What is the epidemiology of prostate cancer?
- Represents 23.1% of all new male cancers diagnosed in 2017 down from 25.2% last year
- Slow growing cancer - 5 year survivability is 95%
- It is not common in younger males (median age is 67)
What are the risk factors of prostate cancer? (Familial and Hereitary)
Familial: increased incidence with family history (rare)
- Relatives diagnosed before 55-60
- 3.5 x greater in men with two affected relatives
- 3 or more 1st degree relatives with prostate cancer
- Increased risk with the more relatives diagnosed
Hereditary (5-15%)- Not very common
- HBOC syndrome (hereditary and ovarian cancer) - association with BRAC1 & BRAC2 gene
What are the signs and symptoms of prostate cancer?
Can remain asymptomatic for several years
Patients will initially present with:
• Urinary changes – difficulty starting or maintaining a urinary stream
• Frequency and/or urgency difficulty maintaining bladder volume
• Dysuria
• Haematuria
How do we test for prostate cancer?
PSA - prostate specific antigen (monitoring doubling time) - not conclusive proof
Digital Rectal Exam
- Not always conclusive
- Doctor places lubricated finger into the rectum and palpates for abnormal lumps
Biopsy & TRUS Biopsy
- the only conclusive way of determining prostate cancer
What are the the patterns of spread for prostate cancer (LOCAL)
Most prostate cancers are multifocal They extend out of the gland - Spread to seminal vesicles -Neck of bladder -Rectum
What are the the patterns of spread for prostate cancer (LYMPH NODES )
Invasion of lymphatics and blood vessels
- Internal and External iliac lymph nodes - Inguinal lymph nodes - Pre-sacral and sacral lymph nodes
What are the the patterns of spread for prostate cancer (METASTATIC)
- The highest incidence of metastatic spread is to Bone (80-85%)
- Other regions include liver, brain, lung and other soft tissue (haematogenous spread)
- Patients with metastatic disease can survive for many years
What is the pathology/histology of most prostate cancer?
Adenocarcinoma 95-98%
Lesser involved
- Transitional cell, squamous cell, sarcoma
How is prostate cancer graded/staged?
Gleason scoring - a new grade group of 1-5
AJCC - TNM staging
o Tx – primary tumour cannot be assessed
o T0- No evidence of primary tumour
o T1 – Clinically inapparent tumour neither palpable nor visible
o T2 -Tumour confined within prostate
o T3 – Tumour extends through prostate capsule
o T4 – Tumour is fixed or invades adjacent structures other than seminal vesicles
Which gleason score is worse? 3+4=7 OR 4+3=7
4+3=7
What is the clinical management of prostate cancer?
Watchful waiting
Active surveillance
- Repeated PSA, DRE and biopsies
Surgery
- Radical prostatectomy, Da Vinci Robot
Hormone Therapy
- Oestrogen therapy
- Androgen deprivation
- Orchiectomy - removal of testicle
- High intensity focused ultrasound (HIFU) - High intensity ultrasound cause cellular destruction
Radiation Therapt (EBRT, Brachy, Proton Therapy)
What are the main advantages of radiation therapy?
Prostate is retained
Acts as an alternative to radical prostatectomy
Improves local tumour control, disease free survival
What are the acute side effects of radiation therapy?
- Tiredness
- Bladder: irritation, frequency, urgency
- Rectum: irritation, soreness, wind, diarrhoea
What are the late side effects of radiation therapy?
Bladder: Urinary incontinence
Rectum: radiation proctitis – chronic bleeding & change in bowel habit
Erectile impotence – common and permanent
What are common doses used for prostate cancer?
Conventional: 74Gy in 37#
Hypofractionated: 60Gy in 20# , 57 Gy in 19# over 3.8 weeks
Bracytherapy doses??
What are the risk factors prostate cancer? (environmental)
Environmental and occupational exposure
- Agent orange (chemical used in vietnam war)
- Workers in rubber industry
- Exposure to cadmium
What are the risk factors of prostate cancer? (Ethnic background)
Race/ethnicity - more common in African American men (compared to causasian), not very common in asian males
What are some lifestyle risk factors of prostate cancer?
Diet, obesity age
Patients with metastatic disease will present with what symptoms?
- Bone pain or back pain
- Loss of appetite, weight loss
- Testicular pain
