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Prostate Cancer PowerPoint Presentation

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Description : This medical presentation on cancer titled "Prostate Cancer" talks about prostate cancer and its screening, prevention and treatment. The presentation also provides information on lobes of the prostate (Anterior lobe, Median lobe, Lateral lobe, and Posterior lobe), zones of the prostate (Peripheral, Central, and Transitional), and its risk factors and symptoms, etc.

Tags : Cancer, Prostate, Cancer, screening, prevention, treatment, risk, Benign, Malignant, tumor, Types, Lymphomas, Leukemias, Myelomas, Lobes of the Prostate, Antigen, DRE, Biopsy, TRUSP, Bone scan, CT abdomen, pelvis, PET scan, Chest x-ray, Staging, CS Lymph Nodes, Surgery

Published on : May 03, 2021 | Views : 6750 | Downloads : 41

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Slide 1-

Prostate Cancer Louanne Currence, RHIT, CTR
Slide 2-

"You and Your Prostate," produced by the Australian Department of Veterans' Affairs.
Slide 3-

Central zone Urethra Urethra Transitional zone Fibromuscular zone Capsule Peripheral zone Ductus deferens nld.by/e/current/stat13.htm#15
Slide 4-

Lobes of the Prostate Anterior lobe Median lobe Lateral lobe Posterior lobe Image Source: SEER Training Website
Slide 5-

Zones of the Prostate Peripheral Central Transitional Image Source: SEER Training Website
Slide 6-

Prostate Cancer Facts #1 cancer in men (non-skin) 1/6 men diagnosed Estimate 230,000 new cases in 2006 1/34 men die of prostate cancer Estimate 27,000 deaths in 2006 70% over 65 y.o. at diagnosis 90% diagnosed at early stage Over past 20 years, survival 67% to 97%
Slide 7-

Risk Factors Male Age Race Higher rate in African-American, lower in Asian Family history (1st degree relatives) Diet?
Slide 8-

Symptoms a difficulty in starting to pass urine a weak, sometimes intermittent flow of urine dribbling of urine before and after urinating a frequent or urgent need to pass urine a need to get up several times in the night to urinate a feeling that the bladder is not completely empty rarely, blood in the urine
Slide 9-

Prostatic Specific Antigen Protein produced by cells of prostate gland Test introduced in 1986 Age influenced 40 - 49 / 2.5 50 - 59 / 3.5 60 - 69 / 4.5 70 - 79 / 6.5 Elevated indicates possible CA dx PSA 4 – 10 indicates 25-35% risk of cancer diagnosis PSA 10 – 20 indicates 65% risk of cancer diagnosis PSA > 20 indicates possible metastatic disease
Slide 10-

Free PSA PSA that circulates in blood w/o carrier protein The lower the % of free PSA, the greater the risk of CaP Free PSA > 24% probably benign www.marinurology.com
Slide 11-

DRE PSA can be falsely elevated DRE does not palpate entire prostate gland Abnormal: nodules, hard spots, soft spots, enlarged
Slide 12-

Screening AUA recommendation: Annual PSA, DRE Caucasion > 50 y.o. Annual PSA Af-Am males > 40 OR men w/+ FH ACS: Annual tests men > 50 y.o. IF 10 years of life expected (earlier AA men, + FH) American College of Preventive Medicine: Recommends against routine screening tests (PSA/DRE) Men over 50 w/10 years life should be told about benefits & harms of screening
Slide 13-

kidney.niddk.nih.gov/kudiseases Biopsy (TRUSP) Hypoechoic shows abnormal area needing biopsy
Slide 14-

Transrectal sonogram of the prostate. Looking up from the feet of a patient toward his head.
Slide 15-

