PROSTAT KANSERI

1. PROSTAT KANSERI Doç.Dr.Cevdet Kaya Haydarpasa Numune Egitim ve Arastirma Hastanesi 2.Üroloji Klinigi, Istanbul

2. Sunum Plani 1. Prostat nedir? 2. Prostat kanseri 3. Nasil olusur? 4. Tarama 5. Teshis 6. Tedavi 7. Prostat kanseri önlenebilir mi?

3. Prostat nedir?

4. Prostatin görevi nedir?

5. Prostatin büyümesi

6. Prostat büyürse ne olur?

7. Prostat kanseri nedir?

8. Prostat kanseri nasil yayilir?

9. Prostat kanseri ne kadar sik?

10. Tahmini Yeni Kanser Vakalari 2009 ABD’de erkeklerde kanser ölümlerinin ikinci en sik sebebi prostat kanseri. 2009 yilinda tahmini 192 binin üzerinde yeni olgu var. Erkeklerdeki yeni kanserlerin %26’sini olusturur ve 27.000 ölüm vakasina yol açtigi tahmin edilmekte.ABD’de erkeklerde kanser ölümlerinin ikinci en sik sebebi prostat kanseri. 2009 yilinda tahmini 192 binin üzerinde yeni olgu var. Erkeklerdeki yeni kanserlerin %26’sini olusturur ve 27.000 ölüm vakasina yol açtigi tahmin edilmekte.

11. Histolojik (önemsiz) kanser otopsi çalismalarinda çok sik Önemsiz prostat kanseri 20-40 yas grubu erkeklerin 4-5’inden birinde Kanserin farkinda degil, tedaviye gerek yok ve bu hastaliktan hayatini kaybetmez Most researchers have agreed that cancer progression is proportional to tumor volume. The cutoff point of 0.5 ml for clinically significant CaP was described by Stamey and colleagues (1993). Primary tumor volume is also associated with local extent of the cancer and survival (Gann 1995). Chart adapted from Barry, MJ, 2001, Early Detection of Prostate Cancer, a presentation at the Society for General Internal Medicine. Data on this chart comes from autopsy studies performed on males during the 1940s and 1950s. Several autopsy studies of men from different countries and without a prostate cancer diagnosis at death document the large numbers of unsuspected prostate cancers in the general population. A recent autopsy study of 249 U.S. men found unsuspected prostate cancers in 30% of men in their 20s and 30s, and in more than 50% of men over age 50 (Sakr et al., 1994). Most researchers have agreed that cancer progression is proportional to tumor volume. The cutoff point of 0.5 ml for clinically significant CaP was described by Stamey and colleagues (1993). Primary tumor volume is also associated with local extent of the cancer and survival (Gann 1995). Chart adapted from Barry, MJ, 2001, Early Detection of Prostate Cancer, a presentation at the Society for General Internal Medicine. Data on this chart comes from autopsy studies performed on males during the 1940s and 1950s. Several autopsy studies of men from different countries and without a prostate cancer diagnosis at death document the large numbers of unsuspected prostate cancers in the general population. A recent autopsy study of 249 U.S. men found unsuspected prostate cancers in 30% of men in their 20s and 30s, and in more than 50% of men over age 50 (Sakr et al., 1994).

13. Prostat kanseri neden kaynaklanir?

15. Prostat kanseri bulgulari?

16. Prostat kanserini kim tedavi eder?

17. Nasil teshis edilir?

20. Nasil teshis edilir?

21. Nasil teshis edilir?

22. PSA hangi durumlarda artar?

23. Serbest PSA PSA hizi PSA degisikligi > 0.75 ng/ml/yil Yasa uygun PSA PSA seviyesi yasla birlikte artar PSA yogunlugu Serum PSA/prostat hacmi (USG) PSA yüksekse biyopsi mi? The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)

24. Left graphic representation: Prostate cancer can be localized within the gland as represented by the tumor on the lower part of the prostate gland or it can break through the capsule and invade nearby tissues. Right graphic representation: Prostate cancer cells can escape the prostate and invade the lymph nodes that drain the prostate. From there these cells can invade other organs. Prostate cancer cells preferentially invade bones.Left graphic representation: Prostate cancer can be localized within the gland as represented by the tumor on the lower part of the prostate gland or it can break through the capsule and invade nearby tissues. Right graphic representation: Prostate cancer cells can escape the prostate and invade the lymph nodes that drain the prostate. From there these cells can invade other organs. Prostate cancer cells preferentially invade bones.

