Westra: Prevention and Treatment of Carcinoma Flashcards
MC cancer in men
prostate cancer
MC age group at dx for prostate caancer
65-74
ethnic group w/ highest incidence and death rate
AA
only RFs incorporated into current screening recommendations
African American
family hx
male relatives of bresat cancer pts BRCA 1/2
man w/ 1st degree relative w/ prostate cancer 2x
increases risk of prostate cancer
folic acid, dairy and Ca relation to PC
increases risk possibly
high plasma testosterone levels
increase risk of PC
dioxin
exposed on the ground in Vietnam
increases risk of PC
may decrease risk of prostate cancer
lycopene
folate
finasteride and dutasteride
decrease INCIDENCE of prostate cancer
decrease size w/ BPH
pt w/ PC will most likley have what sxs
Asymptomatic or sx of lower UT obstruction
hip/back pain
difficulty/frequent urination
hematuria
PC
Detection fo PC
PSA
digital rectal exam
transrectal US
biopsy
normal PSA
<4
*usually total
PSA 4-10
borderline
PSA >10
high
*higher hte PSA the more likley the presence of PC
PSA velocity
measures how quickly PSA rises over period of time
change of >75 rise in one year is SIGNIFICANT
most prostate cancer begs in posterior part of gland in what zone?
peripheral zone
if digital rectal exam is abnormal?
trans-rectal US
important tool to assess size of prostate and identify areas that need to be biopsied
transrectal US
what is the screening controversy around PSA
unclear whether the PSA blood test saves lives or whether it exposes men to unnecessary physical and emotional anguish
USPSTF recommends
AGAINST PSA screening in healhty asymptomatic men regardless of RF
when can you start screening African american males?
age 40-45
ACS recomends taht you should screen
age 50 for average risk and lifetime survival of 10 years
40-45 for high risk men
when to take a biopsy
abnormality palpated by DRE
elevated PSA on age adjusted reference range
PSA velocity >.75
previous neagative biopsy but increasing PSA
what are most prostate cancers?
adenocarcinomas
55 y/o M nocturia normal DRE PSA 6 subsequent biopsy+ for adenocarcinoma
radical prostatectomy
He’s 55!
radiation woried about rectal problems and diarrhea
a little young for orchiectomy
78 y/o M increased freq/hesitancy nodular DRE PSA 15 Pos biopsy
RADIATION Therapy
he’s doing to well for active surveillance
Don’t want bone mets
74 y/o M severe O2 dep COPD hesitancy enlarged prostate on DRE PSA 8 declined biopsy
active surveillance
if he is really worried you can talk about radiation
wound need to do biopsy first
94 y/o
firm nodular prostate
urinary retention
PSA 100
bilateral orchiectomy and transurethral resection
decreased testosterone and let him go to the bathroom
less aggressive tumors
>70 w/ co existent illnesses
potential tx SE
palliative therapy
active surveillance
radical prostatectomy
removal of prostate and seminal vesicles
50-65 w/out comorbidities
only occurs if cancer has not spread outside prostate gland
SE of radical prostatectomy
impotence
urinary incontinence
transurethral resection
removes cancerous section of PG
destroys prostate cancer by freezing the prostate tissue w/ cryoprobes
cryosurgery
complications of cryosurgery
bladder outlet injury
urinary incontinence
impotence
radiation therapy for pts not candidate for radical prostaectomy
Extrernal beam radation for T3 and T4
> 70
damage rectum, impotency, urinary incontinence
tx for locally advanced prostate cancer
hormonal therapy
LHRH agonists> decrease amt of testosterone in hte body
tx for progressive disease or recurrent after tx, metastatic disease
docetaxel + prednisone
Cabazitaxel
best way to monitor for recurrent cancer
PSA
