Flashcards in 16 Prostate Cancer Chan Deck (84)
What are some facts on prostate cancer?
Most common cancer in men. Indolent (or slow) growth pattern in early stages compared to other cancer types. AA > Whites > Asians
What is the etiology of prostate cancer?
Hormonal (increase exposure to testosterone (growth signal to the prostate)). Genetic predisposition (SRD5A2 gene). Presence of pre-malignant lesion
What does the SRD5A2 gene do?
Codes 5-alpha reductase (enzyme converts testosterone to DHT). Gene variant increases activity and may increase prostate cancer
What does the presence of pre-malignant lesions indicate?
Prostatic Intraepithelial Neoplasia (PIN) or Proliferative Inflammatory Atrophy (PIA). Precedes prostate cancer by 10 years or more. Detection of PIN requires needle biopsy. Presence of PIN does NOT cause changes in PSA level
What are the Prostate Cancer Risk Factors?
Age (~66 years). Male. Race (AA > White > Asian). Family history (One 1st degree relative = two-fold increase, two 1st degree relative = four-fold increase). Diet
How does Diet change your risk of prostate cancer?
Increase risk: high intake of dietary fat. Decrease risk: Soy (anti-carcinogen) and Lycopenes (found in tomatoes). Lack benefits - Vit E, Selenium
What are NOT considered risk factors for Prostate Cancer?
Smoking and alcohol consumption. Benign Prostatic Hyperplasia (BPH) - non-malignant condition1
What are the warning signs and symptoms of prostate cancer?
Non-specific, similar to symptoms caused by BPH. Dysuria, nocturia, anuria, hematuria. Impotence. Less firm penile errection. Advance stage disease: Anorexia, bone pain that is persistent in lower back, pelvic region or upper thighs
What did the PCPT trial show?
Finasteride (Proscar) (off label - risk reduction) = 5mg daily for 7 years. Significantly reduce prostate cancer rate detectable with biopsy by 25% vs. placebo
What did the REDUCE
Dutasteride (Avodart) (off label - risk reduction) = 0.5mg daily for 4 years. Significantly reduce prostate cancer rate detectable with biopsy by 25% vs. placebo
What are the new screening guidelines for prostate cancer?
Recommend for men age > 50 w/ average risk of prostate cancer, life-expectancy > 10 years. Men at high risk (i.e. AA, family history of prostate cancer before age 65). Men at higher risk (multiple family history < 65) - discussion at age 40.
What are the potential treatment toxicities for prostate cancer?
Incontinence. Impotence (decrease QOL). Difficult to identify indolent vs. aggressive tumor
What are the screening methods for prostate cancer?
Digital rectal exam (DRE) optional, and Prostate-specific antigen (PSA) blood test (none 100% predictive)
What are you looking for in a DRE?
Presence of lumps, hardness, and inability to move the prostate. Only 25-50% palpable mass are cancerous
What is the PSA blood test?
Glycoprotein produced by epithelial cells of prostate. Specific for the prostate, not specific for cancer. Normal ranges: 0-4 (PSA 2.6-4 requires further evaluation by biopsy. PSA > 10 suspicious for malignancy). Abstinence for 2 days prior to obtaining PSA
What do the grades in the Gleason Scale indicate?
Grades <7 (slow-growing, well differentiated tumors) = better prognosis. Grade 7 (moderately differentiated tumors). Grades 8-10 (aggressive, poorly differentiated tumors) = poor prognosis. Higher the score, the greater probability of extracapsular spread, nodal involvement and distant metastases
What is the natural history of the disease?
Indolent (slow) growth commonly seen in early stages. Spreads by local extension via the lymphatic system to regional lymph nodes or via bloodstream to other part of the body. Metastases common to the bone (80%) usually involve the lumbar spine, may also metastases to lung and liver
What is Stage I Prostate Cancer?
Non-palpable, localized, biopsy detected, high PSA
What is Stage II Prostate Cancer?
Palpable, confined to capsule (1-2 lobes)
What is Stage III Prostate Cancer?
Local extension beyond capsule
What is Stage IV Prostate Cancer?
Lymph node involvement with mets to other areas
What does Neoadjuvant mean?
Initial treatment of locally advanced tumors that are unlikely to be cured by surgery or irradiation. Goal is to reduce tumor volume
What does Adjuvant mean?
Systemic therapy following curative surgery or irradiation for tumors that have a high probability of recurrence
What does Salvage Treatment mean?
Systemic therapy in patients who have failed initial treatment
What does Palliation mean?
Treatment used only to relieve or alleviate symptoms NOT to provide cure
What are the treatment goals for prostate cancer?
Androgen deprivation or ablation (80% of tumors are androgen dependent): Maintain suppression of serum testosterone < 50 (considered castration level). Decrease symptoms. Delay progression and improve QOL
What are the treatment options for Prostate Cancer?
Expectant management or watchful waiting. Surgery (Radical Prostatectomy). Radiation therapy. Pharmacological intervention (hormonal therapy, immunotherapy, chemotherapy, clinical trials)
When should Expectant Management or Watchful Waiting be considered?
For LOCALIZED early Stage I, II tumors. Recommended for elderly men with life expectancy < 10 years, low grade disease, and slow PSA velocity
When is Surgery (Radical Prostatectomy) recommended?
Men of any age with life expectancy > 10 years, localized stage I, II tumors, high grade disease, high PSA velocity