PROSTATE CANCER

· A gland

· Location – opening of the bladder

· Wraps around the urethra

· Child-size of a "pea"

· Adult-size of a "walnut"

· Function – to produce a nutritious fluid to support sperm

· Glandular tissue – produces a fluid that forms semen

· Smooth muscle – squeezes during ejaculation and forces the fluid into the urethra

· Support tissue – gives it tone and shape

· Converts testosterone into dihydrotestosterone (DHT)

· DHT contributes to growth of prostate

· Produces insulin-like growth factor which interacts with DHT to induce cancer formation

· A malignant tumor that arises in the glandular portion of the prostate

· Very slow growing solid tumor

· May stay dormant for many years

· Incidence increases with age

· Some type of geographic etiology

· Age

· One half of the men over the age of 70

· It is the most common male cancer

· Second in deaths to lung cancer

· Afro-American men

· 66% higher risk than non-blacks

· Native Americans and Hispanic American have a lower incidence than white Americans

· Black men in Africa have a lower risk

· Vegetarians get less prostate cancer

· Environmental factors at work

· 10% or less of all cases are genetically inherited

· Usually linked to p53 gene malfunction

· Occurs early (younger you are), is more aggressive

· Genetically inherited

· Much more sever outcomes

· Infection – no definite link, even with multiple viral exposures

· Benign Prostatic Hyperplasia (BPH) begins at 40 years of age (all men over forty have BPH)

· Sexual activity – no relationship

· Occupational hazard – exposure to chemicals, radiation, possible link to farming

· Vasectomy – European study not supported by large US studies

· Diet – high animal fat in diet is linked to prostate cancer

· Smoking – chemicals in inhaled smoke

· Alcohol – only in high quantities (22-50 drinks per week)

· Frequent urination

· Weak stream of urine

· Blood in urine

· Weight loss

· Bone pain

· Loss of appetite

· Hematospermia (blood in semen)

· BPH – enlargement of the prostate

· Prostatitis – infection of the prostate

· Prostatosis – swelling of the prostate

· Prostadynia – pain in the prostate

· Symptoms – usually none; may have common symptoms with other conditions

· Physical exam – digital rectal exam

· PSA blood test – PSA (Prostate Specific Antigen) = protein made my epithelial cells, helps keep the semen in liquid state

· Is elevated in early as well as late prostate cancer

· Lower normals in African-American men

· Slowly increases with age

· Free PSA (ratio of free PSA to bound PSA is used to calculate risk), complex PSA

· Screening – good or bad after a certain age

· Prostate specific test but not cancer specific

· Any abnormal digital rectal exam

· Any PSA test, confirmed, corrected for age

· Possibly any free PSA level outside of the normal range

· Prostate biopsy with ultrasound guidance

· TRUS – insertion of a probe into the rectum to direct sound waves against the prostate

· This gives a visual image and allows accurate biopsies

· Look at the histological pattern of the cancer – Gleason score

· Add the PSA level

· Consider the age of the patient

 

· Bone scan

· CT scan of the pelvis

· MRI scan using rectal probe

· Chest X-ray

· Lymph node biopsy

· Surgery – radical prostatectomy with bilateral lymph nodes dissection

o Side effects (10% leakage, incontinence, impotence, and possible infection)

· 3-D conformal external beam radiation therapy

· Radio-active seed implantation brachytherapy

· Add total androgen suppression to all of the treatments

o Seed implantation – glow in the dark, irritative urinary symptoms

o Total androgen suppression – hot flashes, hot flashes and the desire to go shopping

o Gleason score 7 or less, PSA low, organ confined disease

1. At least 88% survival at 5 years

2. 80% at 10 years

o Non-organ confined Disease

1. 70% survival at 5 years

2. 50% or less survival at 10 years

3. Hormone treatment will delay the onset of disease progression but will not lengthen life expectancy

o Anti-oxidants vitamins

o Vitamin E

o Green Tea

o Vegetables

o Selenium

o Zinc

o Family history of prostate cancer

o PSA testing starting at age 40, at least yearly

o Yearly digital rectal exams

o Diet, vitamin, and exercise

o Low fat diet

o Soy protein

o High fiber diet

o Tomatoes – antioxidant lycopene

o Broccoli and cabbage

o Exercise

o Change life style

o Save your organs

Last modified: March 25, 2001 01:45 PM
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