Podcast
Questions and Answers
What percentage of prostate cancer cases diagnosed in 2009 were considered early disease?
What percentage of prostate cancer cases diagnosed in 2009 were considered early disease?
Which of the following factors is NOT considered to significantly increase the risk of prostate cancer?
Which of the following factors is NOT considered to significantly increase the risk of prostate cancer?
Which demographic is least likely to be diagnosed with prostate cancer?
Which demographic is least likely to be diagnosed with prostate cancer?
What was the primary finding of the Selenium and Vitamin E Cancer Prevention Trial regarding prostate cancer risk?
What was the primary finding of the Selenium and Vitamin E Cancer Prevention Trial regarding prostate cancer risk?
Signup and view all the answers
At what PSA level is prostate cancer most likely to be diagnosed?
At what PSA level is prostate cancer most likely to be diagnosed?
Signup and view all the answers
What is the approximate 15-year relative survival rate for prostate cancer patients?
What is the approximate 15-year relative survival rate for prostate cancer patients?
Signup and view all the answers
Which of the following is a common misconception about prostate cancer risk factors?
Which of the following is a common misconception about prostate cancer risk factors?
Signup and view all the answers
What is the role of the digital rectal exam in prostate cancer screening?
What is the role of the digital rectal exam in prostate cancer screening?
Signup and view all the answers
Which statement about prostate cancer statistics is true?
Which statement about prostate cancer statistics is true?
Signup and view all the answers
In what geographical areas is prostate cancer more commonly diagnosed?
In what geographical areas is prostate cancer more commonly diagnosed?
Signup and view all the answers
What is the primary purpose of the nerve-sparing procedure in Radical Retropubic Prostatectomy?
What is the primary purpose of the nerve-sparing procedure in Radical Retropubic Prostatectomy?
Signup and view all the answers
Which of the following is NOT a treatment for symptomatic metastatic disease?
Which of the following is NOT a treatment for symptomatic metastatic disease?
Signup and view all the answers
Which of the following describes Watchful Waiting in prostate cancer management?
Which of the following describes Watchful Waiting in prostate cancer management?
Signup and view all the answers
What type of radiation therapy involves the use of radioactive seeds implanted into the prostate?
What type of radiation therapy involves the use of radioactive seeds implanted into the prostate?
Signup and view all the answers
What are the neurovascular bundles associated with in prostate surgery?
What are the neurovascular bundles associated with in prostate surgery?
Signup and view all the answers
Which of the following is considered an initial therapy for locally advanced or metastatic prostate cancer?
Which of the following is considered an initial therapy for locally advanced or metastatic prostate cancer?
Signup and view all the answers
What is the role of chemotherapy in hormone refractory prostate cancer?
What is the role of chemotherapy in hormone refractory prostate cancer?
Signup and view all the answers
Which of the following factors is considered a risk factor for prostate cancer?
Which of the following factors is considered a risk factor for prostate cancer?
Signup and view all the answers
What is the benefit of early detection of localized prostate cancer?
What is the benefit of early detection of localized prostate cancer?
Signup and view all the answers
Which statement about hormonal therapy is correct?
Which statement about hormonal therapy is correct?
Signup and view all the answers
What is the probability of having prostate cancer for men with a PSA level in the range between 4 and 10?
What is the probability of having prostate cancer for men with a PSA level in the range between 4 and 10?
Signup and view all the answers
Which of the following conditions could potentially cause an increase in PSA levels?
Which of the following conditions could potentially cause an increase in PSA levels?
Signup and view all the answers
PSA Density is normalized related to what factor?
PSA Density is normalized related to what factor?
Signup and view all the answers
What does a lower Free PSA/Total PSA ratio suggest?
What does a lower Free PSA/Total PSA ratio suggest?
Signup and view all the answers
Which of the following symptoms is NOT commonly associated with prostate cancer?
Which of the following symptoms is NOT commonly associated with prostate cancer?
Signup and view all the answers
In the 2004 study of men never exceeding a PSA level of 4 ng/ml, what percentage had prostate cancer with a PSA level of 3.1 to 4.0 ng/ml?
In the 2004 study of men never exceeding a PSA level of 4 ng/ml, what percentage had prostate cancer with a PSA level of 3.1 to 4.0 ng/ml?
Signup and view all the answers
Which factor is associated with a decrease in PSA levels?
Which factor is associated with a decrease in PSA levels?
Signup and view all the answers
What significance does a PSA level exceeding 10 ng/ml hold for prostate cancer diagnosis?
What significance does a PSA level exceeding 10 ng/ml hold for prostate cancer diagnosis?
