ON12 Prostate Cancer

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)​.

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 ❌)​.

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: ❌