Epidemiology: Median age at diagnosis is ❌ years. ❌ 5 year survival rate with local or regional disease ❌ 5 year survival rate with distant disease 95% are ❌(cancer that starts in the mucous glands in epithelial tissue).
In New Zealand… ❌ cancer in men (3000 new cases/year, 600 deaths/year).
Which of these is NOT a risk factor for prostate cancer?
Male
Age >40
Black (race)
Family history
Alcohol consumption
There is controversy with screening for prostate cancer as there is no clear evidence of mortality benefit with screening.
Screening methods:
- Digital rectal exam (circa 1900s). ❌ BUT not ❌, poor interobserver reliability, poor ❌
- PSA blood test (prostate specific antigen) Low ❌. Many other causes (BPH, acute ❌, urinary ❌,benign prostatic ❌).
Select ALL the symptoms of prostate cancer which indicate advanced disease.
Painful urination
Erectile dysfunction
Urinary hesitance
Urinary retention
Hematuria
Weight loss
Back pain
Lower extremity oedema
Anemia
Diagnosis History and physical exam. DRE and PSA. TRUS - ❌ - if one of above positive). ❌ (confirmative)
Staging: Stage A - ❌ Stage B -❌ Stage C - ❌ Stage D - Metastatic disease
❌ (non-palpable) ❌ - Not palpable or visible by imaging ❌ - Confined within prostate ❌ - Extends through capsule ❌ - Fixed or invades adjacent structures (other than seminal vesicles)
Gleason Score: Histologic grade of tumor. Calculated based on dominant ❌ grades. Scores range from 1 = well ❌ healthy tissue, to 5 = very ❌ differentiated abnormal tissue. Gleason score = sum of ❌ pattern grades (❌). Higher is worse.
Factors influencing prognosis: Extent of ❌ Histological ❌ of tumor Patient’s ❌ ❌ (Bcl-2, Bax, Ki67, p53, p27, E-cadherin, Microvessel density, DNA ploidy, p16) PSA level?
Initial treatment depends on the stage, Gleason score, presence of symptoms, and life expectancy.
Low risk patients (T1 or T2, GS of ❌, PSA<10ng/ml) – excellent survival (10yr): ❌ Radical ❌
Life expectancy <10 years? Observation Radiation therapy
Nonpharmacological Treatments: Observation - DRE and PSA performed every ❌ months and biopsy if signs of ❌ Radiation - Effective yet complications (❌) Radical prostatectom y - Complications: ❌, impotence, ❌, fistula Bilateral orchiectomy (removal of testes). Need ❌.
Hormonal Treatment: Rationale - Androgens stimulate prostate cancer cells to ❌. Main androgens are ❌ and dihydrotestosterone (DHT). Most androgens made by ❌ but also by adrenal glands. Lowering androgen levels makes prostate cancer cells shrink or grow more ❌ but does not cure prostate cancer.
Indication - If cancer cannot be cured by surgery or radiation or ❌... In combination with radiation therapy if high ❌ (high Gleason)... OR before radiation to shrink cancer and make radiation more ❌ .
Pharmacological (hormone) Treatment: 1. LHRH ❌ - Reversible method of androgen ablation as effective as orchiectomy. Puts patient at risk for ❌. Drugs: ❌ Triptorelin, Histrelin.
2. GnRH ❌ - Works directly in ❌ to reduce testosterone
3. Antiandrogens - Bind to ❌ receptors so androgens cannot. Not used alone, typically with LHRH agonists/removal of testicles. Drugs: ❌
Which of these is not an ADR of androgen lowering therapies?
Reduced or absent sexual desire
Erectile dysfunction
Shrinkage of testicles and penis
Hot flushes
Osteoporosis
Loss muscle mass
Weight gain
Depression
Weight loss
