The definition and clinical application of extraprostatic involvement and positive surgical margin

Explore Xintiandi---MDT Selection Explore Xintiandi is sponsored by the Beijing Medical Award Foundation, guided by the Chinese Anti-Cancer Association Urology and Andrology Reproductive Tumor Committee, and fully supported by Yimaitong
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It aims to promote the communication and interaction of doctors in the field of urinary oncology-MDT resource sharing, academic cutting-edge broadcasts, and improvement of clinical diagnosis and treatment
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Click to watch the highlights of the MDT highlights
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Special report (1): The application of mCRPC first-line NHT treatment + radical prostatectomy (RP) in patients with oligometastatic CRPC, Professor Mo Chengqiang from the First Affiliated Hospital of Sun Yat-sen University, mainly reported four aspects Contents: 1.
The treatment of metastatic castration-resistant prostate cancer (mCRPC) is lined up, and the first-line plan is very important; 2 From clinical trials to real-world studies (RWE), enzalutamide is the first-line treatment of mCRPC before chemotherapy ; 3 There are poor prognostic factors for mCRPC patients before chemotherapy, enzalutamide benefits better; 4 radical prostatectomy (RP) in patients with oligometastatic mCRPC
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Professor Mo said that in the process of mCRPC treatment, first-line treatment is very critical
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Enzalutamide has become a first-line treatment option with considerable efficacy; in addition, in the subgroup analysis of enzalutamide, such as high Gleason score and high baseline PSA level, the benefit is better than abiraterone
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Professor Mo also summarized the application of RP in mCRPC patients.
He put forward the following points: ◆McRPC patients who have undergone rigorous screening and can benefit from short-term clinical follow-up of prostate lesion resection + other comprehensive treatment methods Use RP therapy (but the long-term effect still needs data support); ◆Due to the difficulty of the operation, it is necessary to pay attention to the timing of RP surgery, try to avoid/reduce the occurrence of perioperative complications, and improve the safety of the operation; ◆Before surgery Should fully communicate with patients
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Case sharing and discussion Professor Pi Zhuo from the Cancer Hospital of Xinjiang Medical University shared with us a typical case of prostate cancer.
Multidisciplinary experts put forward suggestions on the follow-up treatment plan of this case and discussed common clinical problems
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The patient is 67 years old
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Main complaint: Prostate cancer endocrine for more than 3 months, back pain for 1 month
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◆ Whole body bone imaging: multiple signs of bone metastasis ◆ Pathological puncture: prostate cancer, Gleason score 5+4=9 points Diagnosis: prostate cancer treatment experience: 1.
Surgery + androgen deprivation treatment (ADT) in an outside hospital in June 2019
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2.
In October 2019, docetaxel chemotherapy was given due to bone metastasis
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3.
In February 2020, due to neuroendocrine changes, docetaxel + carboplatin chemotherapy was given
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4.
In August 2020, the patient developed diarrhea and a mass in the scapular area
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For similar prostate cancer patients whose general condition is already very poor, how should follow-up treatment options be selected? Experts express their opinions
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Professor Wang Daohu said that chemotherapy drugs would be better than endocrine therapy
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For follow-up treatment, PARP inhibitors, radium-223 or immunotherapy can be considered
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Once effective, the patient hopes to get complete relief
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Special report (2): External prostate involvement & positive surgical margin Professor Liu Dawei from the First Affiliated Hospital of Sun Yat-sen University said that external prostate involvement and positive surgical margin are some of the elements within the definition that are very closely related to the prognosis, so in pathology This is best reflected in the report, which is very helpful for statistics
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In addition, when encountering complex, difficult and rare pathological conditions, it is necessary to explain some detailed etiological factors clearly in the surgical MDT team, so that surgeons, physicians, oncologists, and radiotherapy doctors can grasp these indicators, and then make The treatment plan can have more references and be more accurate when analyzing the prognosis
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In the special report, what is the definition of extra-prostatic involvement & positive surgical margin? How to apply? In the case discussion, for prostate cancer patients with very poor general conditions, how should the follow-up treatment options be selected? Click "Read the original text" below to watch the wonderful special report and MDT discussion
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Click "Read the original text" below to watch the full wonderful special report and MDT discussion