26. Dogal Seyir

27. Adenokarsinom (%98) Hastaligin derecesi Gleason Skoru Skor arttikça kanser daha kötü Kanser tanisi nasil konuluyor? The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)

28. Erkegi yada disisi yok Kanserin derecesi var Yayilma ihtimali? Nüks eder mi? Kanser disisi mi? The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)

29. Prostat kanserinde tedavi The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)

30. Her hastada ayni tedavi mi? The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)The limitations of PSA velocity include: 1) difficult to calculate; 2) non-specific nature of PSA and tendency to vary over time; 3) confounding by ejaculation, prostatitis, and pharmacologic agents; 4) the need to have at least 3 measurements over a two year period. More work is needed to refine the use of free-PSA percentages as the patient’s age and prostate volume will influence the free-PSA ratios. In addition, the type of assay used, the method of specimen storage and time for processing affect the stability of free PSA in collected serum. Physicians need to be aware of these factors when using free PSA. (See Partin and Stutzman. Office management of urologic problems. Urologic clinics of North America, 1998;25(4):581-93.)

31. Düsük, orta, yüksek riskli hastalik Partin tablosu Kattan tablosu D’Amico siniflandirmasi Kan testinin ikiye katlanma zamani Hastaligin seyrini nasil belirliyoruz?

32. Kattan Nomogrami

33. Kimler sadece takip edilir?

34. Genel anestezi Insizyon:10-12 cm Üretra-mesane boynu tekrar birlestirilir Radikal Prostatektomi

35. Ameliyat süresi 2.5 saat Prostat, seminal veziküller, lenf dokulari Diren 2-3.gün, taburcu Dikisler 7.gün ve sonda 2 hafta Kegel egzersizi idrar tutmayi saglar Nasil bir ameliyat?

36. Ameliyata bagli yan etkiler Ameliyat sirasinda ve hemen sonrasinda Ciddi kanama, rektum yaralanmasi, derin ven trombozu, emboli Geç dönemde Idrar kaçirma (%5-20) Sertlesme bozuklugu (%40-60) Idrar kesesi çikisinda darlik (%5-15) Hastayi ne bekler?

37. Ameliyat sonrasi hastaliga ait uzun yasam Çok sayida hastada tam iyilesme 10 yilda: %90-97.6 15 yilda: %82 Ameliyat basarisi nedir?

39. Cerrah 3 boyutlu ekranli konsoldan operasyon sahasindaki cerrahi aletleri kontrol eder Robotik kollar parmak, el ve bilek hareketlerini yönetir Kisa ögrenim egrisi Maliyet-Fayda?

46. Ilk teshiste % 20’si (evre 3) Bunlarda tümör yayilma egiliminde Lenf bezelerinde tümör ihtimali yüksek (%40) Kemik yayilimi arastirilir Ameliyat tek basina yetersiz (sadece 5’te birinde) Ilaç yada isin tedavisi eklenir

47. Genel durumu iyi ve en az 10 yillik yasam süresi Küçük hacimli tümör Kemikler ve lenf bezeleri temiz hastalar

50. Hormona dirençli Prostat Kanseri Hormona baslangiçta tedavi çok iyi Zamanla hormona dirençli Ortalama yasam Kemoterapi Lokal radyoterapi Radyoizotoplar (Str-89)

51. Hipertermi Lazer ablasyon Alternatif tip Nar suyu Ginseng Vitamin D Asilar

52. Finasterid ilaci (Avodart) Bitkisel tedavi Yesil çay sarimsak Mikrobesinler Likopen/karoten selenyum vitamin E vitamin D Diyet önlemleri Yag azaltmak