Signup and view all the answers
What is PSA Velocity?
What is PSA Velocity?
Signup and view all the answers
What percentage of men with cancer and low PSA levels had aggressive, rapidly multiplying high-grade tumors?
What percentage of men with cancer and low PSA levels had aggressive, rapidly multiplying high-grade tumors?
Signup and view all the answers
What is the recommended approach for screening men who are over the age of 70?
What is the recommended approach for screening men who are over the age of 70?
Signup and view all the answers
Which Gleason score range indicates the best prognosis for prostate cancer?
Which Gleason score range indicates the best prognosis for prostate cancer?
Signup and view all the answers
What is the median survival for metastatic prostate cancer patients?
What is the median survival for metastatic prostate cancer patients?
Signup and view all the answers
Which of the following staging tests is NOT typically performed for staging prostate cancer?
Which of the following staging tests is NOT typically performed for staging prostate cancer?
Signup and view all the answers
Which risk category is characterized by T2b-T2c or a Gleason score of 7?
Which risk category is characterized by T2b-T2c or a Gleason score of 7?
Signup and view all the answers
What is the primary goal of therapy for Stage III prostate cancer?
What is the primary goal of therapy for Stage III prostate cancer?
Signup and view all the answers
What should be the primary consideration when deciding treatment for clinically localized prostate cancer?
What should be the primary consideration when deciding treatment for clinically localized prostate cancer?
Signup and view all the answers
In which situation is it acceptable to perform screening in men under the age of 60?
In which situation is it acceptable to perform screening in men under the age of 60?
Signup and view all the answers
The presence of a PSA level under 10 ng/ml generally indicates what regarding metastatic disease?
The presence of a PSA level under 10 ng/ml generally indicates what regarding metastatic disease?
Signup and view all the answers
Which factors are considered in determining the prognosis of prostate cancer?
Which factors are considered in determining the prognosis of prostate cancer?
Signup and view all the answers
Study Notes
Prostate Cancer Overview
- Most common cancer in the US (excluding skin cancer)
- New cases increased by 50% between 1980 and 1990
- 2009 new cases: ~192,280 (estimated); 80% early disease
- Deaths (estimated): ~27,360
- Increasing number of "non-lethal" tumors diagnosed
- 1 in 6 men will be diagnosed; 1 in 35 will die from it (10% of cancer related deaths in men)
Survival Rates
- 5-year relative survival rate: nearly 100%
- 10-year relative survival rate: 91%
- 15-year relative survival rate: 76%
Cancer Death Rates (Age-Adjusted)
- Prostate cancer death rates saw an increase from 1930 until 1992, when the PSA test was introduced.
- Lung & bronchial cancer death rates continued to increase after 1992.
- Other cancers analyzed include Stomach, Colon & Rectum, Leukemia, Liver and Pancreas.
Prostate Cancer Incidence
- Rates of diagnosis have seen increases over the years (data from SEER program)
- Incidence rates vary by race (all races, white and black).
Prostate Cancer: Incidence and Death Rates (1992-1996), by Age and Race
- Incidence and death rates vary significantly across different age groups for both black and white men. (Note, ages 40-85 are on display, and data is numerical).
Risk Factors for Prostate Cancer
- Age: Rare before 40, 65% over 65
- Race: More common in African Americans (diagnosed later, higher death rates); Less common in Asian and Hispanic Americans
- Family History: 1st degree relatives (father, brother)
- Nationality: North America and NW Europe higher incidence than Asia, Africa, and Central/South America.
- Genetics: BRCA1 and BRCA2 increase risk but are a small percentage
- Diet: Red meat, high-fat dairy. Fruits, vegetables, grains
- Obesity, Exercise, prostatitis, STDs, Vasectomy: no significant effect.
Chemoprevention Studies
- Selenium and Vitamin E trials failed to show that the supplements reduce prostate cancer in healthy men.
Early Detection and Screening
- Digital Rectal Exam (DRE): Feel for nodules.
- Prostate Specific Antigen (PSA): How high? (Note, need additional info to interpret PSA results).
- Transrectal Ultrasound (TRUS): Not for screening
PSA and Prostate Cancer Risk
- PSA levels usually above 4 when cancer develops, but levels below 4 don't rule out cancer; ~15% of men with PSA below 4 have cancer.
- PSA 4-10: ~1 in 4 chance of cancer.
- PSA > 10: Chance of cancer is over 50%.
Confunding Factors for PSA
- Increasing factors: Benign Prostatic Hyperplasia (BPH), Age, Prostatitis, Ejaculation
- Decreasing factors: Finasteride, dutasteride, some herbal mixtures, Obesity
PSA Density, PSA Velocity, % Free PSA
- PSA Density: Normalized to prostate volume.
