I covered a number of topics including is it valid to compare the outcomes of radical prostatectomy with radiation?

How does one determine whether one treatment is better than another?

And I talked about some of the controversies in that area.

There is some major selection bias that is the healthier patients tend to get treated with surgery and the older patients with more medical problems tend to get treated with radiation.

I also talked about the use of something called androgen deprivation therapy, or hormonal therapy, in combination with radiation in terms of when you are treating a patient with intermediate risk prostate cancer how long should you give hormone therapy.

For patients that have low risk prostate cancer we don’t recommend hormone therapy at all.

For patients with very high risk prostate cancer we recommend hormone therapy for two or three years.

But for patients with intermediate risk we recommend short term hormone therapy.

So I discussed the question of should we use three months, should we use four months, should we use six months, should we use eight months, should we use nine months and my formal recommendation is that four months is the optimal duration for short-term hormone therapy.

I also talked about the use of radiation in patients who were previously operated on.

So let’s say a man has prostate cancer and his prostate is cut out and at the time of the operation they find the cancer has spread a little bit.

Should you treat the patient then or should you wait until the PSA starts to come up?

Generally speaking, for most patients if they have extensive disease found at the time of surgery I recommend they receive radiation before the PSA starts to go up.

But still many patients will not receive radiation then, they will receive radiation when the blood test, the PSA, which stands for prostate specific antigen, starts to rise.

So then I talked a little bit about how should you do the radiation.

Should you give hormone therapy with the radiation? Should you use something that we call image guidance?

That is we like to put marker seeds where the prostate used to be and use that to help target the prostate area.

Finally I talked about what happens to patients that have had radiation if their PSA starts to come up again.

I discussed the possible use of radiation again, whether you can sometimes give radiation after radiation.

So the classic example would be a patient had external beam radiation, that is they came in eight weeks for radiation, or seven weeks for radiation, and then five years later their PSA starts to come up again.

Some of those patients you can cure them by adding radioactive seeds back into the prostate and offer those patients a definitive treatment.

After my overview of treatment of prostate cancer I did a debate with another doctor on the merits of pelvic nodal radiation.

In a patient with high risk disease should your radiation only be directed at the prostate or should you treat the lymph nodes that drain from the prostate.

So I presented the arguments for why you might want to treat the lymph nodes that drain the prostate.

What are the differences in specific treatments from the United States in contrast with Latin America?

I think there’s less PSA screening done here than in the United States so I think that the patients tend to have more locally advanced disease.

Many of the topics I covered were actually more relevant to this country than even in my own country because in my own country most of the men are diagnosed early with low volume disease and fewer men are diagnosed with high volume disease.

I think here more of the men have high volume disease so the message about using hormone therapy, the message about using image guidance, the message about giving radiation after surgery and possible use of radiation after radiation failures are probably very relevant to the practice of radiation here.