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Prostate Cancer PowerPoint Presentation

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Description : Awareness on prostate cancer

Tags : Ca Prostate,Prostate Cancer,Cancer

Published on : Jan 01, 2024 | Views : 2111 | Downloads : 4

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Prostate Cancer Awareness Dr. Jehangir Farman Ali (MBBS, FCPS, FACS) Assistant Professor Surgery SIUT
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The prostate is a gland found only in men, it is a part of male reproductive system . The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm. What is Prostate? Anatomy
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Background The most common type of cancer in men and second most frequent cause of cancer-related death in men A malignant (cancerous) tumor that begins in the prostate gland. Some prostate cancers grow very slowly and may not cause problems for years. Second leading cause of cancer death in U.S. men. About 25% of prostate cancers are thought to be clinically significant. 1 in 6 will be diagnosed, 1 in 35 will die from it. (10% of cancer related deaths in men.) A new case is diagnosed every 2.3 min. Campbell-Walsh UROLOGY, 9th edition Comprehensive Textbook of Genitourinary Oncology, 3rd edition
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1 in 35 will die from it. (10% of cancer related deaths in men.)
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Natural History of Prostate Cancer
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Incidence The incidence and mortality rates exhibit widespread geographic variation.(North America/Northern Europe v/s Asia, Africa, South America) Most commonly diagnosed cancer in men after 50. Life time risk -30% (microscopic). Risk of developing clinical disease -10%. Incidence : 36% of all cancers in males
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New Cases and Death Estimates Jemal et al. Cancer statistics, 2014. CA cancer J clin, 2014 Mar-Apr;61(2):133-4.
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Trends in Incidence Rates for Selected Cancers by Sex, United States, 1975 to 2010 Jemal et al. Cancer statistics, 2014. CA cancer J clin, 2014 Mar-Apr;61(2):133-4.
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Survival Rates – Prostate Cancer 5-year relative survival rate nearly 100% 10-year relative survival rate is 91% 15 year relative survival rate is 76%
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Signs and Symptoms Most patients are asymptomatic. Diagnosed due to elevated PSA or abnormal DRE. Advanced cancer may present with bone pain, unintentional weight loss, hematuria, worsening LUTS, urinary retention, hydronephrosis, LE weakness/leg numbness/difficulty with ambulation. Campbell-Walsh UROLOGY, 9th edition Comprehensive Textbook of Genitourinary Oncology, 3rd edition
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Risk Factors for Prostate Cancer Age (About 6 out of 10 prostate cancers are found in men older then 65). Rare before 40 Family History ( Having father or brother “doubles the risk”. Higher the risk if several relatives particularly at younger age at the time of diagnosis) Racial Background ( African American are at greater risk then white men)
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Genetics (some inherited genes {BRCA1/BRCA2} seems to raise the risk, but for most genetic testing is not available) Diet (Red meat and fat/dairy products and diet with low fruits and vegetable may increase the risk)
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Can Prostate Cancer Be Prevented? Because exact cause of prostate cancer is not known at this time, it is not possible to prevent this disease. Risk factors are modifiable and non modifiable. Medicines(Proscar &Avodart) and supplement (Vitamin E and Selenium), role still not proven, extensive work is being going on in the form of many trials. {SELECT Trial, REDUCE trial, PCPT Trial} Early detection of Prostate cancer via screening is the only best modality that has proven its impact.
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Screening for Prostate Cancer
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Made by cells in Prostate Gland. Most healthy men have small amount of PSA ( less then 4ng/ml in their blood) Can be used to define the risk of prostate cancer and NOT to diagnose it. Can be elevated secondary to BPH, Prostatitis, Recent ejaculation, prostatic trauma (Massage, biopsy, instrumentation, DRE, Cycling etc..) No Universally accepted threshold value.
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PSA-Based Prostate Screening Potential Benefits Earlier diagnosis: Allows finding cancer at earlier stage, before it is symptomatic, while it is likely localized 70% decrease in metastatic disease at diagnosis1 Relative survival has increased to close to 100% since PSA screening became highly utilized1 From 1975-1979, 10-year survival was 55.7% In 2000, 10-year survival was 98.4% US death rates have decreased about 4% per year Risks and Limitations Potential for over diagnosis and overtreatment in patients with clinically insignificant cancer Decrease in quality of life, complications, and cost. If PSA detectable, no matter how low, prostate cancer still a possibility2 Can take time for effect of population-based PSA screening to become significant3 Though increase in survival of prostate cancer patients, not able to directly link it to PSA-based screening. 1. Howlader N et al. SEER Cancer Statistics Review, 1975-2010, National Cancer Institute. http://seer.cancer.gov/csr/1975_2010/Accessed Sept 2, 2013. 2. Thompson IM et al. N Engl J Med. 2004;350:2239-46. 3. Loeb S et al. J Clin Oncol. 2011;29:464-7.
