presentation1,prostat cancer

7/27/2019 Presentation1,Prostat Cancer

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KANKER PROSTAT

By

H.T.FARIZAL FADIL4 OKT 2010


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Prostat Illustration


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What is prostate cancer?

Prostate cancer is a malignant

(cancerous) tumor (growth) that consists

of cells from the prostate gland. Generally,

the tumor usually grows slowly and

remains confined to the gland for manyyears. During this time, the tumor

produces little or no symptoms or outward

signs (abnormalities on physicalexamination). However, all prostate

cancers do not behave similarly.


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As the cancer advances, however, it can

spread beyond the prostate into the

surrounding tissues (local spread).

Moreover, the cancer also can

metastasize (spread even farther)

throughout other areas of the body, suchas the bones, lungs, and liver.


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Why is prostate cancer important?

Prostate cancer is the most commonmalignancy in American men and the

second leading cause of deaths from

cancer, afterlung cancer. According to the

American Cancer Society's most recent

estimates, 192,280 new cases of prostate

cancer would be diagnosed in 2009 and

27,360 would die
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The estimated lifetime risk of being

diagnosed with the disease

is 17.6% for Caucasians

20.6% for African Americans.

The lifetime risk of death from prostatecancer similarly is 2.8% and 4.7%

respectively.


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What are prostate cancer causes?

The cause of prostate cancer is unknown,

but the cancer is not thought to be related

to benign prostatic hyperplasia (BPH).

The risk (predisposing) factors for prostate

cancerinclude advancing age,

genetics (heredity),

hormonal influences, and such

environmental factors as toxins,

chemicals, and industrial products.


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Testosterone, the male hormone produced

by the testicles, directly stimulates the

growth of both normal prostate tissue andprostate cancer cells.

this hormone is that decreasing the level

of testosterone should be (and usually is)effective in inhibiting the growth of prostate

cancer.


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Although still unproven, environmental

factors, such as

cigarette smoking and

diets that are high in saturated fat, seem to

increase the risk of prostate cancer. There

is also a suggestion that

obesityleads to an increased risk of

having more aggressive, larger prostate

cancer,
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Of note, there is no proven relationship

between the frequency of sexual activity

and the chances of developing prostate

cancer.


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What are prostate cancer symptoms

and signs?

In the early stages, prostate cancer often

causes no symptoms for many years. As a

matter of fact, these cancers frequently

are first detected by an abnormality on a

blood test (the PSA, discussed below) or

as a hard nodule (lump) in the prostate

gland.


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Rarely, in more advanced cases, the

cancer may enlarge and press on theurethra. As a result, the flow

of urine diminishes and

urination becomes moredifficult. Patientsmay also experience

burning with urination

blood in the urine
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The cancer then can spread even farther (metastasize)to other areas of the body. Symptoms of metastaticdisease include

fatigue, malaise, and weight loss.

rectal examination can sometimes detect local spreadinto the surrounding tissues. That is, the physician canfeel a hard, fixed (not moveable) tumor extending from

and beyond the gland. Prostate cancer usually metastasizes first to the lower

spine or the pelvic bones (the bones connecting thelower spine to the hips), thereby causing back or pelvicpain.

The cancer can then spread to the liver and lungs.

Metastases


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to the liver can cause

pain in the abdomen and

jaundice (yellow color of the skin) in rare

instances.

Metastases to the lungs can cause chestpain and coughing.
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What are the screening tests for

prostate cancer?

These screening tests are a digital rectal

examination and a blood test called theprostate specific antigen (PSA). The PSA

level is usually higher than 4ng/mL in

people with prostate cancer than in people

without the cancer.
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Results of the PSA test under 4 nanograms per

milliliter of blood are generally considered

normal. Very high values, such as 30 or 40 andover, are usually caused by prostate cancer.

What are false-positive elevations in the PSA

test?

False-positive elevations in the PSA are

increases in the PSA that are caused by

conditions other than prostate cancer. For

example, benign prostatic hyperplasia (BPH)and infection or inflammation of the prostate

(prostatitis)


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Accordingly, the age-specific

normal ranges are 0 to 2.5 for in their 40s,

0 to 3.5 in their 50s,

0 to 4.5 in their 60s, and

0 to 6.5 for men 70 years of age and over.