- PSA Velocity: Change in PSA over time (e.g., more than 15% per year)
- Free PSA/Total PSA: Lower ratio suggests cancer.
Presenting Symptoms of Prostate Cancer
- Decreased urine flow
- Increased urinary frequency
- Hematuria
- Bone pain
- Limb numbness or weakness
- Bowel/bladder incontinence
PSA Levels and Their Predictive Value for Diagnosis (2004 Study)
- Study of men with PSA never above 4ng/ml and no abnormal rectal exam, percentage with prostate cancer varies with PSA levels (3.1 - 4.0, 2.1 - 3.0, etc.).
Effect of Early Diagnosis
- Incidence higher in areas with aggressive screening
- Prostate cancer death rate similar in screened and unscreened populations.
- Randomized trials underway to evaluate screening.
- Conclusion:
- No screening over 70, unless high family history
- No screening under 60, unless high family history
- Recognize limitations (ages 60-70)
Prostate Cancer Survival
- Related to stage, grade, and extent of the tumor
- Local disease: >5 years median survival
- Metastatic disease: 1-3 years median survival, with potential exceptions
Establishing a Diagnosis of Prostate Cancer
- Digital Rectal Exam (DRE)
- PSA/PSA Velocity/Percent-Free PSA
- Transrectal Ultrasound (TRUS)
- U/S-guided biopsy
Evaluation of Abnormal PSA or Prostate Mass
- Ultrasound guided needle biopsies (6-12)
- Gleason score (2-10) (lowest is best) (2 predominant histologies)
Staging and Prognostic Factors
- TNM staging system
- Gleason grading
- DNA analysis by flow cytometry
- PSA level
- Predictive models for organ-confined/non-organ-confined disease
Staging Prostate Cancer
- Abdominal/pelvic CT scans
- Chest x-ray
- Bone scan
- Liver function tests (LFTs)
- Serum PSA and acid phosphatase
Staging Prostate Cancer (Stages I-IV)
- Stage descriptions for clinical staging are presented, including tumor size (T), lymph node involvement (N), metastasis (M), PSA classification, and Gleason score.
Recurrence Risk for Clinically Localized Prostate Cancer
- Low Risk: T1-T2a, Gleason score 2-6, PSA <10 ng/ml
- Intermediate Risk: T2b-T2c, Gleason score 7, PSA 10-20
- High Risk: T3a, Gleason score 8-10, PSA >20
- Very High Risk: T3b-T4 (locally advanced)
Treatment Decisions for Clinically Localized Prostate Cancer
- Based on recurrence risk (low, intermediate, or high)
- Based on life expectancy (<10 years or >10 years)
Prostate - Goals of Therapy
- Primary Therapy:
- T1a (except very young): No treatment.
- T1b, T1c, T2: Radical prostatectomy or high-dose radiation (or observation of low-grade)
- T3 (Stage III): Radiation therapy.
- Metastatic: Treatment when symptoms
- High risk: May include hormonal therapy
Radical Retropubic Prostatectomy (RRP)
- "Nerve-Sparing" procedure developed by Walsh
- Modified surgical technique to control blood and improve visibility
- Allows identification and potential preservation of nerves controlling erectile function.
Radiation Therapy (RT)
- High-Powered X-Rays to damage DNA and kill cancer cells
- External beam radiation therapy (EBRT)
- Brachytherapy (radioactive seed implants)
Watchful Waiting
- AKA observation/expectant therapy/deferred therapy.
- Diagnosis of early-stage (T1-T2), low-grade tumor.
- No medical treatment provided; regular follow-up to monitor tumor.
Treatment of Symptomatic Metastatic Disease
- Hormonal Therapies (initial therapy for locally advanced/metastatic diseases): Orchiectomy, Estrogens, LHRH analogs, Antiandrogens,
- Second-line therapy, if needed, may consist of therapies not previously used.
Conclusions
- Risk factors: Age, family history, race, diet and exercise
- Overall survival: Excellent (many years)
- Early detection: Localized cancer identification for benefits; uncertain
- Treatment: Depends on tumor grade, extent, and location.
- Surgery and radiation: Equivalent for localized prostate cancer.
- Hormone-refractory: Responds to chemotherapy, occasional long-term improvement
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz provides an overview of prostate cancer, highlighting its prevalence, survival rates, and incidence data. Understand the statistics surrounding this common disease and the trends in diagnosis over the years. Test your knowledge on the impact of PSA testing and demographic variations in incidence rates.
