. Adjuvant Radiation Therapy ARO/AUO – German Study pT3aR1 5 year F-up: 25% benefit for progression-free survival

12. Adjuvant Radiation Therapy SWOG 8794 Survellance adj. Radiation

13. Adjuvant Radiation Therapy SWOG 8794

14. Adjuvant Radiation Therapy

15. Intermittend Androgen Deprivation • Cyclic therapy • On-treatment period • Off-treatment period • IHT aims to • Minimise adverse events / improve quality of life (QoL) • Delay progression to hormone resistant Pca • Reduce costs of care

16. Intermittend Androgen Deprivation

17. Intermittend Androgen Deprivation Calais da Silva FEC et al. ; Eur Urol 2009

18. Intermittend Androgen Deprivation EC507: IHT does not affect progression-free survival Tunn U. BJU Int 2007;99(Suppl 1)

19. Intermittend Androgen Deprivation

20. Follow-up: local

21. Follow-up: ADT

22. Follow-up: ADT CAVE: Diabetes mellitus Metabolic Syndrom Cholesterine, Triglyceride Cholesterine/HDL - Ratio Follow-up: cancer specific: PSA, T endocrinologic metabolic cardiovascular