18 UROLOGY, URO-ONCOLOGY AND SEXOLOGY UPDATE Introduction Over the past decade or so the management of prostate cancer has evolved signicantly. Several technological advances have been made in terms of accurate staging and imaging modalities, surgical techniques, radiation therapy schedules and techniques, and novel hormonal therapies. As with every type of cancer, optimal management of prostate cancer involves a range of specialists, starting with the urologist, and quickly summoning the expertise of the pathologist, radiologist, radiation oncologist and medical oncologist. Many ancillary disciplines also have an important role to play, such as nurses, radiation therapists, oncology nurses, and a psycho-social support system. Because prostate cancer is an indolent disease in the majority of patients, many will die with prostate cancer, but not as a result of cancer progression. As such, to maintain quality of life is imperative, and an important goal in many of the newest developments in denitive treatment of prostate cancer. The aim of this article is to give an overview of denitive radiation therapy for localised prostate cancer and shed some light on newer techniques. Dening risk In order to decide on the optimal treatment for a patient, it is necessary to determine the patient’s risk of disease progression and developing metastases. Several factors are taken into account. Since this article focuses on localised prostate cancer only, the management of metastatic disease is not part of our discussion. How do we determine a patient’s risk? Several factors need to be taken into account. Firstly, the pathology of the tumour must be established. The grade of the tumor is a reection of how abnormal the tumor cells appear. This was initially grade according to the Gleason score but has subsequently been replaced by the Grade group score. The Grade group score (1-5) is one of several factors that is used to predict the risk of metastatic disease developing after local treatment. The pathologist will determine the Gleason score (GS), which considers the primary and secondary growth patterns, and according to which the grade group (GG) is then determined. The use of the grade groups adds more accuracy to the GS by assigning a higher group to a tumour with GS 4 + 3 = 7, than GS 3 + 4 = 7, the former showing more aggressive behaviour and poorer outcomes than the latter, even though both have the same combined GS. Secondly, the pre-treatment Prostate-specic Antigen (PSA) will be considered. Mostly, if the PSA is lower than 10 ng/ml, it is likely DR MARYKE ETSEBETH Localised prostate cancer: the role of radiation therapy Whilst my course of life provided me with an enriched path of discovery, I found myself where I was destined to be, specialising as a Radiation Oncologist. My contribution in Oncology is to make daily, positive changes to the lives of my patients as well as their family members. I offer patient focused care throughout the cancer journey. Whilst we work toward the ideal of cure, I ensure that in the very least of outcomes, my patients receive symptom relief whilst maintaining the dignity and quality of life they deserve – throughout their treatment. I feel that knowledge comes through academic pursuit, whilst wisdom is attained through the experience of life and its complexities. How we nurture wisdom and translate it into value, for one another, is what makes a difference.” Dr Etsebeth obtained her MBChB at the University of Pretoria in 2000 and thereafter joined a private healthcare practice. It was here that she realised a deeper desire to specialise and in October of 2010, started as a registrar at the University of Pretoria, in the Department of Radiation Oncology. After qualifying as a Radiation Oncologist in October of 2014, Dr Etsebeth joined the Department of Radiation Oncology at the Steve Biko Academic Hospital. In April of 2016, Dr Etsebeth completed her Masters of Medicine in the Speciality of Radiation Oncology from the University of Pretoria, where she achieved cum laude for the research element of her dissertation. She is a member of SASCRO and the European Society for Radiotherapy and Oncology (ESMO). Dr Etsebeth s latest contributions to these societies include an oral presentation at SASCRO in 2015 as well as a visual presentation for the 2016 ESMO conference in Copenhagen. Dr Etsebeth practises at the Groenkloof Radiation Oncology and Mûelmed Radiation Oncology Centres and has a special interest in Genito-urinary Cancers, Head and Neck Cancers, Central Nervous System tumours and rare cancer types.-
RkJQdWJsaXNoZXIy NTIyOTQ=