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American Urological Association 2009 National Comprehensive Cancer Network 2010 European Association of Urology 2009 American Cancer Society 2010 Guidelines for Screening
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PSA cancer screening: A case for shared decision-making. J Fam Pract. 2020 January;69(1):26-28,30-32,46
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Limitation and Controversies related to “Screening” Should you screen at all? What age should you stop screening? Does PSA-based screening lead to decrease in risk of death from prostate cancer? {US based and EUROPEAN based trials??} Some advocate men >75 should not be screened* AUA and NCCN guidelines state that screening should be individualized based on overall health (life expectancy >10yrs, FH of longevity, minimal competing medical co morbidities) *U.S. Preventative Service Task Force Guidelines, 2008
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Sources: Cooner WH, Mosley BR, Rutherford CL Dr. et al. Prostate cancer detection in a clinical urological practice by ultrasonography, digital rectal examination and prostate specific antigen. J Urol. 1990;143:1146-52. Cited in Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, et al. Krumholtz JS, Carvalhal GF, Ramos CG, et al. Prostate-specific antigen cutoff of 2.6 ng/mL for prostate cancer screening is associated with favorable pathologic tumor features. Urology. 2002;60:469-473. 26% 24% 17% 10% 7 % Percent with prostate cancer PSA level (ng/ml) 3.1 to 4.0 2.1 to 3.0 1.1 to 2.0 .6 to 1.0 less than .5 2004 Study of men: PSA never above 4ng/ml; no abnormal rectal exam In those with cancer and low PSA levels, 12.5% had aggressive, rapidly multiplying high-grade tumors likely to spread.
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The Memorial Sloan Kettering Cancer Center Recommendations for Prostate Cancer Screening
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Diagnosis Of Prostate Cancer PSA levels and DRE help in early detection but not diagnostic modality. Cystoscopy/Trans Rectal U/S. Biopsy is Gold Standard for diagnosis.(Trans Urethral/Trans Rectal) Indication for Biopsy (Abnormal DRE, abnormal PSA levels, age, +ve family history, ethnicity)
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Gleason Score evaluation(>8) Imaging studies usually for staging and metastatic disease (Bone Scan, CT, MRI, PET scan)
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The AJCC TNM staging system A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC (American Joint Committee on Cancer) TNM system, which was most recently updated in 2018. The TNM system for prostate cancer is based on 5 key pieces of information: The extent of the main (primary) tumor (T category)* Whether the cancer has spread to nearby lymph nodes (N category) Whether the cancer has spread (metastasized) to other parts of the body (M category) The PSA level at the time of diagnosis The Grade Group (based on the Gleason score), which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy (or surgery).
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Based on the Gleason score, prostate cancers are often divided into 3 groups: Cancers with a Gleason score of 6 or less may be called well-differentiated or low-grade. Cancers with a Gleason score of 7 may be called moderately-differentiated or intermediate-grade. Cancers with Gleason scores of 8 to 10 may be called poorly-differentiated or high-grade.
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Treatment Options for Localize Prostate Cancer Active Surveillance (Early disease, Low Gleason Score, PSA<7, Life expectancy greater then 20years) Surgery (Open, Laparoscopic and Robotic, showed overall survival benefit*) Radiation (External Beam, Brachy-therapy for low risk group**) Cryoablation (salvage therapy for recurrent disease, not good modality for locally advance disease) *Bill-Axelson A et al. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian Prostate Cancer Group 4 randomized trial. J Natl Cancer Inst, 100, 2008 **D’Amico et al. Androgen suppression and radiation vs. radiation alone for prostate cancer. JAMA, 299, 2008
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Active Surveillance: Current Approach Offered to all men with Gleason 6, PSA ≤10 (accepted by most). PSA kinetics a guide only. Confirmatory biopsy within 1 year, targeting anterior/antero lateral horn. Repeat biopsy every 3-5 years (age, risk tolerance, PSA) to age 80 years. MP-MRI for PSA doubling time < 3 years or volume increase or 3+ minor element 4 Treat if significant Gleason 4 or unequivocal lesion > 1 cm on MRI
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Prostate cancer very common problem. Need to know which men to offer screening, when to begin and end, and how often to offer screening. Early detection can find localized cancer. Desperately need to find better ways to delineate aggressive forms of prostate cancer from indolent disease. Offer treatment to men who will benefit and spare those who will not. Conclusions
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