Managing Prostate Cancer Recurrence After Radical Prostatectomy with Dr. Adam S. Kibel, MD скачать в хорошем качестве

Managing Prostate Cancer Recurrence After Radical Prostatectomy with Dr. Adam S. Kibel, MD

Adam S. Kibel, MD, Chief of Urology, Brigham and Women’s Hospital, Boston, Massachusetts, Adam S. Kibel, MD, explores the management of prostate cancer recurrence following radical prostatectomy, focusing on risk stratification, imaging advancements, and evolving treatment strategies. In this 21-minute presentation, Dr. Kibel presents a case of a 62-year-old patient with Gleason 9 disease, emphasizing the importance of PSA kinetics in determining prognosis and treatment direction. Historical data suggests that while some patients can be safely monitored, those with rapid PSA doubling times and early recurrence require intervention. Advances in PSMA PET imaging have transformed decision-making, identifying local versus metastatic recurrence and guiding treatment planning. Dr. Kibel highlights the critical role of salvage radiation therapy, emphasizing early intervention. Meta-analyses confirm that salvage and adjuvant radiation yield comparable survival benefits. The integration of androgen deprivation therapy with radiation therapy is well-established, particularly for patients with a high risk of micrometastatic disease. Recent trials investigating intensified androgen receptor inhibition with agents like enzalutamide, apalutamide, and abiraterone show promising results, potentially reshaping future management strategies. The EMBARK and PRESTO trials further validate the role of intensified systemic therapy, demonstrating prolonged metastasis-free survival. Dr. Kibel underscores the need for tailored treatment, balancing oncologic control with quality-of-life considerations. While aggressive treatment benefits high-risk patients, those with indolent recurrence may avoid unnecessary therapy. The evolving landscape of systemic and targeted therapies continues to refine decision-making, optimizing outcomes for men with recurrent prostate cancer.