PLWC Slide Deck Series

1
Presents
PLWC Slide Deck Series Understanding Prostate
Cancer
2006
2
What is Cancer?

• A group of 100 different diseases
• The uncontrolled, abnormal growth of cells
• Cancer may spread to other parts of the body

3
What is Prostate Cancer?

• 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
• Prostate cancer is somewhat unusual in that many
  men with advanced cancer respond to treatment

4
What is the Function of the Prostate?

• The prostate is a walnut-sized gland located
  behind the base of the penis, in front of the
  rectum and below the bladder
• It surrounds the urethra, the tube-like channel
  that carries urine and semen through the penis
• The primary function of the prostate is to
  produce seminal fluid, the liquid in semen that
  protects, supports, and helps transport sperm

5
What Are the Risk Factors for Prostate Cancer?

• Age
• Race/ethnicity
• Family history
• Diet
• Hormones

6
Prostate Cancer and Early Detection

• Prostate-specific antigen (PSA) test
• Digital rectal examination (DRE)
• Discuss screening with your doctor

7
What Are the Symptoms of Prostate Cancer?

• Frequent urination, or weak or interrupted urine
  flow
• Pain or burning during urination or blood in the
  urine
• The urge to urinate frequently during the night
• Different symptoms if the cancer has spread pain
  in the back, weight loss, fatigue
• Sometimes, people with prostate cancer do not
  show any of these symptoms, or these symptoms may
  be similar to symptoms of other medical conditions

8
How is Prostate Cancer Evaluated?

• PSA test
• DRE
• Diagnosis is confirmed with a biopsy
• Transrectal ultrasound (TRUS)
• Imaging tests can determine if the cancer has
  spread

9
Prostate Cancer Staging

• Staging is a way of describing a cancer, such as
  the depth of the tumor and where it has spread
• Staging is the most important tool doctors have
  to determine a patients prognosis
• Staging is described by the TNM system the size
  of the Tumor, whether cancer has spread to nearby
  lymph Nodes, and whether the cancer has
  Metastasized (spread to organs such as the liver
  or lungs)
• Another staging system assigns letters (A,B,C,D)
  to describe the cancer
• The type of treatment a person receives depends
  on the stage of the cancer

10
Prostate Cancer Grading

• Grade describes how much cancer cells look like
  normal cells (for example, do the cells look
  almost normal or very abnormal?)
• The grade of the cancer can help the doctor
  predict how quickly the cancer will spread
• The Gleason System is the most common grading
  system and describes the cell patterns seen under
  the microscope

11
Stage I or Stage A Prostate Cancer

• Stage I cancer is found only in the prostate and
  usually grows slowly

12
Stage II or Stage B Prostate Cancer

• Stage II cancer has not spread beyond the
  prostate gland, but involves more than one part
  of the prostate, and may tend to grow more
  quickly

13
Stage III or Stage C Prostate Cancer

• Stage III cancer has spread beyond the outer
  layer of the prostate into nearby tissues or to
  the seminal vesicles, the glands that help
  produce semen

14
Stage IV or Stage D Prostate Cancer

• Stage IV cancer has spread to other areas of the
  body such as the bladder, rectum, bone, liver,
  lungs, or lymph nodes

15
How is Prostate Cancer Treated?

• Treatment depends on stage of cancer
• More than one treatment may be used
• Surveillance (watchful waiting) for some early
  stage cancers
• Surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy

16
Cancer Treatment Watchful Waiting

• A way to monitor early stage, slow-growing,
  prostate cancer
• Appropriate when treating cancer would cause more
  discomfort than the disease itself
• Mostly used in older men or men who are unwell
  from other illnesses
• Treatment begins when the tumor shows signs of
  growing or spreading

17
Cancer Treatment Surgery

• Used to try to cure cancer before it spreads
  outside the prostate
• Usually the prostate and nearby lymph nodes are
  removed
• Urinary incontinence and sexual side effects may
  result from surgery. These side effects are
  treatable
• Cryosurgery (destroying cancer cells by freezing)
  is still experimental