Other Workup Bone scan CT abdomen/pelvis PET scan Chest x-ray
Slide 16-

Histology 99% Adenocarcinoma 1% Other Sarcoma, small cell, other PIN – do NOT abstract 30% men will go on to develop CaP Close follow-up recommended for 2 years visualsonline.cancer.gov
Slide 17-

ppt slide no 17 content not found
Slide 18-

www.prostate-cancer.org
Slide 19-

Grade Priority (FORDS) 1. Gleason’s grade 2. Terminology Differentiation (well differentiated, moderately differentiated, etc) 3. Histologic grade Grade I, grade II, grade III, grade IV 4. Nuclear grade only
Slide 20-

Grade Conversion
Slide 21-

Partin nonogram Doctors need PSA, Gleason score, and clinical staging items (PE) Can determine probability of: Organ-confined disease Extraprostatic extension Seminal vesical invasion Lymph node involvement urology.jhu.edu/prostate/partintables.php
Slide 22-

ppt slide no 22 content not found
Slide 23-

Collaborative Staging: Prostate
Slide 24-

CS Extension – Clinical/Notes 1: Do not include prostatectomy info 2: Explains codes 10 – 15: clinically INapparent 20 – 24: clinically apparent (palpable, radiology) 30: Not know if clinically apparent 31, 33, 34 OBSOLETE about apex 41 – 49 extension beyond prostate
Slide 25-

CS Extension – Clinical/Notes 3: Talks about apex, but that is in SSF now 4: 13 – 14 when TURP done 5: Prostatic urethra involvement no effect 6: “Frozen pelvis” definition 7: AUA stages included 8: Pathologic tissue of other organs 9: Explains how mapping works
Slide 26-

CS Extension - Clinical 00 in situ 10 – T1 NOS 13 – T1a ≤ 5% 14 – T1b > 5% 15 – T1c because of needle biopsy www.upmccancercenters.com ≤ 5% > 5% Clinically Inapparent Not palpable Not visible on imaging Not visible on sono Incidental finding Latent Occult
Slide 27-

CS Extension - Clinical 20 – T2 NOS 1 lobe 21 – T2a ≤ ½ lobe 22 – T2b > ½ lobe 23 – T2c both lobes 24 – Stage B NOS 30 – Localized NOS Clinically Apparent Palpable Nodule Induration Firm, Irregular Visible on imaging Extracapsular extension Visible on sono Hypoechoic Streaky densities
Slide 28-

CS Extension - Clinical 41 - T3 NOS thru capsule NOS 42 – T3a unilateral 43 – T3a bilateral 45 – T3b seminal vesicle 49 – T3 NOS Periprostatic extension NOS T3a T3b T3a www.upmccancercenters.com
Slide 29-

CS Extension - Clinical 50 – T4 extension to/ fixation to adjacent 52 – T4 muscles, ureter 60 – T4 pelvic wall or bone, “frozen” pelvis 70 – T4 further contiguous extension 95 No evidence 99 Unk www.upmccancercenters.com
Slide 30-

CS Evaluation Fields (CS/TS)
Slide 31-

CS Lymph Nodes Prostate is inaccessible organ (pg 14) 00 None 10 Regional LNs 80 LNs NOS 99 Unknown CS Reg Nodes Eval, # Pos, # Eval Use Standard Table www.upmccancercenters.com
Slide 32-

CS Mets at Dx Prostate is inaccessible organ 00 None 11 Common iliac LN 12 Other distant LN 30 Bone mets (not direct*) 35 – 30 + 11 or 12 40 Other distant mets 45 Mets NOS 50 40 - + 11 or 12 55 40 - + 30 or 35 99 Unknown
Slide 33-

Site Specific Factors SSF 1 PSA Value 000 Test not done 001 - < 0.1 002 – 989 actual # 990 - ≥ 99.0 ng/ml 999 Unknown SSF 2 PSA 000 Test not done 010 Positive 020 Negative 030 Borderline 080 Order, results ?? 999 Unknown Highest PSA prior to bx or tx Use same value for SSF1 and SSF2
Slide 34-

