Download MANAGEMENT OF EARLY PROSTATE CANCER

Carcinoma of the prostate
INTRODUCTION
Prostate cancer is the most common
cancer diagnosed and is the second leading
cause of cancer death in men in the United
States.
Prostate cancer is predominantly a disease of the
elderly man, with more than 75% of new prostate
cancers being diagnosed in men older than 65
years.
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RISK FACTORS
Hereditary Prostate Cancer
An estimated 10% of prostate cancers
are believed to be inherited
Androgen
Diet
Fat.
Calcium.
Infection
• -Lycopene. Lycopene is a carotenoid
present at high concentrations in
tomatoes.
Lycopene is a potent antioxidant .
• -Selenium. Selenium is a trace mineral
component of the antioxidant glutathione
peroxidase
• -Vitamin E. Vitamin E (α-tocopherol)
• -Vasectomy
Diagnosis
Clinical features
• 1-Digital rectal examination (DRE) :
• 2- Serum level of PSA
• 3- Transrectal ultrasound (TRUS) +/- biopsy :
*Indications for biopsy:
Palpable mass on DRE.
Elevated PSA.
Both high PSA & palpable mass.
Risks and Complications
Infection
Bleeding
Urinary retention
Vasovagal Reaction
• 4-Bone scan is indicated if there is a high risk
factors (PSA > 10ng/ml ; Gleason score > 8 ),
or if the patient is symptomatic
• 5-Pelvic CT scan and MRI are essential for
local staging
localization of prostate lesions and
targeting for conformal external beam
radiation therapy or brachytherapy
• 6-MRI had a great addition to CT scan for
initial staging
target localization for radiation therapy
Pathology
• PROSTATIC INTRAEPITHELIAL
NEOPLASIA
• ADENOCARCINOMA
Location : Majority (75%) in peripheral
zone , 15% in the central zone , and 10-15 % in the
periurethral zone.
Spread of Tumor
Local extension
• extra capsular
• Perineural invasion
Distant metastasis
lymphatics
Obturater L.N
hematogenous
Lumber spine
Proximal femur
Pelvis
Thoracic spine
Grade
The Gleason system is based on the glandular
pattern of the tumor as identified at relatively
low magnification . Both the primary
(predominant) and the secondary (second most
prevalent) architectural patterns are identified
and assigned a grade from 1 to 5, with 1 being
the most differentiated and 5 being the least
differentiated.
• Mesenchymal Tumors 0.1-0.2%
Rhabdomyosarcoma is the most frequent
mesenchymal tumor within the prostate and is
seen almost exclusively in childhood
Leiomyosarcomas are the most common sarcomas
involving the prostate in adults.
• Transitional Cell Carcinoma
Primary transitional cell carcinoma of the prostate
without bladder involvement accounts for 1% to
4% of all prostate carcinomas.
Treatment options for prostate cancer
Localized disease
Watchful waiting Follow up regimen :
recommended to have a six monthly assessment of
• PSA
• DRE
• -Repeat prostate biopsy after the 1st year ( to detect
transformation to higher grades.
Radical Prostatectomy
• Retropubic
• Perineal
• Laproscopic
• robotic assisted surgery
External-beam Radiation
• Radiation to the prostate from outside
the body
• Newer techniques (such as 3-D
conformal) hope to increase radiation
delivery and to decrease toxicity
• Most common side effects are impotence
and rectal irritation
Brachytherapy
• Radiation implants placed directly into the
prostate under ultrasound or CT guidance
• Very high dose radiation to the prostate with
little radiation outside the prostatic bed
• Acute urinary symptoms common, some
patients with impotence
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types
1-Permanent seeds implantation :
2-temporary seeds implantation
CRYOTHERAPY
Treatment of Locally Advanced or
Microscopic Nodal Disease
• Hormonal therapy plus radiation
• Hormonal therapy plus surgery
• ? Chemotherapy
• Treatment of metastatic disease :this done
by hormonal therapy .
• Hormone refractory disease :
• This term referred to patient with failed hormonal
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therapy in metastatic disease .
Treatment
2nd line hormonal therapy (ketoconazol )
Chemo therapy (mitoxantron +prednisolone) ,
Docetaxel is a cytotoxic agent and become the
agent of choice
Abiraterone acetate
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