10 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE Prostate cancer is among the most common cancers in males worldwide. The spectrum of prostate cancers range from localised low and high risk tumours to metastatic hormone sensitive and hormone resistant disease. Radiation therapy is an important treatment modality in the management of prostate carcinoma and its role has evolved in the setting of oligometastatic disease. Oligometastatic prostate cancer (OMPC) can be dened as cancer with a limited number of metastases, typically fewer than 5 lesions. These patients have a better prognosis than patients with extensive 4 metastatic disease. The concept of oligometastatic disease was rst proposed by Sam Hellman and Ralph Weichselbaum at the American Society of Clinical Oncology (ASCO) over 20 years ago. It is derived from the Greek word “oligo” meaning “few.” The concept involves controlling a primary tumor completely or controlling a single or limited number of metastatic lesions with local therapy, which can result in a cure. Oligometastatic disease is an intermediate biological state with a unique clinical picture within the spectrum of advanced disease, which has a favourable phenotype that is ideal 3 for an intensive approach. The relatively slow proliferation rate of prostate cancer is reected in a low α/β ratio between 1 and 4. Because the α/β ratio for prostate cancer is similar to or lower than the surrounding tissues responsible for most of the toxicity reported with radiation, radiation treatment elds and schedules using extremely hypofractionated regimens and stereotactic radiotherapy result in good cancer control rates [1] without increased risk of late toxicity. Stereotactic body radiotherapy (SBRT) is a form of real or near-realtime image guidance radiation therapy that uses high doses of radiation delivered in a precise and targeted method to the tumour, in a very limited number of fractions with low toxicity and excellent tolerance. DR NIRASHA CHIRANJAN Radiotherapy in the setting of Oligometastatic Prostate Carcinoma "I have lived through the effects of cancer on close family and friends. This rst-hand experience inspired me to pursue my studies in Oncology. Having walked this road, I am determined to give my patients the care they need, and so rightfully deserve. I remain steadfast in my dedication to my patients, their families and have long ago resolved to make this walk with them - my life's work." – Dr Nirasha Chiranjan. Dr Chiranjan completed her MBchB at the University of Cape Town in 2006. Following two years of internship at McCord's Hospital in Durban, Dr Chiranjan completed a year of community service at Evander Hospital in Mpumalanga. In 2010, she joined the Radiation Oncology Department at the Charlotte Maxeke Johannesburg Academic Hospital. Dr Chiranjan was successfully admitted as a Fellow of the College of Radiation Oncologists in early 2014 and joined DMO in August of the same year, where she is now a senior partner. She consults at the Ahmed Kathrada Cancer Institute, Sandton Oncology and the West Rand Oncology Centre and is part of a team of eight Oncologists that consult at the DMO locations. Being available to the patient is of importance to us. Our Oncologists are available daily to our patients, throughout their treatment programme, and beyond for follow up care and are rostered on call, 24/7 - all year. Dr Chiranjan treats a broad range of malignancies, with special interest in prostate, breast, gynaecological, head and neck, and central nervous system areas. She is an active participant in several multi-disciplinary forums related to cancer treatment and also has a keen interest in screening processes. Example of a stereotactic body radiation therapy (SBRT) planning on a metastatic bone lesion
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