Therefore, as an example, a PSA of 4would be considered borderline for men in

their 30s and 40s but could be normal for

men in their 50s, 60s, and 70s.


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Prostate cancer gene 3 (PCA3) is a new

gene-based test carried out on a urine

sample.

PCA3 is highly specific for the diagnosis

of prostate cancer.


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How is prostate cancer diagnosed and

graded?

Prostate cancer is diagnosed from the

results of a biopsy of the prostate gland. If

the digital rectal exam of the prostate or

the PSA blood test is abnormal, a prostatecancer is suspected. A biopsy of the

prostate is usually then recommended.


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Gleason score

of 6 is supposed to indicate low-grade(less aggressive) disease while that of 8-

10 demonstrates high grade (more

aggressive) cancer; 7 is regarded as

somewhere in between these two.


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How is the staging of prostate cancer

done?

The staging of a cancer refers to

determining the extent of the disease

(where in the body have the prostate

cancer cells spread). Once a prostatecancer is diagnosed on a biopsy,

additional tests are done to assess

whether the cancer has spread beyond thegland.


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Radionuclide bone scans can determine if

there is a spread of the tumor to the

bones.

Chest X-ray can be used to detect

whether or not cancer has spread to the

lungs. Additionally,

CT scans (coaxial tomography) and

MRIs (magnetic resonance imaging)

Cystoscopy is usually performed in

selected situations.
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The stages of prostate cancer are categorized as follows:

Stage I (or A): The cancer cannot be felt on a digital rectal exam,

and there is no evidence that it has spread outside the prostate.These are often found incidentally after surgery for an enlargedprostate.

Stage II (or B): The tumor is larger than a stage I and can be felt ona digital rectal exam. There is no evidence that the cancer hasspread outside the prostate. These are usually found on a biopsy

when a man has an elevated PSA level.

Stage III (or C): The cancer has invaded other tissues neighboringthe prostate.

Stage IV (or D): The cancer has spread to lymph nodes or to otherorgans


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Evaluation of the (primary) tumor ("T")

TX: The primary tumor cannot be evaluated.

T0: There is no evidence of tumor.

T1: Tumor is present but not detectable clinically or with imaging.

T1a: Tumor was incidentally found in less than 5% of prostate tissueresected (for other reasons).

T1b: Tumor was incidentally found in greater than 5% of prostate tissueresected.

T1c: Tumor was found in a needle biopsy performed due to an elevatedserum PSA.


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T2: The tumor can be felt (palpated) onexamination but has not spread outside theprostate.

T2a: The tumor is in half or less than half of oneof the prostate gland's two lobes.

T2b: The tumor is in more than half of one lobe,but not both.

T2c: The tumor is in both lobes


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T3: The tumor has spread through the prostatic capsule(if it is only partway through, it is still T2).

T3a: The tumor has spread through the capsule on oneor both sides.

T3b: The tumor has invaded one or both seminalvesicles.

T4: The tumor has invaded other nearby structures.


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Evaluation of the regional lymph nodes ("N")

NX: The regional lymph nodes cannot be

evaluated.

N0: There has been no spread to the regionallymph nodes.

N1: There has been spread to the regionallymph nodes.


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Evaluation of distant metastasis ("M")

MX: Distant metastasis cannot be evaluated.

M0: There is no distant metastasis.

M1: There is distant metastasis.

M1a: The cancer has spread to lymph nodes beyond the regional ones.

M1b: The cancer has spread to bone.

M1c: The cancer has spread to other sites (regardless of boneinvolvement)


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What are the treatment options for

prostate cancer?

surgery,

radiation therapy,

hormonal therapy,

cryotherapy, combinations of some of

these treatments

chemotherapy, therefore, are considered

palliative


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What about prostate cancer surgery?

The surgical treatment for prostate cancer

is commonly referred to as a radical

prostatectomy,


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The potential complications of a radical

prostatectomy include

the risks of anesthesia, local bleeding,

impotence (loss of sexual function) in 30%-70%

of patients, and incontinence (loss of control of urination) in 3%-

10% of patients.

