Download Lecture 18: Prostate Cancer and Testicular Cancer

Biology 207
Biology of Cancer
Spring 2004
Lecture 18: "Prostate Cancer and Testicular Cancer"
Reading: Scientific American, Does Screening for Prostate Cancer Make
Sense?
Web site: Testicular Cancer, National Cancer Institute web site:
http://www.cis.nis.nih.gov
Recommended books:
Korda, M. (1997) Man to Man: Surviving Prostate Cancer, Vintage Books.
Armstrong, L. (2001) It's Not About the Bike: My Journey Back to Life, Berkeley
Publishing Group.
Lecture Outline:
1. Prostate Cancer
a. What is the prostate?
b. Diagnosis: PSA test
c. Treatments
2. Testicular Cancer
a. Statistics
b. Diagnosis
c. Treatment
Lecture:
1. Prostate Cancer
 1/5 men will develop prostate cancer in their lifetimes
 average age of men diagnosed is 70; many cases go undiagnosed
 U.S. has highest incidence in world
 Incidence in African American men highest in U.S.
What is the prostate?
 Gland located in male reproductive system behind penis
 Produces fluid secretion that contributes to fluid of semen
 Requires testosterone (male sex hormone) to function properly
Symptoms of possible prostate cancer
 Frequent urination
 Burning urination
 Difficulty starting or holding urine
 Blood in urine or semen
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Diagnosis
 Digital rectal exam (recommended annually after age 40)
 Prostate Specific Antigen (PSA)
o Blood test for protein that seeps out of prostate
o Indirect test for prostate function
o Higher the PSA levels, higher the risk for prostate cancer
PSA level (ng/ml)
Risk of prostate cancer
0-4 ng/ml
~4 ng/ml
normal
borderline
4-10 ng/ml
20-50% chance of
prostate cancer
50-75% chance
90% chance of prostate
cancer
10-20 ng/ml
>20 ng/ml
Recommended
treatment
Medication to reduce
PSA levels
Keep eye on; biopsy to
test for prostate cancer
Reasons for high PSA levels
 Infection of the prostate
 Benign prostate enlargement
 Transurectal resection (surgery in area of prostate)
 Prostate cancer
 Can have age specific differences in PSA levels and differences in
prostate density important
Staging:
 TNM staging not used much yet
 "Gleason scoring" based on analysis of microscope slides of cancer
 Advanced prostate cancer spreads to lymph nodes of groin area and to
bone
Confirmatory Tests:
 Ultrasound used to determine prostate density; helps in interpreting PSA
test
 Biopsy: most critical test for identify cancer; sample >3 sample sites
 X-ray: test for spread to bones
 CT scan, MRI test for spread of cancer
Treatment for Prostate Cancer
 Radical Prostatectomy: Surgical removal of the prostate
o Complications:
 Risk of infection
 60% chance of at least temporary incontinence
 60-90% chance of impotence: Viagra as possible treatment
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Radiation therapy
o May involve implants to provide localized doses
Hormonal therapy
o Prostate regulated by testosterone, an androgen
o Treat cancer with androgen blockers
"Watchful waiting": Older patients more likely to die of other diseases;
monitor prostate, but don't offer treatment.
In a recent study where 144 cases were reviewed of men 65-70 years old:
Treatment
Watchful waiting
Radical prostatectomy
Radiation treatment
Life Expectancy
14.1 yr
14.2 yr
14.3 yr
Therefore: Treatment of older men provided very little difference in life
expectancy.
For personal account of prostate cancer and recovery from a radical
prostatectomy, read Michael Korda's book, Man to Man.
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Diagnosed at age 58 with BPH, benign prostatic hyperplasia, after
problems with urination.
In his early 60's he went in for PSA tests. In one test his PSA levels were
15 ng/ml and a follow-up biopsy was negative.
In the following year, his PSA levels were at 22 ng/ml and his biopsy was
positive.
Was hospitalized for a radical prostatectomy and was fairly healthy except
for occasional urination problems.
His recovery involved > 1 year loss of bladder control.
> 1 year impotent
Required day nurse for 6 months
Attended support groups; found his cohorts included men of all economic
levels and races
New diagnostics and treatments
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Improved PSA test can distinguish between free and bound PSA. More
accurate test, particular for men with PSA levels between 4 and 10 ng/ml.
A cancer vaccine that activates an immune response against PSA
expressing cells is in early testing stages.
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2. Testicular cancer
a. Statistics:
 Accounts for only 1% of cancers in men
 Most common form of cancer in young men aged 15-35
 Testicular cancer incidence is increasing
b. Diagnosis
Most cases found via one of the following:
 Testicular self exam
 Routine physical
 Doctor's visit for groin or abdominal pain
Tests for identifying testicular cancer
 Blood tests for tumor markers
o Alpha-fetoprotein (AFP): a marker of undifferentiated cells
o Beta Human chorionic gonadatrophin (β-HCG): hormone detected
in pregnancy tests
o Lactate dehydrogenase LDH: a metabolic enzyme
In addition to TNM staging for testicular cancer, serum tumor markers are
reported (S)
SX: Tumor marker studies not available or not performed
SO: Tumor marker levels within normal limits
S1 LDH<1.5x normal and HCG (mlU/ml),5000 and AFP(μg/ml)<1000
S2:LDH 1.5-10x normal or HCG (mlU/ml) 5000-50,000 or AFP (μg/ml) 100010,000
S3: LDH >10x normal or HCG (mlU/ml) > 50,000 or AFP (μg/ml) > 10,000
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Ultrasound to identify tumor mass
Biopsy
Other imaging techniques used to detect metastatic prostate cancer (Xrays, PET scan, MRI, CT scan)
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Treatment:
 Surgery: Remove testicle (orchiectomy) and perhaps neighboring lymph
nodes
 Radiation Therapy: Effective for only some types of tumors
 Chemotherapy
Treatments are mostly effective; even metastatic cancers may be amenable to
treatments (as was case for Lance Armstrong).
Recommended: Lance Armstrong, Its Not About the Bike
Issues raised:
Treatment of cancer patients
Elite athletes: contracts/medical insurance
Loss of fertility: banking sperm
Chemotherapy: understanding your own care
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