MICROBIO 160 1st Edition Lecture 17 Outline of Last Lecture I II Cervical Cancer History HPV Types III How does HPV cause Cancer IV Risk Factors V VI VII VIII IX X Prevalence of HPV Infection Pap test Colposcopy and Cervical Exam Treating Cervical Cancer Advanced Stages HPV Vaccines and Cancer Outline of Current Lecture I What is Prostate Cancer II Staging Tests and Staging III IV Gleason Score Prostate Cancer Grade and Stage are used Together to Determine Prognosis V Treatments and Statistics VI Surgery VII Hormones VIII Complications IX Testicular Cancer These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute X Symptoms XI Risk Factors XII Diagnosis and treatment Current Lecture Prostate Cancer cancer that forms in tissues of the prostate a gland in the male reproductive system found below the bladder and in front of the rectum it usually occurs in older men very slow growing Estimated new cases and deaths from prostate cancer in the US in 2013 o New cases 238 590 o Deaths 29 720 spread to bladder or rectum or higher up in the bladder Staging Tests and Staging Physical exam Digital rectal exam if the tumor in the prostate is larger enough to be felt your doctor may be able to examine it doctor can feel the cancer o Bone scan to look to see if the prostate cancer has metastasized to the bone like the spine and pelvic bones CT scan MRI o Staging depends on Whether the tumor has invaded nearby tissue such as the bladder or rectum Whether prostate cancer cells have spread to lymph nodes or other parts of the body such as the bones Grade Gleason score of the prostate tumor PSA level prostate specific antigen blood level rises when carcinoma of the prostate is present random fluctuations what is PSA why has it fallen out of favor Gleason Score looking at the cells themselves so you have to get a sample of the tissue Gleason Score 2 to 4 Gleason Score 5 and 6 Well differentiated Small glands that are closely packed Cancer cells behave in predictable manner Least aggressive least likely to metastasize Moderately well differentiated Variable sized glands with little stroma May also see a cribiform pattern of several cells fused together Cancer cells behave in predictable manner Most common place Gleason Score 7 Can be considered a moderately well differentiated or poorly differentiated cancer Glands are incompletely formed Gleason Score 8 to 10 most aggressive and most dangerous Poorly differentiated Single cells have broken away and may be found within vascular lumen loses adhesion Cancer cells can behave in unpredictable manner Prostate Cancer Grade and Stage are used Together to Determine Prognosis The TNM staging scheme is used for prostate cancer however some clinicians use a different method TNM is gained via fully body imaging this information is combined with Gleason Grading to generate a prognosis and a treatment regime Anything higher than a Gleason score of 4 will push you to different stages o Stage 4 T4 very severe might not have lymph node metastasis Treatments and Statistics What can be done What stage are you in and how active is the cancer o Active surveillance come back yearly for check ups o Surgery o Radiation therapy o Hormone therapy o Chemotherapy o Immunotherapy What is considered o o o o o Your age Gleason score grade of the tumor Stage of prostate cancer Your symptoms Your general health comorbidity presence of two or more chronic diseases present in the patient Diagnosis rate 1 in 6 death rate 1 in 35 o Most men are over 70 at time of diagnosis and die of other causes o Overall 5 year survival rate 99 o For localized prostate cancer 5 year survival 100 o For metastatic prostate cancer 5 year survival 33 o Long term survival The relative 10 year survival rate is 91 The relative 15 year survival rate is 76 Surgery The entire prostate can be removed in several ways o Radical retropublic prostatectomy trying to go through the body wall o Laparoscopic prostatectomy small tiny cuts in the abdomen o Robotic prostectomy robots can be very tiny remotely trying to find the prostate and remove as much as possible o Radical perineal prostatectomy Other surgery options for treating prostate cancer or relieving its symptoms are o Cyrosurgery insert the probe and freeze the surgery o Heating trying to heat up the prostate to destroy the tissue o TURP transurethral resection of the prostate they can surgically start snipping away at the prostate gland has the least risk Hormones therapy if you don t want surgery Men with advanced prostate cancer usually receive hormone therapy a man with early stage prostate cancer may have hormone therapy before during and after radiation therapy Hormone therapy prevents prostate cancer cells from getting androgens such as testosterone androgens can cause prostate cancers to grow Types of hormone therapy include o A drug that can prevent the testicles from making testosterone LH RH agonist o A drug that can block the action of male hormones anti androgen prevents growth o Surgery to remove the testicles which are the body s main source of testosterone o A drug that can prevent the adrenal glands from making testosterone Complications Urinary incontinence o Loss of urine flow most men regain at least some bladder control after a few weeks Your nurse or doctor can teach you an exercise to help you recover control of your bladder Some men however incontinence may be permanent Viagra created to treat Erectile dysfunction o Surgery may also damage nerves near the prostate and cause Sexual function usually improves over several months but for some men this problem can be permanent There are ways to help manage the sexual side effects of prostate cancer treatment o Viagra created to treat Hormone therapy side effects o Most common erectile dysfunction hot flashes and loss of sexual desire o Other possible side effects include breast growth an increase in body fat around the waist an increase in sugar level in your blood can become diabetic and osteoporosis An LH RH agonist may make pain and other symptoms worse at first this temporary problem is called flare o To prevent a flare your doctor may give you an anti androgen for a few weeks along with the LH RH agonist Testicular cancer US 7 500 and 8 000 diagnoses per year Lifetime risk 1 in 200 The most common cancer in males aged 20 39 period of peak incidence Rarely seen before the age of 15 years
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