Why PSA Twice? PSA varies by age & race patient < 40 y.o. < 2.0 ng/ml 40-50 y.o. < 2.5 ng/ml 51-60 y.o. < 3.5 ng/ml 61-60 y.o. < 4.5 ng/ml > 70 y.o. < 6.5 ng/ml PSA varies norms by lab method Generally, 4-10 ng/ml borderline
Slide 35-

SSF 3 Pathologic Extension Notes 1. Prostatectomy info only 2. Prostatectomy done as first course 3. Involvement prostatic urethra not matter 4. Apical or distal urethral margin, bladder base or neck margin + w/o extension = 040 5. 031, 033, 034 OBSOLETE about apex 6. If incidental dx, code appropriately per path 7. “Frozen pelvis” definition 8. AUA stages included 9. Explains how mapping works
Slide 36-

SSF3 similar to CS Extension 3-digit code No T1 codes 024 absent 040 Margins involved 045 = T3b 048 = T3a 048 extracapsular extension 095 No evidence primary 096 Unknown if prostatectomy done 097 No prostatectomy w/in first course 098 Prostatectomy performed but not first course
Slide 37-

SSF 4 Prostatic Apex 1 No involvement 2 Into/arising in 3 Arising in 4 Extension into 5 Apex extension unk 1st number = clinical 2nd number = path www.upmccancercenters.com
Slide 38-

SSF4 Apex 1 No involve – statement of normal apex or neg on path 2 Into/arising NOS – can’t be determined where cancer started (avoid this code) 3 Arising in – If apex is ONLY site of cancer 4 Extension to – cancer present in other parts + apex 5 Unknown – no description; no prostatectomy
Slide 39-

SSF 5 & 6 SSF 5 Gleason’s pattern Note 1 explains what to do if only 1 number If more than one Gleason’s pattern, use the one from the largest specimen Different from other rules where we code to the worst This is not instructions for grade of tumor If multiple Gleason’s in single specimen, use the worst SSF 6 Gleason’s score Note 1 same Add the 2 patterns If more than one, use largest specimen
Slide 40-

Treatment Surgery Beam RT Seed RT Hormone Experimental Observation
Slide 41-

Watchful Waiting aka Active Surveillance PSA q 6 mos Slow growing cancer Delay for other diseases to improve Comorbidities prevent other tx
Slide 42-

Surgery kidney.niddk.nih.gov TURP CRYOSURGERY www.nemc.org
Slide 43-

Prostatectomy Perineal, Retropubic, Suprapubic – depends on patient anatomy and surgical history Nerve-sparing Robotic www.prostate-cancer.org
Slide 44-

Brachytherapy www.prostate-cancer.org
Slide 45-

Beam Radiation www.prostate-cancer-radiotherapy.org.uk Prostate sitting on rectum IMRT 3-D
Slide 46-

Hormone Therapy LHRH analogs Lupron, Zoladex Androgen blockades Casodex, Eulexin, Nilandrone Estrogen therapy (DES) NOT orchiectomy www.upmccancercenters.com
Slide 47-

Other Hem Tsplt & Endocrine Procedures Endocrine surgery or radiation Bilateral Could have subcapsular orchi Could have testicular prosthesis Chemotherapy Not first course Stage IV Hormone refractory
Slide 48-

Experimental Hyperthermia Laser ablation Alternative medicine Pomegranate juice Ginseng Fasting Mini-trampoline Vitamin D Vaccines
Slide 49-

www.cdc.gov/cancer/prostate/screening
Slide 50-

Treatment for Recurrence/Mets Hormones Orchiectomy Radiation to mets Radioisotopes strontium-89 (Metastron) samarium-153 (Quadramet) Chemotherapy
Slide 51-

Follow-Up (NCCN Guidelines) OBSERVATION < 10 years? H&P q 6 mos 10 years? PSA & DRE q 6 mos Repeat bx at 1 year CURATIVE PSA q 6 mos x 5 yr DRE q year x 5 yr STAGE IV PSA q 3-6 mos H&P w/sx discussion