| Stage (TNM) |
Grade(Gleason score) |
Treatment Protocols offered for Prostate Cancer in Ghana |
| Early (T1 and T2 N0 M0) |
GS ≤7 |
External beam radiotherapy EBRT 2D/3D 70 – 74GYBrachytherapy 160 GY – I seedsRadical Prostatectomy (RP) (Open retropubic or perineal/ Laparoscopic) |
| Active SurveillanceT1 – T2 N0M0 |
Low Risk GS ≤6 (No GS 4 no GS 5) |
Life expectancy <10 yrs. PSA <10ng/ml Follow up every 3 months for 1st year and every 6 months subsequently. Check TPSA, PSA velocity, DRE at each visit. If progression by TPSA, ↑PSA velocity >0.75ng/ml/yr., repeat biopsy and appropriate Rx by radiation or hormonal therapy |
| Early (T1 and T2a N0 M0) |
GS 7- 10 |
Neoadjuvant ADT/Radical Prostatectomy /Brachytherapy External beam radiotherapy 2D or 3D conformal + neoadjuvant or adjuvant hormonal therapy with antiandrogens or Luteinizing Hormone Releasing Hormone(LHRH) analogues ± Total Androgen Blockade(TAB) |
| Late LOCALLY ADVANCED(any T3 and T4) N0 M0 |
GS ≤7 |
Neoadjuvant hormonal therapy with antiandrogens ± TAB orBilateral orchidectomy/Hormonal therapy TAB and EBRT/ Brachytherapy |
| Late(any T3 and T4) M1 |
High Risk GS 7 – 10 |
Bilateral orchidectomy Hormone therapy LHRH analogues ± TAB ADT ↑supportive therapy |
| Hormone Refractory |
|
Stilboestrol, Cyclophosphamide, antiandrogen withdrawal, docetacel, prednisolone |
