– What you need to Prostate cancer know!

Prostate cancer – What you need to
know!
Miss Hazel Warburton FRCS (Urol), MD
Consultant Urological Surgeon
The prostate
What is Prostate cancer?
Incidence
• ~37 000 cases diagnosed in the UK
• ~215 000 men living in the UK with prostate
cancer
Mortality
• ~10 100 deaths per year (12%)
• 70% 5 year survival (95-98% 5 year survival
for treated localised disease)
Risk Factors
• Age
• Race
• Family history
Family History
Relative Risk
Absolute risk (%)
None
1
8
Father or brother
2
15
Father or brother
<60 years
3
20
Father and brother
4
30
Hereditary prostate
cancer
5
35-45
Prevention
• Little evidence
• ??Lycopene, green tea, soya sauce,
selenium and vitamin E, low saturated fats,
finasteride
Symptoms
• Early disease – none or those of benign
disease
• Late disease – systemic symptoms, bone
pain
Diagnosis - DRE
Diagnosis - PSA
•
•
•
•
What is PSA?
What is a normal PSA?
What does an abnormal PSA mean?
Does a normal PSA mean no cancer?
PSA
• What is PSA?
PSA
• What is a normal PSA?
Age Range
Normal PSA range (ng/ml)
All ages
<4.0
40-49
<2.5
50-59
<3.5
60-69
<4.5
>70
<6.5
PSA
• What does an abnormal PSA mean?
Causes of an Elevated PSA
• Prostate Cancer
• Age
• BPH
• Infection
• Retention
• Catheterisation/ Instrumentation
• Prostate biopsy
• Post Pelvic Radiotherapy
•
• Potential causes an Elevated PSA
• Cycling
• Prostate massage
PSA
• Does an normal PSA mean no cancer?
PSA ng/ml
Risk for prostate cancer
0.0 - 0.5
6.6%
0.6 – 1.0
10.1%
1.1 - 2.0
17.0%
2.1 – 3.0
23.9%
3.1 – 4.0
26.9%
50-66 year old
Thompson IM et al: N Eng J Med 2004;350(22):2239-2246
Prostate Biopsy
Diagnosis
• Grading
• Gleason grade
Diagnosis
• Staging
• TNM
Treatment – Localised Disease
• Low risk
• Intermediate risk
• High Risk
• Also an individual’s age, preference and
other medical problems (life expectancy)
Active surveillance
• Very close monitoring and avoidance of the
side effects of treatment until evidence of
growth of the tumour
• PSA every 3-4 months, rectal examination
(ideally by a urologist) and repeat biopsy
every 18 months to 2 years
Surgery
• Radical Prostatectomy
Radiotherapy + hormones
Brachytherapy
Experiment procedures
• HIFU
• Cryotherapy
Metastatic disease
Metastatic disease
Metastatic disease
• First line GnRH analogues or orchidectomy
• Second/Third line hormones (anti-androgens)
• MAB
• Steroids and chemotherapy
• Trials
• Palliative care
Blue Skies 10km Run for Prostate
Cancer
Thank you
• Any questions?
PCA 3
• Urine test post prostatic massage
• Prostate cancer gene 3 (66 fold greater
expression in prostate cancer)
• Most useful in men with a negative biopsy
• Level >35 suggest cancer, available in some
private clinics cost £300-£400
Abiraterone
• Metastatic prostate cancer
• CYP17 inhibitor, ablates androgens and
oestrogen synthesis in tissue
• Currently in phase III trials
• Need to take in conjunction with high dose
steroids
The next Foundation Trust Health
Seminar will take place on:
Monday 11th April 2011
10.30-11.30 am in the Lecture Theatre ,
Education Centre, BVH
The topic is:
“A better tomorrow starts today – Making steps
towards a healthier lifestyle.”