Timo Joensuu
Docrates Cancer Center, Finland
Title: Multimodality approach in the treatment of metastatic prostate cancer
Biography
Biography: Timo Joensuu
Abstract
Androgen deprivation has been the only treatment recommended by guidelines for metastatic prostate cancer. The radiotherapy and radiopharmaceuticals like Samarium are used mainly as pain killers. Hormonal therapies are well established but the problem is that castration resistant disease eventually emerges and then our patients are expected to survive about two years. Our personalized clinical practice has been to combine different treatment modalities in primarily metastatic prostate cancer in order to decrease the number of cancer cells as low as possible. Diagnostic procedures we start with ermp MRI of the prostate which will be done in most cases already before biopsies, followed by NaF-PET-CT and/or choline-/PSMA-PET-CT. First goal is to get PSA down (<1). All men receive mamillar irradiation with 12Gy, 6/9 Me-V. We combine LHRH analogs or Degarelix with bicalutamide plus zoledronic acid or denosumab and if it appears that we do not reach our first target we combine Docetaxel and most recently we have included also abiraterone/enzalutamide to the systemic therapy per need. Immediately, when our goal has been achieved we start radical VMAT radiotherapy of the prostate. We fuse all of our primary scanning with dose planning-CT and try to irradiate also bone metastases including also the lymph nodes to the target volumes. In addition some patients have received samarium intensified by mitoxantrone. The good feasibility of this multimodality approach and follow up-results will be presented.
