Prostate Cancer Prevention Flashcards
What is the estrimated incidence of prostate cancer?
233,000 incidence
it’s the most common male cancer
What age group typically gets the diagnosis?
65-74
What is the lifetime risk for a US male?
1 in 6
What is 5 year survival depending on stage at time of diagnosis?
99.2%
What ethnic group has highest risk?
African American males
note they also have higher death rates
Men with a father or brother wiht prostate cancer are ____ as likely to develop prostate cancer
twice
True or false: male relatives of breast cancer patients have a higher incidence of prostate cancer.
true - this is related to the BRCA2 mutation
Hereditary prostate cancer 1 locus is found on what chromosome?
1q24-25
What is the risk factor in diet?
Folic acid as a man-made supplement slightly increases the risk for prostate cancer
same is true with dairy and other high calcium foods
What about folate in foods?
that’s actually protective
Are men with higher plasma testosterone levels at increased risk?
probably
What are the occupational or chemical risk factors for prostate cancers?
polyaromatic hydrocarbons in coal, liquid fuel combustion products, metallic dust, lubricating oils and greases
aetic acid and acetic anhydrate - treating silk and photo film
Dioxin - agent orange - service connection with hx of agent orange exposure during the war
Does selenium and vitamin E decrease risk?
no
Does decreasing fats or increasing fruits help?
not known
What about lycopene?
some risks say that a diet high in lycopene may be linked to a decreased risk of prostate cancers, but others have not
Back to folate…what foods are high in it?
green veggies, beans, orange juice
What are the chemoprevention drugs for prostate cancer?
finasteride
dutasteride
but evidence is inadequate to determine whether it reduces mortality from prostate cancer
What are the signs and symptoms of prostate cancer?
difficulty initiating flow less force to the stream dribbling after urinating frequent urination hematuria dysuria pain with ejaculation hip or bone pain that doesn't resolve (met)
many will be asymtomatic though
What are the four ways we can potentially evaluate a prostate cancer?
PSA
Digital rectal
Transrectal US
Biopsy
What is a normal PSA and what is an abnormal?
less tan 4 ng/m normal
4-10 borderline
over 10 is high
take in context of the clinical situation too
Percent free PSA is what?
the stuff that isn’t protein bound - not really clinically useful
we usually check total
What is PSA velocity?
how quickly the PSA levels rise over a period of time
a change of over .75 ng/ml in one year is significant
What is PSA density?
reflects the relationhsip between the PSA level and size of gland measured by transrectal ultrasound TRUS
if you have high PSA compared to the actual size of the prostate, that’s concerning
Does the normal range depend on ethnicity? age?
yes - normal is lower for younger males and asian males
order from high to low goes black, white, hispanic, asian
What are the general PSA guidelines?
some say shared decision making
the USPSTF says don’t screen healthy asymptomatic men regardless of age, family history or ethnicity
Where does most prostate cancer occur?
in the posterior part of the peripheral gland - so we can typically feel it
If the digital rectal is abnormal, what do you do next?
transrectal US
What are the treatment options for prostate CA?
active suveillance surgery cryosurgery external beam radiation interstitial brachytherapy hormonal therapy chemotherapy
Active surveillance is often used for less aggressive tumors especially in what age group?
over 70 (or in those who have comorbidities that make surgery risky)
How often do you see peopl ein active surveillance?
see every 3 months during the first year and every 6 months after that
check urological function, quality of life, PSA and annual bone scan
What are the two general surgeries we can do for this?
radical prostatectomy (remove the prostate and seminal vesicles)
transurethral resection - removal of just the cancerous portion
What are the main side effects of these surgeries?
impotence and urinary incontinence
How does cryosurgery do?
freezes the prostate with cryoprobes to destroy the cancer
What are the two ways we do radiation therapy for this?
external beam radiation
brachytherapy - this is where they place permanent radioactive seeds in the prostate
What are the 4 options for hormonal therapy?
GnRH agonists
anti-androgens
orchiectomy
estrogens
What is the surveillance after you find locally disease?
DRE annually
PSA every 6-12 months for 5 years, then annually after that
What are the surveillance guidelines for advanced disease after treatment?
DRE every 3-6 months
PSA every 3-6 months
bone scan if signs of recurrence
If the cancer has metastasized at time of diagnosis, what is 5 yr survival?
28%
