Prostate%20Cancer

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Prostate Cancer

• James B. Benton,M.D.

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Prostate Cancer

• Significant of the clinical problem
• Early detection/screening
• Prevention/Management

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Prostate Cancer

• 220,000 new case per year in US
• 380,000 cases projected in 2025
• 40,000 death per year
• Second largest cancer killer after lung cancer.
• Probably 1 in non-smokers.

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• Lifetime risk of diagnosis of prostate cancer is
  17
• Lifetime risk of death from prostate cancer is
  3.4
• Autopsy series (22 -55 incidence of prostate
  cancer)

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Epidemiology

• The incidence and mortality of prostate cancer is
  quite varied among different populations
• The incidence rate among African Americans is
  224/100,000 and American Indians..46/100,000

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Epidemiology Contd

• African-American men have the highest mortality
  in the world (54/100,000)
• A high mortality rate has also been noted in
  African heritage in Brazil , Jamaica, and in
  sub-Saharan Africans.

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Epidemiology Contd

• In 1990, 172,596 cases.33011 deaths
• 149,631 whites.25,281 deaths
• 17,417 blacks.5,181 deaths
• 4,291 Hispanics.727 deaths
• lt400 Orientals.lt70 deaths

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• African American (AA) men historically presented
  with more advanced disease, and an increased
  death rate.
• Because of early detection and more aggressive
  treatments, survival may be equilibrating.

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Age Specific PSA
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Age Specific PSA..contd
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Age Specific PSA..contd
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Age Specific PSA..contd
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Prevention

• Restrict excessive fat and/or carbohydrates
• ?Vitamins/Minerals Selenium and Vitamin E, and
  Lycopene
• Annual exam DRE and PSA at age 40-50
• ? Hormonalie. Proscar

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Prostate Cancer Prevention Trial

• 18,882 men 55y/o or older Finasteride(Proscar)
  or placebo nl DRE and PSA lt3.0 7 year study
• (Thompson NEJM2003)
• CAP developed in 24 of placebo and 18 proscar
  (25 reduction)
• High grade cancers in 22 of placebo and 37 of
  proscar
• Side effects impotence with proscar

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Prostate Cancer Screening

• Since introduction of the PSA in the 1980s,
  there is evidence that prostate cancer mortality
  has decreased.
• In countries not using PSA testing, prostate
  cancer mortality continues to rise (Denmark,
  Mexico, and Sweden)

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American Cancer Society Prostate Cancer Screening
Guidelines

• Beginning at age 50, all men with a ten year life
  expectancy should be offered both PSA and DRE
  annually
• Men in high risk groups, such as African-
  Americans or those with a family history should
  start at age 45

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ACS Guidelines Contd

• Men at an appreciably higher risk due to multiple
  first-degree relatives who were dx at an early
  age could begin at age 40
• If PSA lt 1.0, no more until age 45
• If PSA 1.0 2.4, annual testing
• If PSA gt 2.4, consider biopsy

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American Urological Association Guidelines

• All men 50 or older with a ten year life
  expectancy
• Men 40 50 with first degree relative with
  prostate cancer or of African-American heritage
  background
• Exams DRE and PSA

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PSA Density and Free PSA

• PSA density(PSAD) PSA value divided by the
  volume of the prostate gland gt0.15 considered
  abnormal.
• Free PSA unbound PSA divided by bounded PSA lt
  25 is considered abnormal
• Used as factors to determined the need for a
  biopsy when PSA is 4.0 10.0 range

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Treatment Options

• Surgery
• Simultaneous Radiotherapy
• External Beam Radiotherapy alone
• Seed Implants alone
• Cryotherapy
• Observation
• Hormonal Ablation
• ? Vaccines

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Treatment contd

• Combined Radiation and Tumor-specific vaccine
  regimen.
• Chemotherapy Doxil /- hormonal therapy

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Surgery

• Traditional Radical Prostatectomy
• Laparoscopic Prostatectomy
• Robotic Prostatectomy

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Radiotherapy

• Simultaneous Seeds/XRT
• Sequentially XRT/Seeds
• Seeds alone
• XRT alone IMRT- Proton/Neutron/Photons

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Cryotherapy

• Freezing the prostate
• Limited experience

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Hormonal Therapy

• Chemical
• Orchiectomy

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Experienmental

• Vaccines
• High energy microwaves therapy

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Learning How to Count
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