Prostate Cancer

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Prostate Cancer

• Int. ? ? ?

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• Prostate cancer is the Second leading cause of
  death from cancer in the United States
• American male, the lifetime risk of1.
  Developing prostate cancer is 172. Dying of
  prostate cancer is only 3
• Autopsy - small prostatic carcinomas64 of 60
  to 70 years of age
• Screening1. Digital rectal examination2. PSA
  level(lt 4.0 ng/Ml) if abnormal ?Transrectal
  ultrasonography to guide Prostate biopsy

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Prostate cancer screening has been a
controversial issue because the effectiveness of
screening remains uncertain. No studies have yet
proven a survival benefit with screening
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Gleason Score? assigns a grade to each of the
two largest areas of cancer in the tissue
samples. ? The two grades are then added
together to produce a Gleason score 2 to 4
low grade 5 to 7 intermediate grade8 to 10
high grade
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Early prostate cancer Treatment

• Radical Prostatectomy
• Radiation therapyExternal beamBrachytherapy -
  can be considered a standard therapeutic option
  for men with low-risk disease
• Watchful waiting
• Hormone therapy

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RADIATION THERAPY (External Beam)

• Does not require hospitalization and normal
  activity can usually be maintained during the
  course of therapy.
• Cure rates appear to be comparable with Radical
  Prostatectomy(RP), at least for the first five to
  eight years
• Late recurrences can occur. As a result, ten
  years or more after treatment, the outcome with
  RT may not be as favorable as with RP. However,
  the available data on this issue using modern
  radiotherapy techniques are limited.

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Brachytherapy

• Permanent seeds implantation requires only a
  one-time insertion in an outpatient setting.
  Radiation exposure to physicians, nursing
  personnel, and family members is negligible.

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Brachytherapy

• High dose rate (HDR) temporary brachytherapy A
  computer-controlled machine pushes a single
  highly radioactive iridium seed into the
  catheters one by one. Because the computer can
  control how long this single seed remains in each
  of the catheters, we are able to control the
  radiation dose in different regions of the
  prostate.

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Watchful waiting or Radical Prostatectomy ??
Death from Prostate Cancer
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Watchful waiting or Radical Prostatectomy ??
Distant Metastasis
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Watchful waiting or Radical Prostatectomy
Cumulative Probability of Death
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Watchful waiting or Radical Prostatectomy

• A statistically significant difference in the
  risk of death due to prostate cancer after
  radical prostatectomy as compared with watchful
  waiting, yet there was no significant difference
  between the two groups in the overall survival
  rate.
• Life quality

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Hormone therapy

• In randomized trials (N Engl J Med 1997 Jul
  31337(5)295-300 ) in men with locally advanced
  prostate cancer Neoadjuvant hormone therapy
  (androgen deprivation therapy) significantly
  improves disease-free survival, time to the
  development of progressive disease and overall
  survival

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Advanced prostate cancer Treatment

• Second-line hormone therapy
• Chemotherapy 1. In early trials, objective
  response rates were 10 to 20 percent, and
  median survival did not exceed 12 months. 2.
  Newer regimens, particularly those that include
  docetaxel, a significant prolongation in
  median survival, approaching 20 months.
• Sr 89can release 60 80 symptoms of bone
  metastasis
• Re186-HEDPAggregate in sites of bone metastasis,
  release 80 of pain