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Prostate cancer

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Prostate Biopsy Diagnosis Grading Gleason grade Diagnosis Staging TNM Treatment ... PCA 3 Urine test post prostatic massage Prostate cancer gene 3 ... – PowerPoint PPT presentation

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Title: Prostate cancer


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

Family History Relative Risk Absolute risk ()
None 1 8
Father or brother 2 15
Father or brother lt60 years 3 20
Father and brother 4 30
Hereditary prostate cancer 5 35-45
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?

Age Range Normal PSA range (ng/ml)
All ages lt4.0
40-49 lt2.5
50-59 lt3.5
60-69 lt4.5
gt70 lt6.5
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?

PSA ng/ml Risk for prostate cancer
0.0 - 0.5 6.6
0.6 1.0 10.1
1.1 - 2.0 17.0
2.1 3.0 23.9
3.1 4.0 26.9
50-66 year old Thompson IM et al N Eng J Med
2004350(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 individuals 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
Metastatic disease
  • First line GnRH analogues or orchidectomy
  • Second/Third line hormones (anti-androgens)
  • MAB
  • Steroids and chemotherapy
  • Trials
  • Palliative care

27
Blue Skies 10km Run for Prostate Cancer
28
Thank you
  • Any questions?

29
(No Transcript)
30
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 gt35 suggest cancer, available in some
    private clinics cost 300-400

31
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

32
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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