2.1 Prostate Oncology and Treatment.pdf

Prostate Oncology and Treatment including Brachytherapy CSB048 [email protected] 00 21...

Prostate Oncology and Treatment including Brachytherapy CSB048 [email protected] 00 21 3J o. N S O C I R ACKNOWLEDGEMENT OF TRADITIONAL OWNERS QUT acknowledges the Turrbal and Yugara, as the First Nations owners of the lands where QUT now stands. We pay respect to their Elders, lores, customs and creation spirits. We recognise that these lands have always been places of teaching, research and learning. ​ QUT acknowledges the important role Aboriginal and Torres Strait Islander people play within the QUT community.​ ASSUMED KNOWLEDGE Read chapter 53 - Clinical Radiation Oncology PROSTATE Cancer Learning objectives Anatomy Treatment Field Arrangement Aetiology & Epidemiology Treatment QA Signs & Symptoms Side Effects & Patient Care Patterns of Spread Pathology & Staging Clinical Management Patient Positioning & Set-up CRICOS No.00213J 4 Anatomy Overview CRICOS No.00213J 5  Epidemiology & Aetiology Estimated new prostate cases in Australia 2021 – 18110 males Represents 23% of all new male cancers diagnosed in 2021 down from 25.2% in 2016 There will be an estimated 3323 deaths from prostate cancer in 2021 The second most common cause of male cancer death in 2021 Estimated that it will become the fourth most common cause of cancer death in Australia 12% of all cancer deaths in males Survivability for at least five years = 96% stats from (2013-2017) Males living with prostate cancer to end of 2016 = 88778 Aboriginal and Torres Strait Islander males have a lower incidence however the same mortality – Why? www.canceraustralia.gov.au/cancer-types/prostate-cancer/statistics CRICOS No.00213J 6 Epidemiology & Aetiology Risk Factors – Diagnosis = 1 in 8 risk to age 85, Death = 1 in 55 risk to age 85 Familial - increased incidence with family history Age – Increases with age Race/ethnicity Hereditary breast and ovarian cancer (HBOC) syndrome Other genetic changes Agent orange exposure Diet ? CRICOS No.00213J 7 Signs and Symptoms Prostate cancer may remain asymptomatic for many years CRICOS No.00213J 8  Signs and Symptoms Patients may initially present with Urinary changes – difficulty starting or maintaining a urinary stream Frequency and/or urgency difficulty maintaining bladder volume Dysuria Haematuria CRICOS No.00213J 9 Signs and Symptoms Metastatic disease Bone pain or back pain Loss of appetite, weight loss Testicular pain CRICOS No.00213J 10 Diagnosis Initial testing PSA – Prostate Specific Antigen or PSMA - Prostate specific membrane antigen Protein produced in prostate, found freely in the blood Higher than “Normal” level (age related) correlates with the presence of prostate cancer Not conclusive proof either way. CRICOS No.00213J 11 Diagnosis Digital Rectal Exam – DRE CRICOS No.00213J 12 Diagnosis The only conclusive way of determining prostate cancer Biopsy TRUS Biopsy Transperineal Prostate Biopsy Multiparametric MRI CRICOS No.00213J 13  Biopsy http://www.slideshare.net/marclaniado/prostate-cancer-modernising-the-diagnostic-pathway-20130611-by-marc-laniado http://www.e-sciencecentral.org/articles/SC000004880 CRICOS No.00213J 18 Patterns of Spread Local: Most prostate cancers are multifocal They extend out of the gland Spread to seminal vesicles Neck of bladder Rectum Invasion of lymphatics and blood vessels CRICOS No.00213J 15 Patterns of lymphatic spread CRICOS No.00213J 16 Metastatic Spread The highest incidence of metastatic spread is to Bone Other regions include liver, brain, lung and other soft tissue CRICOS No.00213J 17 Metastatic Spread CRICOS No.00213J 18 Survivability Patients can survive with metastatic disease for many years Prostate cancer: Lymph node metastases: not always the same prognosis Nature Reviews Urology 10, 435-436 (August 2013) | doi:10.1038/nrurol.2013.127 CRICOS No.00213J 19 Pathology and Staging Histologically Adenocarcinoma 95-98% Lesser involvement in no particular order Transitional cell, Squamous cell and Sarcoma CRICOS No.00213J 20 Pathology & Staging Grade Gleason score confusing 6, 7, 8, 9, 10 3+4 = 7 vs 4+3 = 7, not the same prognosis New system Grade group 1-5 http://pathology.jhu.edu/ProstateCancer/NewGradingSystem.pdf CRICOS No.00213J 21  Grade group Grade Group 1 (Gleason score ≤6) – Only individual discrete well-formed glands Grade Group 2 (Gleason score 3+4=7) – Predominantly well-formed glands with a lesser component of poorly-formed/fused/cribriform glands Grade Group 3 (Gleason score 4+3=7) – Predominantly poorly-formed/fused/cribriform glands with a lesser component of well-formed glands† Grade Group 4 (Gleason score 8) - Only poorly-formed/fused/cribriform glands or - Predominantly well-formed glands with a lesser component lacking glands†† or - Predominantly lacking glands with a lesser component of well-formed glands†† Grade Group 5 (Gleason scores 9-10) – Lacks gland formation (or with necrosis) with or w/o poorly-formed/fused/cribriform glands† † For cases with >95% poorly-formed/fused/cribriform glands or lack of glands on a core or at RP, the component of