Urology>>>>>Prostate Cancer
Question 9#

Which of the following is CORRECT regarding men with localised prostate cancer treated with radiotherapy?

a. Dose escalation from 70–80 Gy does not affect biochemical survival at 5 years
b. Prophylactic lymph node irradiation improves cancer specific survival in highrisk patients
c. There is no subsequent increased risk of developing bladder cancer
d. Recurrence is defined as a rise in PSA of >1 ng/mL above a PSA nadir
e. In men with Gleason 8–10 disease the use of neoadjuvant and 2 years adjuvant androgen deprivation therapy has a significant effect on 10-year overall mortality

Correct Answer is E

Comment:

Answer E

The RTOG 9292 study reported significant improvement in local control, the development of metastases and disease-free survival in patients receiving long-term ADT and overall survival in men with GS 8–10 disease. Numerous studies demonstrate the benefit of dose escalation, there is no good evidence that pelvic irradiation is of benefit in N0 disease. Radiotherapy does increase the risk of bladder cancer by 2.3x and rectal cancer by 1.7x. The Phoenix Consensus Conference definition of PSA failure (with an accuracy of >80% for clinical failure) is any PSA increase >2 ng/mL higher than the PSA nadir value, regardless of the serum concentration of the nadir.