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CA of Prostate:Incidence

CA of Prostate:Incidence. In a 50 y/o man In autopsy: 40% Clinical: 10% Death: 3% Most common non- cutanous diagnosed cancer Second cause of cancer death. Risk factors. Age: peak 68 yrs, 63% in >65 yrs Race: African-American Family history (4-7 times)

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CA of Prostate:Incidence

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  1. CA of Prostate:Incidence In a 50 y/o man In autopsy: 40% Clinical: 10% Death: 3% Most common non-cutanous diagnosed cancer Second cause of cancer death

  2. Risk factors • Age: peak 68 yrs, 63% in >65 yrs • Race: African-American • Family history (4-7 times) • Fatty meal ( 2 times) • Androgen • IGF-1 • Inflamation and infection

  3. CA of prostate (Pathology) • Adenocarcinoma 95% • Transitional cell carcinoma 5% • Peripheral zone 60-70% • Transitional zone 10-20% • Central zone 5-10% • Basal cell layer, Architecture • PIN: HGPIN, LGPIN

  4. Grade and stage • Gleason grade and score • Well differentiated:2-4 • Moderate differentiated :4-6 • Poor differentiated : 8-10 • 7 ??? • Staging by DRE and TRUS not biopsy

  5. CA of prostate (progression) • Volume and grade are important factors • Lymph node: obturator,common iliac, periaortic • Bone: lumbar vertebra,femur,pelvis • Visceral: lung, liver, adrenal gland

  6. CA of prostate (clinical findings) • Mostly asymptomatic • Obstructive and irritative urinary symptom • Bone pain, cord compression • Lymphedema • DRE

  7. CA of prostate (paraclinical finding) • Azotemia • Anemia • Acid phosphatase • Alkaline phosphatase (bone metastasis) • PSA

  8. CA of prostate and PSA • Not specific • PSA velocity:0.75 ng/yr in 18 months • PSA density:0.12 gm in BPH,>0.1-0.15 • PSA and age: 40-49 yrs 2.5,70-79 yrs 6.5 • Molecular form: 90% bound, F/T>25%

  9. CA of prostate (imaging) • TRUS: BX, staging, volume, brachytherapy • Endorectal MRI,MRS (sensitivity 50-90%) • CT and MRI: R/O node metastasis, sensitivity 40-50% • Bone scan: most common metastasis, negative if PSA<10 ng

  10. CA of prostate (treatment) • Watchful waiting • Radical prostatectomy • EBRT • Brachytherapy • Cryosurgery + HIFU • Hormone therapy • Systemic chemotherapy

  11. Watchful waiting • No therapeutic benefit for radical Rx of early stage prostate cancer • Small, well diferentiated pc are associated with very slow growth rate • Appropriate treatment for highly selected patients: old wit small well diferentiated cancers

  12. Radical prostatectomy • Prognosis correlates with the pathologic stage and grade • Retropubic, perineal, laparascopic • Immediate complications: blood loss, rectal injury, ureteral injury • Late complications: urinary incontinence, impotence • Total incontinence:3%, stress 20%

  13. Radical prostatectomy • Return of incontinence is gradual • Age is the single most important factor in restoration of incontinence • Nerve sparing surgery • Preservation of potency depend on age, preoperative sexual function and preservation of one or both neurovascular bundle

  14. Raditherapy • External beam radiotherapy (XRT) • Conformal radiotherapy • Less normal tissues is irradiated • Better PSA response • Brachytherapy • Precise dose of radiotherapy by TRUS can be applied

  15. Cryotherapy • For treatment of localized prostate cancer • 5 probe by TRUS • Cell destruction needs -25 to -50c • Morbidity is significant • Long term results are unknown • In short term result in –ve post treatment biopsy and low or undetectable PSA

  16. Hormonal therapy for PC. GnRH-agonists • Leuproreline, Busereline, Gosereline • All product are equal in casteration in terms of effectiveness • First injection will result in temporary increase of serum testostrone • Side effects: impotence, loss of libido, hot flashes, anemia, osteoprosis, weight gain, mood changes

  17. Hormone therapy pc GnRH antagonists • Directly blocking the GnRH receptors • Available in depot injections • Avoid the flare-up reaction • Faster suppression of testosterone than GnRH agonists • Side effects: as GnRH agonists + histamine mediated reactions

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