Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
Management of renal cell carcinoma and wilms' tumor Anil Gupta
This document provides an overview of the management of renal tumors. It discusses the classification, epidemiology, clinical presentation, diagnostic evaluation, staging, and management of both localized and locally advanced renal cell carcinoma. For localized RCC, treatment options include radical or partial nephrectomy, which can be performed openly, laparoscopically, or robotically. Active surveillance is also discussed. For locally advanced RCC, the aim is complete excision though extended surgery may be needed. Neoadjuvant radiotherapy has not proven beneficial.
This document discusses the histopathological evaluation of prostate needle biopsies. It begins by covering normal prostate histology, including the components and cell types present. Variations of normal tissue are then reviewed. Key features that indicate prostate cancer are described, such as mucinous fibroplasia, glomerulation, and perineural invasion. Architectural patterns commonly seen in cancer, like infiltrative growth and cribriform structures, are also outlined. The document provides guidance on distinguishing between benign and malignant findings in prostate biopsies.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
Retroperitoneal lymph node dissection (RPLND) is a surgical procedure used to treat testicular cancer. It involves removing lymph nodes in the retroperitoneum which are the first draining sites of metastasis from testicular cancer. Over time, the procedure has evolved from open approaches to minimally invasive techniques. Key developments included mapping of lymphatic drainage patterns, adoption of nerve-sparing approaches to preserve ejaculation, and use of modified or extended templates based on tumor staging. While RPLND remains an important treatment option, ongoing debates include its role compared to surveillance for very small residual masses after chemotherapy and optimal surgical extent. Complication rates also vary based on whether performed for primary staging or post-
Management of renal cell carcinoma and wilms' tumor Anil Gupta
This document provides an overview of the management of renal tumors. It discusses the classification, epidemiology, clinical presentation, diagnostic evaluation, staging, and management of both localized and locally advanced renal cell carcinoma. For localized RCC, treatment options include radical or partial nephrectomy, which can be performed openly, laparoscopically, or robotically. Active surveillance is also discussed. For locally advanced RCC, the aim is complete excision though extended surgery may be needed. Neoadjuvant radiotherapy has not proven beneficial.
This document discusses the histopathological evaluation of prostate needle biopsies. It begins by covering normal prostate histology, including the components and cell types present. Variations of normal tissue are then reviewed. Key features that indicate prostate cancer are described, such as mucinous fibroplasia, glomerulation, and perineural invasion. Architectural patterns commonly seen in cancer, like infiltrative growth and cribriform structures, are also outlined. The document provides guidance on distinguishing between benign and malignant findings in prostate biopsies.
The document discusses the anatomy and diagnostic evaluation of prostate cancer. It describes the prostate as a walnut-sized gland located below the bladder and surrounding the urethra. The primary function is to produce seminal fluid. Diagnostic workup involves PSA levels, digital rectal exam, prostate biopsy and various imaging modalities like CT, MRI, bone scan and PSMA PET/CT to stage disease extent and metastasis. Gleason scoring is used to grade prostate cancer based on architectural patterns seen on biopsy.
This document provides information about bladder carcinoma, including:
1. Bladder carcinoma is the most common cancer of the urinary tract, affecting men more than women. It is most common in the elderly, around ages 67-70.
2. Risk factors include family history, chemical exposure, smoking, irradiation, arsenic exposure, and urinary disorders. Preneoplastic abnormalities and carcinoma in situ can develop.
3. Transitional cell carcinoma accounts for 90% of bladder cancers and can range from low to high grade. Staging involves determining if the cancer is superficial, invasive, or metastatic. Treatment depends on the stage and grade.
This document discusses the management of urinary bladder carcinomas. It begins with epidemiology and risk factors, then covers diagnosis and staging. For non-muscle invasive bladder cancer (NMIBC), it describes transurethral resection of bladder tumor (TURBT) followed by adjuvant BCG or chemotherapy. For muscle invasive bladder cancer (MIBC), options discussed are radical cystectomy or bladder preservation protocols using trimodality therapy. Radiotherapy plays a role in bladder preservation or post-operatively in certain high risk cases.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
The document discusses carcinoma of the pancreas. It covers the anatomy, epidemiology, risk factors, genetics, screening, staging, pathologic conditions, clinical presentation, evaluation, management approaches for resectable, borderline resectable, and unresectable disease, surgical procedures including Whipple procedure and distal pancreatectomy, complications, adjuvant therapy approaches studied in trials such as ESPAC-1, and the role of chemoradiation following gemcitabine chemotherapy.
