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Prostatacancer Hvad nyt sker der? Referat fra EAU Milano d. 15-19. marts 2013

Prostatacancer Hvad nyt sker der? Referat fra EAU Milano d. 15-19. marts 2013. Overlæge Johan Poulsen Urologisk Afdeling, Aalborg Sygehus King’s College Hospital, London. Prostatacancer . Screening Diagnostik Intenderet kurativ behandling

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Prostatacancer Hvad nyt sker der? Referat fra EAU Milano d. 15-19. marts 2013

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  1. ProstatacancerHvad nyt sker der?Referat fra EAU Milano d. 15-19. marts 2013 Overlæge Johan Poulsen Urologisk Afdeling, Aalborg Sygehus King’s College Hospital, London

  2. Prostatacancer • Screening • Diagnostik • Intenderet kurativ behandling • Symptomatisk behandling ved hormonfølsom dissemineret prostatacancer • Behandling med CRPC

  3. Diagnostik af prostatacancer • PSA • TRUSP + B • Multiparametrisk MR-skanning + targeted biopsier

  4. Intenderet kurativ behandling • Lokaliseret PC: • lavrisiko sygdom • intermediær risiko • højrisiko

  5. Behandling for prostatacancer • Watchful waiting, active surveillance • Operativ behandling • Strålebehandling • Brachy terapi

  6. Operativ behandling for PC • Åben prostatektomi • Robotassisteret laparoskopisk prostatektomi • smerter, blødning, rekonvalescens • potens radikalitet • operationsresultat afhænger af, hvor syg patienten er (hvilke type indgreb det er forsvarligt at udføre) • flere T3ere/T4ere opereres, også med dissimineret sygdom

  7. Strålebehandling versus operation for PC • 45.000 svenske mænd behandlet for PC. • Endpoint: Mortalitet pga. PC: • Dødelighed x 2 ved strålebehandling • lav risiko • intermediær risiko • høj risiko • Dødelighed x 1,7 ved strålebehandling • høj-høj risiko (PSA>50) Kilde: Peter Wirklund, Karolinska i Stockholm

  8. Endogenreceptor antagonisterMedicinsk/kirurgisk kastration • Bicalutamid • LHRA agonister (Eligaard) • LHRA antagonister (Degarelix) • Evt. behandling – bisphosphonater eller Denosumab

  9. Behandling af CRPC • Doxacetel • Cabazilaxel • Abariterone • Zoledronsyre • Denosumab • MDV 3100 (enzalutamid) • Provenge (lipoleucel) • Prostvac - VF • Radium 223

  10. Castration resistant PC • The present • Chemotherapy • Hormone therapy • Zolodronic acid • Denusomab • The future • New hormonal agents • Immunotherapy • Targeted therapy • New combinations

  11. Doxacetel (taxotere)

  12. EAU Guidelines 2011 • Symptomatic patient should be offered Docetaxel chemotherapy 75 mg/m2 three weekly in combination with 2x5mg Prednisolon (Grade B recommendation)

  13. EAU Guidelines 2011 Asymptomatic patient can be offered chemotherapy if • PSA DT is low (< 3 months) • imaging shows progression of measurable lesions • the patients want treatment

  14. Docetaxel monotherapyTax 327: Overall survival Berthold DR et al. J Clin Oncol 2008;26:242-245

  15. Cabazitaxel

  16. Second line chemotherapy

  17. AbirateroneKan gives efter kemoterapi med Doxacetel. Kan også gives før kemoterapi

  18. Second line ”hormone therapy

  19. COU-AA-301: Abiraterone AcetateOverall survival

  20. DenosumabvsZoledronsyre

  21. CRPC Pipeline • Hormone therapy: • Abiraterone • MDV3100 (enzalutamid) • Cytotoxics: • Cabazitaxel • Epothilones • Targeting angiogenesis: • VEGF-Trap • Lenalidomide • Targeting Clusterin: • OGX-011 • Bone targeting: • RANK-L (Denosumab) • Cabazantinib • Src (Dasatinib, AZD0350) • Alpharadin • Immune system: • Sipuleucel-T • Prostvac • Ipilimumab

  22. Sipuleucel-T(Provenge)

  23. IMPACT Overall Survival: Primary EndpointIntent-to-Treat Population

  24. Enzalutamid(MDV3100)

  25. Alpharadin(Radium-223)

  26. Screening for prostatacancer(ESPC undersøgelse – 300.000 europæiske mænd) • 308 patienter skal have taget PSA • 9 diagnoser af prostacancer skal stilles • 1 prostatacancer patient redder livet Screening for prostatacancer kommer!

  27. Take home messages • Docetaxel first line standard • Abiraterone second line standard • Cabazitaxel third line standard • Abiraterone will replace Docetaxel • Cou 302 • Sequenz: AA – DOC – CAB • Denusomab complements ZOL • More new compounds to come

  28. King’s College Hospital, London

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