Prostate Cancer Prevention

Question 1

What is the estrimated incidence of prostate cancer?

Answer 1

233,000 incidence

it’s the most common male cancer

Question 2

What age group typically gets the diagnosis?

Answer 2

65-74

Question 3

What is the lifetime risk for a US male?

Answer 3

1 in 6

Question 4

What is 5 year survival depending on stage at time of diagnosis?

Answer 4

99.2%

Question 5

What ethnic group has highest risk?

Answer 5

African American males

note they also have higher death rates

Question 6

Men with a father or brother wiht prostate cancer are ____ as likely to develop prostate cancer

Answer 6

twice

Question 7

True or false: male relatives of breast cancer patients have a higher incidence of prostate cancer.

Answer 7

true - this is related to the BRCA2 mutation

Question 8

Hereditary prostate cancer 1 locus is found on what chromosome?

Answer 8

1q24-25

Question 9

What is the risk factor in diet?

Answer 9

Folic acid as a man-made supplement slightly increases the risk for prostate cancer

same is true with dairy and other high calcium foods

Question 10

What about folate in foods?

Answer 10

that’s actually protective

Question 11

Are men with higher plasma testosterone levels at increased risk?

Answer 11

probably

Question 12

What are the occupational or chemical risk factors for prostate cancers?

Answer 12

polyaromatic hydrocarbons in coal, liquid fuel combustion products, metallic dust, lubricating oils and greases

aetic acid and acetic anhydrate - treating silk and photo film

Dioxin - agent orange - service connection with hx of agent orange exposure during the war

Question 13

Does selenium and vitamin E decrease risk?

Answer 13

no

Question 14

Does decreasing fats or increasing fruits help?

Answer 14

not known

Question 15

What about lycopene?

Answer 15

some risks say that a diet high in lycopene may be linked to a decreased risk of prostate cancers, but others have not

Question 16

Back to folate…what foods are high in it?

Answer 16

green veggies, beans, orange juice

Question 17

What are the chemoprevention drugs for prostate cancer?

Answer 17

finasteride
dutasteride

but evidence is inadequate to determine whether it reduces mortality from prostate cancer

Question 18

What are the signs and symptoms of prostate cancer?

Answer 18

difficulty initiating flow
less force to the stream
dribbling after urinating
frequent urination
hematuria
dysuria
pain with ejaculation
hip or bone pain that doesn't resolve (met)

many will be asymtomatic though

Question 19

What are the four ways we can potentially evaluate a prostate cancer?

Answer 19

PSA
Digital rectal
Transrectal US
Biopsy

Question 20

What is a normal PSA and what is an abnormal?

Answer 20

less tan 4 ng/m normal
4-10 borderline
over 10 is high

take in context of the clinical situation too

Question 21

Percent free PSA is what?

Answer 21

the stuff that isn’t protein bound - not really clinically useful

we usually check total

Question 22

What is PSA velocity?

Answer 22

how quickly the PSA levels rise over a period of time

a change of over .75 ng/ml in one year is significant

Question 23

What is PSA density?

Answer 23

reflects the relationhsip between the PSA level and size of gland measured by transrectal ultrasound TRUS

if you have high PSA compared to the actual size of the prostate, that’s concerning

Question 24

Does the normal range depend on ethnicity? age?

Answer 24

yes - normal is lower for younger males and asian males

order from high to low goes black, white, hispanic, asian

Question 25

What are the general PSA guidelines?

Answer 25

some say shared decision making the USPSTF says don't screen healthy asymptomatic men regardless of age, family history or ethnicity

Question 26

Where does most prostate cancer occur?

Answer 26

in the posterior part of the peripheral gland - so we can typically feel it

Question 27

If the digital rectal is abnormal, what do you do next?

Answer 27

transrectal US

Question 28

What are the treatment options for prostate CA?

Answer 28

``` active suveillance surgery cryosurgery external beam radiation interstitial brachytherapy hormonal therapy chemotherapy ```

Question 29

Active surveillance is often used for less aggressive tumors especially in what age group?

Answer 29

over 70 (or in those who have comorbidities that make surgery risky)

Question 30

How often do you see peopl ein active surveillance?

Answer 30

see every 3 months during the first year and every 6 months after that check urological function, quality of life, PSA and annual bone scan

Question 31

What are the two general surgeries we can do for this?

Answer 31

radical prostatectomy (remove the prostate and seminal vesicles) transurethral resection - removal of just the cancerous portion

Question 32

What are the main side effects of these surgeries?

Answer 32

impotence and urinary incontinence

Question 33

How does cryosurgery do?

Answer 33

freezes the prostate with cryoprobes to destroy the cancer

Question 34

What are the two ways we do radiation therapy for this?

Answer 34

external beam radiation brachytherapy - this is where they place permanent radioactive seeds in the prostate

Question 35

What are the 4 options for hormonal therapy?

Answer 35

GnRH agonists anti-androgens orchiectomy estrogens

Question 36

What is the surveillance after you find locally disease?

Answer 36

DRE annually | PSA every 6-12 months for 5 years, then annually after that

Question 37

What are the surveillance guidelines for advanced disease after treatment?

Answer 37

DRE every 3-6 months PSA every 3-6 months bone scan if signs of recurrence

Question 38

If the cancer has metastasized at time of diagnosis, what is 5 yr survival?

Answer 38

28%