Renal Cell Carcinoma Diagnosis And ManagementRHMBONCO
This document provides an overview of renal cell carcinoma (RCC), including its epidemiology, pathology, clinical presentation, evaluation and staging, prognosis, and treatment options. RCC incidence has been rising and is more common in men than women. Surgery is the main treatment for localized RCC, while targeted therapies like sorafenib and sunitinib have improved outcomes for metastatic RCC compared to previous chemotherapy options. Ongoing clinical trials are exploring adjuvant and neoadjuvant therapies to improve prognosis.
Management of prostate cancer involves assessing risk levels based on PSA, Gleason score, and percentage of positive biopsy cores. Treatment options include active surveillance for low risk prostate cancer with potential delayed treatment if cancer progresses. Radical prostatectomy is the gold standard for localized prostate cancer and provides the possibility of cure with minimal side effects when performed by an experienced surgeon. While providing excellent cancer control, radical prostatectomy carries risks of erectile dysfunction and urinary incontinence.
This document discusses the diagnosis and management of bladder cancer. It provides details on staging, risk assessment, and treatment options for superficial and muscle-invasive bladder cancer including transurethral resection of bladder tumor (TURBT), intravesical chemotherapy or immunotherapy, and radical cystectomy or radiotherapy. It also discusses the use of neoadjuvant chemotherapy to improve outcomes and provides case studies on patients who received chemotherapy and radiotherapy for localized and metastatic bladder cancer.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
Carcinoma of the prostate is the most commonly diagnosed cancer and second leading cause of cancer death in men. Risk increases with age and family history. It often metastasizes to bones and lymph nodes. Diagnosis involves elevated PSA levels, abnormal digital rectal exam, biopsy. Staging uses the TNM system - early stages are limited to the prostate while advanced stages have spread outside the prostate. Gleason scoring evaluates microscopic patterns to determine tumor grade and aggressiveness. Treatment depends on tumor stage, grade and patient health.
Prostate biopsy is commonly used to diagnose prostate cancer. Transrectal ultrasound guided biopsy is most common, but transperineal biopsy provides improved sampling. Extended biopsy schemes of 12 cores or more are now standard. Antibiotic prophylaxis and local anesthesia reduce risks of infection and pain. New techniques like MRI-fusion biopsy target suspected cancers more precisely. Overall, prostate biopsy remains a valuable tool but ongoing improvements aim to enhance safety, accuracy and ability to detect clinically significant cancers.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
This document discusses treatment options for urinary bladder carcinoma. It covers non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC), and metastatic disease. For NMIBC, transurethral resection of bladder tumor (TURBT) followed by intravesical immunotherapy like BCG is recommended. For MIBC, radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard treatment. Neoadjuvant chemotherapy may improve survival for MIBC. Adjuvant chemotherapy is recommended for high-risk MIBC following cystectomy.
This document summarizes information about anal canal cancer, including:
- It accounts for 1-2% of large bowel malignancies and is increasing in incidence. Risk factors include HPV infection and HIV infection.
- Screening high-risk groups like HIV+ individuals can detect early anal intraepithelial neoplasia, as HPV vaccines may help prevent cancers.
- Most anal canal cancers are squamous cell carcinomas. Clinical staging evaluates tumor extent, node involvement, and distant spread through digital exam, imaging and biopsy.
This document discusses stage IV prostate cancer and advanced or metastatic prostate cancer. It defines stage IV based on the TNM classification system and notes that approximately 10-20% of newly diagnosed prostate cancer cases involve locally advanced disease. For metastatic prostate cancer, median survival ranges from 9 to 24 months depending on whether metastases are asymptomatic or symptomatic. Main treatments discussed include androgen deprivation therapy and chemotherapy. The document also covers management of bone metastases, hormone-refractory prostate cancer, newer hormone therapies like abiraterone and enzalutamide, immunotherapy with sipuleucel-T, chemotherapy options including docetaxel and cabazitaxel, radiopharmaceuticals like radium-223, and bone-mod
This document discusses the management of locally advanced renal cell carcinoma (RCC) at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It covers RCC with involvement of the inferior vena cava (IVC) or invasion of adjacent organs. For IVC involvement, it describes evaluation methods like MRI/CT and surgical techniques for thrombectomy based on the level of thrombus. It also discusses locally invasive non-metastatic RCC and invasion of adjacent organs like liver, duodenum, colon and approaches to management with extended resections when needed.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document provides an overview of the anatomy and surgical procedures related to the prostate gland. It begins with the surgical anatomy of the prostate, including its relations to surrounding structures, coverings, lobes, blood supply, lymphatic drainage and innervation. It then discusses various prostate surgeries like TURP, open and laparoscopic prostatectomy. It concludes with potential complications of prostate surgery, such as injuries, urinary incontinence, and issues with erection, ejaculation and fertility. Videos are also embedded to demonstrate different prostate procedures.
