Prostate Cancer Flashcards
At what PSA lvl should you start to worry?
- Anything >4.0ng/ml
Location of prostate cancer chart
Prostate cancer cases and deaths statistics
- Prostate cancer estimated new cases in 2017 is #1 for all cancers
- Prostate cancer estimated deaths in 2017 is #3 for all cancers
Males lifetime risk of developing prostate cancer
- 1 in 6; ~16.7%
Prevalence of prostate cancer among men 30-40
- 29%
Prevalence of prostate cancer among men 60-70
- 64%
Percent of males who die from prostate cancer in the U.S.
- 3.5%
Risk factors for prostate cancer - Race
- More common amoung African-American men
- More likely diagnosed at advanced stage
- 2x more likely to die of the disease
- Less common in Asian-American and Hispanic-American men than non-Hispanic whites
Risk factors for prostate cancer - Family History
- 1st degree relatives, father, brother
Risk factors for prostate cancer - Age
- Rare before 40; 65% over the age of 65
Risk factors for prostate cancer - Diet
- Obesity and smoking
- High in red meat and low in fruits/veggies
Finasteride for prostate cancer prevention
- Found to reduce the risk of prostate cancer in low-risk disease; overall reduction was insignificant
- 5-alpha reductase inhibitor, blocks intracellular conversion of testosterone to DHT
- Reduced the incidence of prostate cancer (6% absolure; 25% relatvie risk reduction)
*reduced risk of Gleason <6
*slight increase of Gleason = 8-10
- However, long-term f/u showed equivalent overall and CSS, whether they took 5ARI or not
- FDA did NOT approve 5ARIs for prevention of PCA
Selenium and Vit. E for prostate cancer prevention
- The selenium and vitamin E cancer prevention trial (SELECT)
- Randomized placebo-controlled trial of Vit. E and selenium, alone or in combo
- Failed to demonstrate reduction in prostate cancer
- Multiple other trials (Vit. C, soy, lycopene, and MVI) appear to be ineffective for prevention of PCa)
How do reduce the risk of prostate cancer?
- Don’t smoke
- Lose weight
- Eat less red meat
- Eat plent of fruits and vegetables
Prostate cancer presentation
- Most pts are asymptomatic
*since PSA screening: 75% PTs present asymptomatic localized disease
- Most PCA diagnosed due to elevated PSA or abnormal DRE
- Advanced cancer may present with:
*bone pain, unintentional weight loss, hematuria, worsening LUTS, urinary retention, hydronephrosis, LE weakness/leg numbness/difficulty w/ ambulation
Prostate cancer screening
- Controversial
- >90% of Pca detected by screening are organ-confined (not lethal)
- Advantages
*may prolong survival and save lives
*save men from long painful death w/ little effective treatments available
- Disadvantages
*overdiagnosis which leads to overtreatment
*potential decrease in QOL from treatment
Indications for prostate biopsy
- The decision to biopsy should be multifactorial: age, risk factors, symptoms and other clinical parameters
- Pts w/ PSA lvls beyond age adjusted lvls (chart included)
- Abnormal DRE - nodules and asymmetry
- PSA density >0.15
- PSA velocity (sudden increase in PSA)
- % free PSA = lower % free PSA > risk of Pca
- Other genomic testing and prostate MRI
Pts. PSA last year was 3.0 ng/ml. This year = 4.2 ng/ml, + DRE. What is the next step?
- 12 core prostate biopsy
Gleason score
- Grading system for prostate cancer testing
- Grading is based on architectural pattern of the prostate gland
- 2 most abundant patterns are graded 1-5
- Score is reported as the most abundant grade plus the 2nd most abundant grade
- The higher the grade and sum = worse prognosis (ie 4+3=7 worse than 3+4=7)
What does the “grade” of prostate tumor mean?
- Grade of a tumor is predictive of its likelihood to spread beyond confines of the prostate, affecting curability
- 12% of low-grade tumors (2-4) spread beyond prostate in 10yrs
- 33% of medium-grade tumors (5,6) spread beyond prostate in 10yrs
- 61% of high-grade tumors (7-10) spread beyond prostate in 10yrs
Prostate cancer metastasis
- Spreads in a step-wise fashion
*prostate —> pelvic LNs —> spine —> pelvic bones
- Risk of spread can be calculated using nomograms
- Advanced disease can have direct invasion of rectum and bladder
Prostate cancer staging
- PSA lvl, DRE and biopsy pathology form the core components of clinical staging
- CXR, bone scans and CT/MRIs do NOT play a standard role in staging
*usually ordered if PT high risk of mets or local spread to nodes/seminal vesicles (ie PSA > 20, Gleason score >8)
Avg. doubling time of prostate tumor
- 2-4 yrs
