Professional Documents
Culture Documents
Layout of Presentation
Introduction
Risk factors Diagnosis Grading TNM classification Imaging Treatment Questions
Introduction
Prostate cancer Disease Hormonal management Most common malignancy in elderly men Second most common cause of death in elderly men
diagnosis1,2
PSA
Diagnostic triad
N3
Involvement of regional lymph nodes Regional lymph nodes cannot be assessed No regional lymph node metastases Metastasis in a single regional lymph node, <2 cm in greatest dimension Metastasis in a single regional lymph node, >2 cm but not >5 in greatest dimension, or multiple regional lymph nodes, none >5 cm in greatest dimension Metastasis in regional lymph node >5 cm in greatest dimension
Imaging Tests
Bone Scan Low detection rate. Provides additional information in patients with skeletal symptoms. Computed Tomography (CT) Useful for staging in T4 disease. Recommended in patients with Gleason score of 8 to 10, clinical stage T3 or T4.
Radiography
Bone scan
Treatment Options
Watchful waiting Therapies of curative intent
Radical prostatectomy Retropubic Perineal Laparoscopic Radiotherapy External beam radiation Brachytherapy Cryotherapy
Radical Prostatectomy
Advantages Primary treatment
Stage-dependent
Brachytherapy
Advantages As effective as EBRT or surgery Disadvantages Urinary voiding symptoms Erectile dysfunction Rectal discomfort Edema
Cryotherapy
Advantages Short hospital stay Relatively noninvasive Disadvantages Erectile dysfunction Urinary problems (shortterm) Unknown long-term effectiveness
(CAB)
LHRH-A
Advantages As effective as bilateral orchidectomy in decreasing testosterone levels Administered every 1, 3, 4, or 12 months Potentially reversible Disadvantages Hot flashes Decreased libido Erectile dysfunction
What percentage of men with clinically significant prostate cancer will have a normal PSA level? 5% 20% 40%
If the result of is 8 ng/ml. You therefore advise him to consider a trans-rectal ultrasound guided biopsy. What percentage of tumours are missed at biopsy? 1% 20% 40%
THANK YOU
What percentage of men with clinically significant prostate cancer will have a normal PSA level? 20% Catalona W, Smith D, Ratliff T, Basler J
If the result of is 8 ng/ml. You therefore advise him to consider a trans-rectal ultrasound guided biopsy. What percentage of tumours are missed at biopsy? 20%
Rabbani F, Stroumbakis N, Kava BR, Cookson MS, Fair WR
Prostate cancer is an important health problem that affects mainly older men Each year over 20 000 men are diagnosed with prostate cancer and 9500 die from the disease There is no good evidence to indicate whether a population screening programme would reduce mortality Because of the uncertainties surrounding PSA testing it is important that you give men who request a test balanced information to help them make an informed decision Up to 20% of men with clinically significant prostate cancer will have a normal PSA level About two thirds of men with an elevated PSA level will not have prostate cancer detectable at biopsy Up to 20% of tumours are missed at trans-rectal ultrasound guided biopsy