The prostate is a gland located below the bladder. It helps produce fluid for semen. Common prostate issues include benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. BPH involves non-cancerous growth of the prostate and affects most men as they age. Prostatitis is prostate inflammation that can be acute or chronic. Prostate cancer is the most common cancer in men over 65. Early prostate cancer may have no symptoms, while advanced cases can spread to bones.
1) Transanal total mesorectal excision (TME) is a novel technique for resection of rectal cancers.
2) TME involves excising the rectum and the surrounding mesorectum in one block through the anus to minimize local recurrence.
3) This "down-to-up" transanal approach aims to improve on open TME by reducing morbidity and impairment of function compared to traditional surgery.
The document discusses carcinoma of the pancreas. It covers the anatomy, epidemiology, risk factors, genetics, screening, staging, pathologic conditions, clinical presentation, evaluation, management approaches for resectable, borderline resectable, and unresectable disease, surgical procedures including Whipple procedure and distal pancreatectomy, complications, adjuvant therapy approaches studied in trials such as ESPAC-1, and the role of chemoradiation following gemcitabine chemotherapy.
Renal Cell Carcinoma Diagnosis And ManagementRHMBONCO
This document provides an overview of renal cell carcinoma (RCC), including its epidemiology, pathology, clinical presentation, evaluation and staging, prognosis, and treatment options. RCC incidence has been rising and is more common in men than women. Surgery is the main treatment for localized RCC, while targeted therapies like sorafenib and sunitinib have improved outcomes for metastatic RCC compared to previous chemotherapy options. Ongoing clinical trials are exploring adjuvant and neoadjuvant therapies to improve prognosis.
Management of prostate cancer involves assessing risk levels based on PSA, Gleason score, and percentage of positive biopsy cores. Treatment options include active surveillance for low risk prostate cancer with potential delayed treatment if cancer progresses. Radical prostatectomy is the gold standard for localized prostate cancer and provides the possibility of cure with minimal side effects when performed by an experienced surgeon. While providing excellent cancer control, radical prostatectomy carries risks of erectile dysfunction and urinary incontinence.
This document discusses the diagnosis and management of bladder cancer. It provides details on staging, risk assessment, and treatment options for superficial and muscle-invasive bladder cancer including transurethral resection of bladder tumor (TURBT), intravesical chemotherapy or immunotherapy, and radical cystectomy or radiotherapy. It also discusses the use of neoadjuvant chemotherapy to improve outcomes and provides case studies on patients who received chemotherapy and radiotherapy for localized and metastatic bladder cancer.
This document provides information about testicular cancers, including:
- Testicular cancer accounts for 1% of cancers in males and is highly curable when detected early, often affecting young men.
- The testis has blood supply from the testicular artery and drains into the pampiniform plexus and internal spermatic veins. Lymphatic drainage is to retroperitoneal lymph nodes.
- The majority (95%) are germ cell tumors, including seminomas and non-seminomas. Staging involves tumor markers, imaging scans, and lymph node dissection. Treatment depends on the type and stage but may include surgery, chemotherapy, and radiation therapy.
Carcinoma of the prostate is the most commonly diagnosed cancer and second leading cause of cancer death in men. Risk increases with age and family history. It often metastasizes to bones and lymph nodes. Diagnosis involves elevated PSA levels, abnormal digital rectal exam, biopsy. Staging uses the TNM system - early stages are limited to the prostate while advanced stages have spread outside the prostate. Gleason scoring evaluates microscopic patterns to determine tumor grade and aggressiveness. Treatment depends on tumor stage, grade and patient health.
