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Prostate cancer. Key slides. Diseases of the prostate www.cancerscreening.nhs.uk/prostate. Prostate cancer malignant growth of prostate cells, localised and may spread nearly all prostate cancers are adenocarcinomas, mainly occurring in the peripheral zone of the prostate gland

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Prostate cancer l.jpg

Prostate cancer

Key slides


Diseases of the prostate www cancerscreening nhs uk prostate l.jpg
Diseases of the prostatewww.cancerscreening.nhs.uk/prostate

  • Prostate cancer

    • malignant growth of prostate cells, localised and may spread

    • nearly all prostate cancers are adenocarcinomas, mainly occurring in the peripheral zone of the prostate gland

    • rare in men under 50, and is more common with increasing age

  • Benign prostatic hyperplasia

    • non-malignant increase in size of the prostate with age

    • rare in men under 50

  • Prostatitis

    • inflammation of the prostate

    • can occur in men of any age

The early symptoms of prostate diseases are very similar


Clinical features of prostate cancer www cancerscreening nhs uk prostate prostate booklet text pdf l.jpg

Prostate cancers (unlike BPH) tend to develop in the outer part of the prostate gland

Unusual for early cancers to cause any symptoms

Locally advanced prostate cancers that have extended outside the capsule are also frequently without symptoms

If the tumour is large enough, it can cause lower urinary tract symptoms (LUTS) eg frequency, urgency, hesitancy, leaking, but by the time this happens the cancer will usually have reached an advanced stage

LUTS are similar to those of BPH. Most men with LUTS will not have prostate cancer

Often the first sign of prostate cancer is evidence of metastases (frequently in bone, causing bone pain)

About 20–30% of patients in the UK present with metastatic disease

Clinical features of prostate cancerwww.cancerscreening.nhs.uk/prostate/prostate-booklet-text.pdf


Overview initial investigations l.jpg
Overview: Initial investigations part of the prostate gland

  • Symptoms may occur only when the cancer is advanced and may be similar to BPH

  • Offer a DRE and a PSA test after counselling to patients with symptoms suggestive of prostate cancer before referral to a specialist

  • There is no criterion for PSA level below which men may be reassured that they do not have prostate cancer, nor an agreed level that is considered diagnostic

  • Transrectal ultrasound biopsy (TRUS) should be offered after discussion of the likely risks and benefits to the patient


Slide5 l.jpg

www.nice.org.uk/CG58 part of the prostate gland

TREATMENTS

Localised

Watchful waiting

Active surveillance

Radical prostatectomy

External beam radiotherapy

Brachytherapy

Metastatic

Orchidectomy or continuous LHRHa

Bicalutamide or androgen withdrawal

Intermittent androgen withdrawal

Hormone refractory

Docetaxel

Corticosteroids

Spinal MRI (spinal metastases)

Decompression of urinary tract (obstructive uropathy)

Palliative care

Managing side effects of treatment

Erectile dysfunction (PDE5 inhibitors first line)

Urinary incontinence – refer for possible artificial sphincter

Side effects of hormonal treatments

Hot flushes — progestogens

Gynaecomastia with bicalutamide — radiotherapy to breast buds (or tamoxifen if fails)

Painful bone metastases – strontium-89 or bisphosphonates

High Intensity Ultrasound or Cryotherapy

Only as part of a clinical trial

Localised advanced

Neoadjuvant and concurrent LHRHa with radiotherapy

Adjuvant hormonal therapy with radiotherapy

Pelvic radiotherapy


Slide6 l.jpg
Hormone therapy part of the prostate gland(androgen deprivation therapy)EAU Guidelines 2005; NICE TA101 2006; Damber JE, Aus G. Lancet 2008;371:1710–1721

  • Prostate cells are physiologically dependent on androgens (mainly testosterone) to stimulate growth, function and proliferation

  • The testes are the source of 90–95% of androgens (5–10% from adrenal glands)

  • If prostate cells are deprived of androgenic stimulation, they undergo apoptosis (programmed cell death)

  • Any treatment that ultimately results in suppression of androgen activity is called androgen deprivation therapy (ADT)

  • Can be achieved by suppressing secretion of the testicular androgens (castration, LHRH agonists), by inhibiting the action of circulating androgens (anti-androgens), or both (complete androgen blockade)


Methods used for androgen depletion nice improving outcomes in urological cancers 2002 l.jpg
Methods used for androgen depletion part of the prostate glandNICE. Improving outcomes in urological cancers. 2002


Slide8 l.jpg
NICE recommendations for managing the complication of hormonal therapy NICE Clinical Guideline and Full Guideline 58;2008

  • Offer oral or synthetic progestogens for hot flushes. Offer oral therapy for 2 weeks and re-start when flushes recur, if effective

  • Offer prophylactic radiotherapy to breast buds within the first 6 months of long-term (>6 months) treatment with bicalutamide

  • Consider weekly tamoxifen if radiotherapy does not prevent gynaecomastia

  • Do not routinely offer bisphosphonates to prevent osteoporosis in men receiving androgen withdrawal

    • More research is needed into the prevention and management of osteoporosis in men receiving long-term withdrawal deprivation therapy (NICE)


Prescribing trends l.jpg
Prescribing trends hormonal therapy


Summary l.jpg
Summary hormonal therapy

  • Prostate cancer is the most common cancer in men, and is second only to lung cancer in terms of cancer deaths

  • Unusual for early cancers to cause any symptoms

  • Offer a DRE and a PSA test after counselling to patients with symptoms suggestive of prostate cancer before referral to a specialist

  • NICE guidance makes disease staging-based treatment recommendations

  • Androgen deprivation therapy recommended for locally advanced and metastatic disease


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