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Prostate cancer – What you need to know!

Prostate cancer – What you need to know!. Miss Hazel Warburton FRCS (Urol), MD Consultant Urological Surgeon. The prostate. What is Prostate cancer?. Incidence. ~37 000 cases diagnosed in the UK ~215 000 men living in the UK with prostate cancer. Mortality. ~10 100 deaths per year (12%)

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Prostate cancer – What you need to know!

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  1. Prostate cancer – What you need to know! Miss Hazel Warburton FRCS (Urol), MD Consultant Urological Surgeon

  2. The prostate

  3. What is Prostate cancer?

  4. Incidence • ~37 000 cases diagnosed in the UK • ~215 000 men living in the UK with prostate cancer

  5. Mortality • ~10 100 deaths per year (12%) • 70% 5 year survival (95-98% 5 year survival for treated localised disease)

  6. Risk Factors • Age • Race • Family history

  7. Prevention • Little evidence • ??Lycopene, green tea, soya sauce, selenium and vitamin E, low saturated fats, finasteride

  8. Symptoms • Early disease – none or those of benign disease • Late disease – systemic symptoms, bone pain

  9. Diagnosis - DRE

  10. Diagnosis - PSA • What is PSA? • What is a normal PSA? • What does an abnormal PSA mean? • Does a normal PSA mean no cancer?

  11. PSA • What is PSA?

  12. PSA • What is a normal PSA?

  13. PSA • What does an abnormal PSA mean? Causes of an Elevated PSA • Prostate Cancer • Age • BPH • Infection • Retention • Catheterisation/ Instrumentation • Prostate biopsy • Post Pelvic Radiotherapy • Potential causes an Elevated PSA • Cycling • Prostate massage

  14. PSA • Does an normal PSA mean no cancer? 50-66 year old Thompson IM et al: N Eng J Med 2004;350(22):2239-2246

  15. Prostate Biopsy

  16. Diagnosis • Grading • Gleason grade

  17. Diagnosis • Staging • TNM

  18. Treatment – Localised Disease • Low risk • Intermediate risk • High Risk • Also an individual’s age, preference and other medical problems (life expectancy)

  19. Active surveillance • Very close monitoring and avoidance of the side effects of treatment until evidence of growth of the tumour • PSA every 3-4 months, rectal examination (ideally by a urologist) and repeat biopsy every 18 months to 2 years

  20. Surgery • Radical Prostatectomy

  21. Radiotherapy + hormones

  22. Brachytherapy

  23. Experiment procedures • HIFU • Cryotherapy

  24. Metastatic disease

  25. Metastatic disease

  26. First line GnRH analogues or orchidectomy Second/Third line hormones (anti-androgens) MAB Steroids and chemotherapy Trials Palliative care Metastatic disease

  27. Blue Skies 10km Run for Prostate Cancer

  28. Thank you • Any questions?

  29. PCA 3 • Urine test post prostatic massage • Prostate cancer gene 3 (66 fold greater expression in prostate cancer) • Most useful in men with a negative biopsy • Level >35 suggest cancer, available in some private clinics cost £300-£400

  30. Abiraterone • Metastatic prostate cancer • CYP17 inhibitor, ablates androgens and oestrogen synthesis in tissue • Currently in phase III trials • Need to take in conjunction with high dose steroids

  31. The next Foundation Trust Health Seminar will take place on: Monday 11th April 2011 10.30-11.30 am in the Lecture Theatre , Education Centre, BVH The topic is: “A better tomorrow starts today – Making steps towards a healthier lifestyle.”

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