53. Prostat Kanseri Önleme Çalismasi 55 yas üstü 18 bin erkek 9 bin erkek, PSA<3.0 Iki kol, Finasterid 5 mg Finasterid, prostat kanseri gelisme riskini %25 azaltti (%24, %18) Yüksek dereceli kanserler

54. Kanserin klinik teshisi öncesi sürecinin uzun olmasi erken taniya olanak saglar Metastatik prostat kanserinin yikici etkileri Mortalite oraninin %25 azalmasi Kolay ve ucuz tarama testlerinin bulunmasi (PRM ve PSA) Erken evre hastalik için tedavi alternatifleri A review of the literature can lead to strikingly different opinions on the effectiveness of prostate cancer screening. The lengthy preclinical detectable phase (PCDP) of prostate cancer allows for therapeutic intervention before the prostatic capsule has been penetrated and metastasis has occurred (rendering CaP incurable). Before the widespread use of the screening methods such as PSA and TRUS, more than 40% of men diagnosed with CaP presented with advanced disease (Hostetler 1996). The screening tools—PSA and DRE—have these advantages plus a very high acceptance rate among the population at risk. American men volunteer for screening programs in extraordinarily high numbers; the level of participation among European men is comparable and surpasses numbers for breast and cervical cancer trials within the same geographic area (Fried 1997). In the United States, the most common intervention for clinically localized CaP (some 70% of all newly diagnosed cases) is prostatectomy, followed by radiotherapy. Both of these modalities experience approximately the same success rates (Ciatto et al. 2000). Proponents of screening view the decrease in CaP mortality as the trump card in the screening debate, and attribute the trend to more widespread use of screening, particularly the PSA test. The decrease in mortality may be attributable to the earlier stage at diagnosis that has occurred with the advent of PSA testing. Earlier stage at diagnosis translates into more favorable 5-year survival rates for CaP patients. A review of the literature can lead to strikingly different opinions on the effectiveness of prostate cancer screening. The lengthy preclinical detectable phase (PCDP) of prostate cancer allows for therapeutic intervention before the prostatic capsule has been penetrated and metastasis has occurred (rendering CaP incurable). Before the widespread use of the screening methods such as PSA and TRUS, more than 40% of men diagnosed with CaP presented with advanced disease (Hostetler 1996). The screening tools—PSA and DRE—have these advantages plus a very high acceptance rate among the population at risk. American men volunteer for screening programs in extraordinarily high numbers; the level of participation among European men is comparable and surpasses numbers for breast and cervical cancer trials within the same geographic area (Fried 1997). In the United States, the most common intervention for clinically localized CaP (some 70% of all newly diagnosed cases) is prostatectomy, followed by radiotherapy. Both of these modalities experience approximately the same success rates (Ciatto et al. 2000). Proponents of screening view the decrease in CaP mortality as the trump card in the screening debate, and attribute the trend to more widespread use of screening, particularly the PSA test. The decrease in mortality may be attributable to the earlier stage at diagnosis that has occurred with the advent of PSA testing. Earlier stage at diagnosis translates into more favorable 5-year survival rates for CaP patients.

55. Lokalize prostat kanseri hastalarinda 5 yillik sürvi orani %100 Ileri evre kanser olgularinda 5 yillik sürvi sadece %40 Erken Tani

