Westra: Prostate Screening Flashcards
what is the most common age group at diagnosis of prostate cancer?
65-74 yrs old
men in the U.S. have a ___ in ____ lifetime risk of being diagnosed with prostate cancer
1/6
what is the most common cancer detected in men?
prostate cancer
what RACE has a higher incidence rate for prostate cancer?
AFRICAN AMERICAN MEN
what RACE has a higher death rate due to prostatic cancer?
AFRICAN AMERICAN MEN
____ and ____ are the only risk factors incorporated into the current screening recommendations.
Race, Family Hx (men w/ father or brother with prostate cancer are 2x as likely to develop prostate cancer)
T or F: male relatives of breast cancer patients have a higher incidence of prostate cancer
True. BRCA2 more associated
what dietary choices can increase risk of prostate cancer?
Folic acid. (Diary and calcium….)
**what hormonal levels cause an increased risk of prostatic cancer in men?
high plasma testosterone levels
what occupational/chemical exposure increases risk of prostate cancer?
Dioxin “agent orange” (Vietnam War era)
what is a protective agent for prostate cancer in the diet?
Folate
what exactly is a PSA?
Protein specific antigen. it is a blood test used to measure a protein made by prostate cells. less than 4 ng/ml normal. 4-10 borderline. greater than 10 high
PSA _____ = reflects relationship between PSA level and size of gland measured by transrectal ultrasound
Density
PSA _____ = measures how quickly PSA level rises over period of time.
Velocity. a change of >0.75 ng/ml rise in one year is signficant
if a Digital Rectal Exam (DRE) is abnormal, what is the recommended next step?
Trans-rectal Ultrasound (TRUS)
when would you perform a prostate biopsy?
abnormal palpated by DRE. PSA elevated based on age-adjusted range. PSA velocity >0.75. previous negative biopsy but continually increasing PSA.
What is the TX strategy for a patient who has less aggressive tumors, greater than 70 with co-existent illnesses, potential treatment side effects, palliative therapy? (A) Active Surveliance (B) Surgery (C) Cryosurgery (D) Chemotherapy (E) Hormonal therapy
A
What does a radical prostatectomy consist of?
removal of prostate and seminal vesicles
what are side effects of surgery?
impotence (1/36) and urinary incontinence (1/81)
when should you perform surgery?
if less than 70yrs old, only if cancer HAS NOT spread outside of the prostate gland.
what exactly is Cryosurgery?
destroys prostate CA by freezing the prostate tissue with cryoprobes
Brachytherapy- what is it?
inserting radiation seeds into prostate under TRUS. (percutaneous perineal interstitial seed I125 or Palladium 123)
when is chemotherapy for prostate cancer use? examples of drugs?
for progressive disease or recurrent after treatment. Docetaxel combined with prednisone. cabazitaxel
what treatment strategy would you consider for 55 male with PSA 6, normal DRE and prostate biopsy positive for adenocarcinoma? (1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection
Radical Prostatectomy! He’s only 55.
what treatment strategy would you consider for 78 yr old male with PSA 15, nodular prostate and positive prostate biopsy?
(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection
Radiation therapy! will he get bone metastatsis??
what treatment strategy would you consider for 74 yr old male with severe oxygen dependent COPD with hesitancy and enlarged prostate on DRE. opted for PSA, declined biopsy?
(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection
Active surveillance.
comorbidities and over 70yrs old
what treatment strategy would you consider for a 94 yr old male with firm nodular prostate and urinary retention. opted for PSA 100?
(1) active surveillance (2) radical prostatectomy (3) radiation therapy (4) bilateral orchiectomy and transurethral resection
Bilateral orchiectomy and transurethral resection
if they had local disease, what are the surveillance recommendations?
DRE annually, PSA q 6-12mo for 5 yrs, then annually