18
Cancer Treatment Radiation Therapy

• The use of high-energy x-rays or other particles
  to destroy cancer cells
• Used to try to cure disease or control symptoms
• External-beam outside the body
• Brachytherapy the insertion of radioactive
  pellets into the prostate
• Intensity-modulated radiation therapy (IMRT)
  small beams of radiation are aimed at a tumor
  from many angles
• Side effects may include rash and dry, reddened,
  or discolored skin

19
Cancer Treatment Hormone Therapy

• Reduces level of male sex hormones to slow growth
  of cancer
• Used to treat prostate cancer that has grown
  after surgery and radiation therapy or to shrink
  large tumors before surgery and radiation therapy
• Can be done surgically or through medication
• Hormone therapy may cause a variety of side
  effects
• More information can be found in the ASCO Patient
  Guide Hormone Therapy for Advanced Prostate
  Cancer

20
Cancer Treatment Chemotherapy

• Drugs used to kill cancer cells
• No standard chemotherapy for prostate cancer
• Mitoxantrone (Novantrone) and docetaxel
  (Taxotere) are both used in men with prostate
  cancer that is resistant to hormone therapy
• Paclitaxel (Taxol), estramustine (Estracyte),
  doxorubicin (Adriamycin), and cyclophosphamide
  (Cytoxan, Neosar) have shown promise in treating
  advanced prostate cancer

21
The Role of Clinical Trials for the Treatment of
Prostate Cancer

• Clinical trials are research studies involving
  people
• They test new treatment and prevention methods to
  determine whether they are safe, effective, and
  better than the best known treatment
• The purpose of a clinical trial is to answer a
  specific medical question in a highly structured,
  controlled process
• Clinical trials can evaluate methods of cancer
  prevention, screening, diagnosis, treatment,
  and/or quality of life

22
Clinical Trials Patient Safety

• Informed consent Participants should understand
  why they are being offered entry into a clinical
  trial and the potential benefits and risks
• Informed consent is an ongoing process
  participants are constantly updated as new
  information becomes available
• Participation is always voluntary, and patients
  can leave the trial at any time

23
Clinical Trials Phases

• Phase I trials determine safety and dose of a new
  treatment in a small group of people
• Phase II trials provide more detail about the
  safety of the new treatment and determine how
  well it works for treating a given form of cancer
• Phase III trials take a new treatment that has
  shown promising results when used to treat a
  small number of patients with cancer and compare
  it with the current, standard treatment for that
  disease phase III trials involve a large number
  of patients

24
Clinical Trials Resources

• Coalition of Cancer Cooperative Groups
  (www.CancerTrialsHelp.org)
• CenterWatch (www.centerwatch.com)
• National Cancer Institute (www.cancer.gov/clinical
  _trials)

25
Coping With the Side Effects of Cancerand its
Treatment

• Side effects are treatable talk with the doctor
  or nurse
• Fatigue is a common, treatable side effect
• Pain is treatable non-narcotic pain relievers
  are available
• Medication can treat many sexual side effects
• For more information, visit www.plwc.org/sideeffec
  ts

26
Where to Find More Information PLWC Guide to
Prostate Cancer (www.plwc.org/prostate)

• Overview
• Medical Illustrations
• Risk Factors and Prevention
• Symptoms
• Diagnosis
• Staging With Illustrations
• Treatment

• Side Effects of Cancer and Cancer Treatment
• After Treatment
• Questions to Ask the Doctor
• Current Research
• Patient Information Resources
• Clinical Trials Resources

27
People Living With Cancer (www.plwc.org)

• PLWC is the cornerstone of ASCOs patient
  resources program
• Visitors to PLWC will find
• PLWC Guides to more than 90 types of cancer
• Coping resources
• Ask the ASCO Expert Series, including chats, QA
  forums, and event transcripts
• Cancer information in Spanish
• The latest cancer news
• For patient information resources, please call
  888-651-3038