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Prostate Cancer

Prostate Cancer. James B. Benton,M.D. Prostate Cancer. Significant of the clinical problem Early detection/screening Prevention/Management. Prostate Cancer. 220,000 new case per year in US 380,000 cases projected in 2025 40,000 death per year

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Prostate Cancer

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  1. Prostate Cancer James B. Benton,M.D.

  2. Prostate Cancer • Significant of the clinical problem • Early detection/screening • Prevention/Management

  3. 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.

  4. 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)

  5. 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

  6. Epidemiology Cont’d • 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.

  7. Epidemiology Cont’d • In 1990, 172,596 cases….33011 deaths • 149,631 whites….25,281 deaths • 17,417 blacks….5,181 deaths • 4,291 Hispanics….727 deaths • <400 Orientals….<70 deaths

  8. 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.

  9. Age Specific PSA

  10. Age Specific PSA..cont’d

  11. Age Specific PSA..cont’d

  12. Age Specific PSA..cont’d

  13. Prevention • Restrict excessive fat and/or carbohydrates • ?Vitamins/Minerals: Selenium and Vitamin E, and Lycopene • Annual exam: DRE and PSA at age 40-50 • ? Hormonal…ie. Proscar

  14. Prostate Cancer Prevention Trial • 18,882 men: 55y/o or older: Finasteride(Proscar) or placebo; nl DRE and PSA <3.0: 7 year study (Thompson NEJM…2003) • 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

  15. Prostate Cancer Screening • Since introduction of the PSA in the 1980’s, 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)

  16. 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

  17. ACS Guidelines Cont’d • 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 < 1.0, no more until age 45 • If PSA 1.0 – 2.4, annual testing • If PSA > 2.4, consider biopsy

  18. 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

  19. PSA Density and Free PSA • PSA density(PSAD): PSA value divided by the volume of the prostate gland: >0.15 considered abnormal. • Free PSA: unbound PSA divided by bounded PSA: < 25% is considered abnormal • Used as factors to determined the need for a biopsy when PSA is 4.0 – 10.0 range

  20. Treatment Options • Surgery • Simultaneous Radiotherapy • External Beam Radiotherapy alone • Seed Implants alone • Cryotherapy • Observation • Hormonal Ablation • ? Vaccines

  21. Treatment cont’d • Combined Radiation and Tumor-specific vaccine regimen. • Chemotherapy: Doxil +/- hormonal therapy

  22. Surgery • Traditional Radical Prostatectomy • Laparoscopic Prostatectomy • Robotic Prostatectomy

  23. Radiotherapy • Simultaneous: Seeds/XRT • Sequentially: XRT/Seeds • Seeds alone • XRT alone: IMRT- Proton/Neutron/Photons

  24. Cryotherapy • Freezing the prostate • Limited experience

  25. Hormonal Therapy • Chemical • Orchiectomy

  26. Experienmental • Vaccines • High energy microwaves therapy

  27. Learning How to Count    9    99    100

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