Radical prostatectomy can be performed by

open surgery, laparoscopic surgery, or by

robotic surgery (robotic assisted radical

prostatectomy)


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Ifpost-treatment impotence does

occur, it can be treated by sildenafil (Viagra) tablets,

injections of such medications as

alprostadil (Caverject) into the penis, various devices to pump up or stiffen the

penis, or

penile prosthesis (an artificial penis).
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Incontinence after treatment often

improves with time, special exercises, and

medications to improve the control of

urination. Occasionally, however,

incontinence requires implanting an

artificial sphincter around the urethra. Theartificial sphincter is made up of muscle or

other material and is designed to control

the flow of urine through the urethra.


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What about radiation therapy for

prostate cancer?

Incontinence and impotence can occur as

complications of radiation therapy, as with

surgery,

(brachytherapy) directly into the prostate.

Both can cause severe fatigue, diarrhea,

and discomfort on urination. These effects

are almost always temporary
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What about hormonal treatment for

prostate cancer?

The male (androgenic) hormone is called

testosterone. It stimulates the growth of

cancerous prostatic cells and, therefore, is

the primary fuel for the growth of prostatecancer. The idea of all of the hormonal

treatments (medical and surgical), in short,

is to decrease the stimulation bytestosterone of the cancerous prostatic

cells


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Testosterone normally is produced by the

testes in response to stimulation from a

hormonal signal called LH-RH. The LH-RHstands for (luteinizing hormone-releasing

hormone) and is also called gonadotropin-

releasing hormone. This hormone comesfrom a control station in the brain and

travels in the bloodstream to the testes.

Once there, the LH-RH stimulates thetestes to produce and release

testosterone.


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The surgical hormonal treatment is

removal of the testes in an operation

called an orchiectomy or a castration.

The LH-RH agonists, leuprolide (Lupron)

orgoserelin (Zoladex), are given as

monthly injections in the doctor's office.The anti-androgenic drugs, flutamide

(Eulexin) orbicalutamide (Casodex),


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What is cryotherapy for prostate

cancer?

Cryotherapy is one of the newer

treatments that is being evaluated for use

in the early stage of prostate cancer. This

treatment kills the cancer cells by freezingthem. The freezing is accomplished by

inserting a freezing liquid (for example,

liquid nitrogen or argon) through needlesdirectly into the prostate gland


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What is HIFU for prostate cancer?

HIFU( high intensity focused ultrasound,)

was first developed as a treatment of

benign prostatic hyperplasia (BPH) and

now is also being used as a procedure for

the killing of prostate cancer cells.


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What is chemotherapy for prostate

cancer?

Chemotherapeutic agents, or

chemotherapy, are anticancer drugs. They

are used (for hormone resistant prostate

cancer) as a palliative treatment (palliationto relieve symptoms) in patients with

advanced cancer for whom a cure is

unattainable.


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Several chemotherapeutic agents have

been used effectively to palliate metastatic

prostate cancer. One such agent isestramustine (Emcyt).

Another agent called mitoxantrone

(Novantrone) has been shown to beeffective in combination with prednisone

for palliating androgen-independent

prostate cancer Newer chemotherapy medicines like

docetaxel (Taxotere)


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side effects of chemotherapy include

weakness,

nausea,

hair loss, and

suppression of the bone marrow. The

suppression of marrow, in turn, can

decrease the red blood cells (causing

anemia), the white blood cells (leading to

infections), and the platelets (resulting inbleeding).
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What are the differences between

hormonal treatment and

chemotherapy? Hormonal therapy is the mainstay of

treatment for symptomatic, advanced-

staged prostate cancer


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Orchiectomy is the surgical removal of the

testicles. Luteinizing hormone-releasing

hormone (LHRH) agonists, such asleuprolide (Lupron, Viadur, Eligard),

goserelin (Zoladex), or buserelin

(Suprefact), stop the production oftestosterone from the testes and induce a

state of "medical castration" (castration

without surgery). Many men prefer this

over surgical castration.


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Antiandrogens, such as flutamide

(Eulexin) orbicalutamide (Casodex), block

the action of testosterone on the prostatecancer cells and other parts of the body.

Each of the above two classes of

medicines produce symptomatic relief inabout 80% of patients. Improvement is

often dramatic.


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Side effects of these medications vary.

Orchiectomy and LHRH agonists may

cause impotence, hot flashes, and loss ofsexual desire. Antiandrogens may cause

nausea, vomiting, diarrhea, and breast

enlargement or tenderness. Any of thesetherapies can weaken bones and lead to

osteoporosis and bone fracture.