56. Amerikan Kanser Dernegi (ACS), en az 10 yillik hayat beklentisi olan erkeklerde 50 yasindan itibaren yillik PSA testi ve PRM Yüksek risk grubuna daha erken yaslarda (40-45) tarama önerilmekte Afrikan-Amerikan erkekler Bir veya daha fazla 1.derece akrabasinda PCa öyküsü olan Taramanin yararlari ve potansiyel riskleri? The American Cancer Society’s official stance is that “the majority of available evidence, though not conclusive, supports the view that prostate cancer screening can save lives….[and] recommends that health care providers offer men 50 years or older the option of testing for early detection of prostate cancer….discussing the potential benefits, side effects, and questions regarding early prostate cancer detection and treatment, so that men can make informed decisions about testing.” (American Cancer Society website: <<http://www3.cancer.org/cancerinfo/main_cont.asp>>) The American Urological Association, Inc.® (AUA) endorses the American Cancer Society's policy statement on Early Detection of Prostate Cancer as follows: "Both prostate specific antigen (PSA) and digital rectal examination (DRE) should be offered annually, beginning at age 50 years, to men who have a life expectancy of at least 10 years. Men at high risk should begin testing at age 45. Information should be provided to patients about benefits and limitations of testing. Specifically, prior to testing, men should have an opportunity to learn about the benefits and limitations of testing for early prostate cancer detection and treatment. Men who ask the clinician to make the testing decision on their behalf should be tested. A clinical policy of not offering testing, or discouraging testing in men who request early prostate cancer detection tests, is inappropriate. High risk groups include men of African descent (specifically, sub-Saharan African descent) and men with a first-degree relative diagnosed at a young age. Risk increases with the number of first-degree relatives affected by prostate cancer. The workgroup recommended that these men begin testing for early prostate cancer detection at age 45. Among men of African descent, age-specific risk increases steadily beginning at age 45. Men at appreciably higher risk of prostate cancer due to multiple first-degree relatives who were diagnosed with prostate cancer at an early age could begin testing at age 40. However, if PSA is less than 1.0 ng/dl, no additional testing is needed until age 45. If PSA is greater than 1.0 ng/dl but less than 2.5 ng/dl, annual testing is recommended. If PSA is 2.5 ng/dl or greater, further evaluation with biopsy should be considered. Men at high risk also should be informed about the benefits, limitations, and uncertainties associated with testing for early prostate cancer detection." (American Cancer Society, Prostate Cancer Screening Guideline, Jan Feb 2001 Issue of CA - A Cancer Journal for Clinicians). The American Cancer Society’s official stance is that “the majority of available evidence, though not conclusive, supports the view that prostate cancer screening can save lives….[and] recommends that health care providers offer men 50 years or older the option of testing for early detection of prostate cancer….discussing the potential benefits, side effects, and questions regarding early prostate cancer detection and treatment, so that men can make informed decisions about testing.” (American Cancer Society website: <<http://www3.cancer.org/cancerinfo/main_cont.asp>>) The American Urological Association, Inc.® (AUA) endorses the American Cancer Society's policy statement on Early Detection of Prostate Cancer as follows: "Both prostate specific antigen (PSA) and digital rectal examination (DRE) should be offered annually, beginning at age 50 years, to men who have a life expectancy of at least 10 years. Men at high risk should begin testing at age 45. Information should be provided to patients about benefits and limitations of testing. Specifically, prior to testing, men should have an opportunity to learn about the benefits and limitations of testing for early prostate cancer detection and treatment. Men who ask the clinician to make the testing decision on their behalf should be tested. A clinical policy of not offering testing, or discouraging testing in men who request early prostate cancer detection tests, is inappropriate. High risk groups include men of African descent (specifically, sub-Saharan African descent) and men with a first-degree relative diagnosed at a young age. Risk increases with the number of first-degree relatives affected by prostate cancer. The workgroup recommended that these men begin testing for early prostate cancer detection at age 45. Among men of African descent, age-specific risk increases steadily beginning at age 45. Men at appreciably higher risk of prostate cancer due to multiple first-degree relatives who were diagnosed with prostate cancer at an early age could begin testing at age 40. However, if PSA is less than 1.0 ng/dl, no additional testing is needed until age 45. If PSA is greater than 1.0 ng/dl but less than 2.5 ng/dl, annual testing is recommended. If PSA is 2.5 ng/dl or greater, further evaluation with biopsy should be considered. Men at high risk also should be informed about the benefits, limitations, and uncertainties associated with testing for early prostate cancer detection." (American Cancer Society, Prostate Cancer Screening Guideline, Jan Feb 2001 Issue of CA - A Cancer Journal for Clinicians).