Lecture 20 Prostate and Testicular Cancers Prostate Cancer Definition of 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 Prostate cancer usually occurs in older men Estimated new cases and deaths from prostate cancer in the U S in 2015 New cases 220 800 Deaths 27 540 What is the Prostate Anyways Apricot walnut sized gland that helps regulate flow of urine and importantly semen through urethra and out of the penis Bundles of nerves surrounded it mess with it can interfere with ejaculation The Most Common Cancer in Men 2nd leading cause of cancer related deaths among men after lung cancer Prostate Cancer 5 Year Survival Survival rate is high around 98 Prostate Cancer Incidence and Mortality by Race in the US A lot of men will get this type of cancer African American men have a higher chance of getting this cancer Prostate Cancer Symptoms diagnosed until a later stage Early prostate cancer usually has no or few symptoms and as a result is often not Weak or interrupted urine flow Frequent urination Difficulty urinating Blood in the urine or semen Pain or burning on urination Prostate cancer most frequently metastasizes to the bones causing bone pain Impotence Common Risk Factors Race Aging Hormones Chemicals Diet Family History African American men 1 6X more likely to develop prostate cancer Having at least one close relative who has had the disease increases the risk of having prostate cancer 2 fold Consuming large amounts of fat particularly animal fat and obesity Early exposure to BPA working with pesticides and cadmium welders Male Pattern Baldness Associated with Increased Risk of Prostate Cancer Study prospective cohort of about 40 000 men with no cancer diagnosis who described hair loss at age 45 Followed to track who developed non aggressive and aggressive prostate cancer Frontal plus moderate vertex baldness at 45 was associated with greater risk of Possibly related to testosterone receptors or testosterone related cellular aggressive prostate cancer physiology Trichomonas Vaginalis Infection STI and Prostate Cancer Incidence and Mortality Men with antibodies to T vaginalis were more than 2X as likely to develop tumors that spread outside the prostate and that ultimately led to metastasis or prostate cancer specific death BPA and Prostate Cancer Risk Associations with BPA Messes with hormone signals Metastasis of Prostate Cancer Stage 1 and 2 Cancer inside the prostate Stage 3 Capsule penetration by cancer Stage 4 Spread of cancer to other areas metastasis Staging Tests and Staging Physical exam digital rectal exam If the tumor in the prostate is large enough to be felt your doctor may be able to examine it Bone scan CT scan MRI 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 Gleason s Pattern 1 Small uniform glands 2 More stroma between glands 3 Distinctly infiltrative margins 4 5 Only occasional gland formation Irregular masses of neoplastic glands Prostate Specific Antigen PSA Secreted by epithelial cells of the prostate Allows sperm to have greater movement in semen Often elevated 4ng ml in presence of prostate cancer or prostate disorders PSA has been a traditional cancer screening technique As of 2012 US Preventative Task Force no longer recommends using PSA as a Screening does not significantly diminish mortality and can cause significant side screen effects 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 staging is gained via full body imaging This information is combined with Gleason Grading to generate a prognosis and a treatment regime Treatments and Statistics What can be done Active surveillance Surgery Radiation therapy Hormone therapy Chemotherapy Immunotherapy What is Considered Your age Gleason score grade of the tumor Stage of prostate cancer Your symptoms Your general health Diagnosis rate 1 in 6 Death rate 1 in 35 Most men are over 70 at time of diagnosis and die of other causes Overall 5 year survival rate 99 For localized prostate cancer 5 year survival 100 For metastatic prostate cancer 5 year survival 33 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 Radical retropubic prostatectomy Laparoscopic Prostatectomy Robotic prostectomy Radical perineal prostectomy Other surgery options for treating prostate cancer or relieving its symptoms are Cryosurgery Heating TURP Transurethral Resection of the Prostate Hormones Prostate cancer is hormone sensitive or hormone dependent growth depends on androgens testosterone Men with advanced metastatic prostate cancer usually receive hormone therapy In addition a man with early stage prostate cancer may have hormone therapy before during and after radiation therapy Hormone therapy may also be used after surgery Types of hormone therapy include A drug that can prevent the testicles from making testosterone A drug that can block the action of male hormones anti androgen Surgery to remove the testicles which are the body s main source of A drug that can prevent the adrenal glands from making testosterone testosterone Complications Urinary Incontinence Loss of control 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 For some men however incontinence may be permanent Erectile Dysfunction Surgery may also damage nerves near the prostate and cause ER 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 Hormone Therapy Side Effects Most common erectile dysfunction hot flashes and loss of sexual desire Other possible side effects include breast growth an increase in body fat around the waist an increase in sugar level in your blood and osteoporosis An LH RH agonist may make pain and other symptoms worse at first This temporary problem is called a flare To prevent a
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