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Other agents that are helpful include the

following: progestins such as megestrol

acetate given daily orally and other drugsthat inhibit androgen production such as

aminoglutethimide (Cytadren) or

ketoconazole (Nizoral, Extina, Xolegel,Kuric). These agents are effective but are

sometimes difficult to tolerate.

Corticosteroids are often given

simultaneously.


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What about herbal or other alternative

medicine treatments for prostate

cancer?

Alternative medicine, also called

integrative or complementary medicine,

includes such non-traditional treatmentsas herbs, dietary supplements, and

acupuncture. A major problem with most

herbal treatments is that their compositionis not standardized.


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Can prostate cancer be prevented?

No specific measures are known to prevent the

development of prostate cancer. At present,therefore, we can hope only to prevent

progression of the cancer by making early

diagnoses and then attempting to cure the

disease. Early diagnoses can be made byscreening men for prostate cancer with PSA and

digital rectal examination The purpose of the

screening is to detect early, tiny, or even

microscopic cancers that are confined to the

prostate gland


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Recently, studies have shown that certain

medications (finasteride [Propecia] and

dutasteride [Avodart]) decrease thechances of getting prostate cancer when

taken over the long term.


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What will be the future treatments for

prostate cancer?

the genetic basis of this disease. Genes,which are chemical compounds located on

the chromosomes, determine the

characteristics of individuals. Accordingly,investigators at research centers have

focused on identifying and isolating the

gene or genes responsible for prostatecancer.


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the FDA approved a prostate cancer

vaccine called sipuleucel-T (Provenge)

that has been made for people who are atan advanced stage of prostate cancer.


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There is also a great interest in inventing

better methods to image prostate cancer

to detect its location and spread in thebody. Newer techniques like MRS

(magnetic resonance spectroscopy), PET

(positron emission tomography) andcertain molecular imaging techniques hold

promise in this regard.


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Prostate Cancer At A Glance

Prostate cancer is the second leading cause of deathsfrom cancer among U.S. men.

While the causes of prostate cancer are still unknown,some risk factors for the disease, such as advancing ageand a family history of prostate cancer, have beenidentified.

Prostate cancer is often initially suspected because of an

abnormal PSA blood test or a hard nodule (lump) felt onthe prostate gland during a routine digital (done with afinger) rectal examination.

Refinements in the PSA test, including the PSA ratio,age-specific PSA, and PSA velocity or slope haveimproved the accuracy of the test.

If one of the screening tests is abnormal, the diagnosisof prostate cancer should be suspected and a biopsy ofthe prostate gland is usually done.


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The diagnosis of prostate cancer is made whencancerous prostatic cells are identified in the biopsytissue under a microscope.

In some men, prostate cancer is life threatening, while inmany others, it can exist for many years without causinghealth problems.

The choice of treatment for prostate cancer depends onthe size, aggressiveness, and extent or spread of thetumor, as well as on the age, general health, andpreference of the patient.

The many options for treating prostate cancer includesurgery, radiation therapy, hormonal treatment,cryotherapy, chemotherapy, combinations of some ofthese treatments, and watchful waiting/active

surveillance. Research is under way to identify the genes that cause

prostate cancer.


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Pattern 1 - The cancerous prostate closely resemblesnormal prostate tissue. The glands are small, well-formed, and closely packed.

Pattern 2 - The tissue still has well-formed glands, butthey are larger and have more tissue between them.

Pattern 3 - The tissue still has recognizable glands, butthe cells are darker. At high magnification, some of these

cells have left the glands and are beginning to invade thesurrounding tissue.

Pattern 4 - The tissue has few recognizable glands.Many cells are invading the surrounding tissue

Pattern 5 - The tissue does not have recognizable

glands. There are often just sheets of cells throughoutthe surrounding tissue.
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Interpreting the results

The lower the score, the better. A combined

Gleason score of 10 is very bad (although thereare still many treatments that doctors can offermen with high Gleason scores). Here's how thescores break down:

Scores from 2 to 4 are very low on the canceraggression scale.

Scores from 5 to 6 are mildly aggressive.

A score of 7 indicates that the cancer is

moderately aggressive. Scores from 8 to 10 indicate that the cancer is

highly aggressive.

presentation1,prostat cancer

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