Prostate biopsy is commonly used to diagnose prostate cancer. Transrectal ultrasound guided biopsy is most common, but transperineal biopsy provides improved sampling. Extended biopsy schemes of 12 cores or more are now standard. Antibiotic prophylaxis and local anesthesia reduce risks of infection and pain. New techniques like MRI-fusion biopsy target suspected cancers more precisely. Overall, prostate biopsy remains a valuable tool but ongoing improvements aim to enhance safety, accuracy and ability to detect clinically significant cancers.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
This document discusses treatment options for urinary bladder carcinoma. It covers non-muscle invasive bladder cancer (NMIBC), muscle invasive bladder cancer (MIBC), and metastatic disease. For NMIBC, transurethral resection of bladder tumor (TURBT) followed by intravesical immunotherapy like BCG is recommended. For MIBC, radical cystectomy with pelvic lymphadenectomy and urinary diversion is the standard treatment. Neoadjuvant chemotherapy may improve survival for MIBC. Adjuvant chemotherapy is recommended for high-risk MIBC following cystectomy.
This document summarizes information about anal canal cancer, including:
- It accounts for 1-2% of large bowel malignancies and is increasing in incidence. Risk factors include HPV infection and HIV infection.
- Screening high-risk groups like HIV+ individuals can detect early anal intraepithelial neoplasia, as HPV vaccines may help prevent cancers.
- Most anal canal cancers are squamous cell carcinomas. Clinical staging evaluates tumor extent, node involvement, and distant spread through digital exam, imaging and biopsy.
This document discusses stage IV prostate cancer and advanced or metastatic prostate cancer. It defines stage IV based on the TNM classification system and notes that approximately 10-20% of newly diagnosed prostate cancer cases involve locally advanced disease. For metastatic prostate cancer, median survival ranges from 9 to 24 months depending on whether metastases are asymptomatic or symptomatic. Main treatments discussed include androgen deprivation therapy and chemotherapy. The document also covers management of bone metastases, hormone-refractory prostate cancer, newer hormone therapies like abiraterone and enzalutamide, immunotherapy with sipuleucel-T, chemotherapy options including docetaxel and cabazitaxel, radiopharmaceuticals like radium-223, and bone-mod
This document discusses the management of locally advanced renal cell carcinoma (RCC) at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It covers RCC with involvement of the inferior vena cava (IVC) or invasion of adjacent organs. For IVC involvement, it describes evaluation methods like MRI/CT and surgical techniques for thrombectomy based on the level of thrombus. It also discusses locally invasive non-metastatic RCC and invasion of adjacent organs like liver, duodenum, colon and approaches to management with extended resections when needed.
This document provides information on the management of soft tissue sarcoma. It discusses the clinical presentation, patterns of spread, imaging, histology, grading, staging, prognostic factors and management of soft tissue sarcomas. The key points are:
1) Soft tissue sarcomas most commonly present as painless swellings in the extremities and can invade locally along fascial planes. Imaging like MRI is important for assessing tumor extent.
2) Histologically, the most common subtypes are undifferentiated pleomorphic sarcoma and liposarcoma. Grading systems consider tumor differentiation, mitosis and necrosis.
3) Staging is based on tumor size, depth, nodal status and metastasis
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
The anal canal is approximately 4 cm in length extending from the anorectal junction to the anal verge. Anal cancers are rare and mostly squamous cell carcinomas arising from the anal transitional zone. Risk factors include HPV infection and immunosuppression. Combined chemoradiotherapy is the standard first-line treatment and results in high response rates and organ preservation compared to radiation alone. Salvage surgery may be considered for select cases after failed nonsurgical treatment or as primary treatment for those who cannot tolerate chemoradiotherapy. Prognosis depends on tumor stage, with 5-year survival rates ranging from 45-86% depending on depth of invasion and nodal involvement.
This document provides an overview of the anatomy and surgical procedures related to the prostate gland. It begins with the surgical anatomy of the prostate, including its relations to surrounding structures, coverings, lobes, blood supply, lymphatic drainage and innervation. It then discusses various prostate surgeries like TURP, open and laparoscopic prostatectomy. It concludes with potential complications of prostate surgery, such as injuries, urinary incontinence, and issues with erection, ejaculation and fertility. Videos are also embedded to demonstrate different prostate procedures.
The prostate is a gland located below the bladder. It helps produce fluid for semen. Common prostate issues include benign prostatic hyperplasia (BPH), prostatitis, and prostate cancer. BPH involves non-cancerous growth of the prostate and affects most men as they age. Prostatitis is prostate inflammation that can be acute or chronic. Prostate cancer is the most common cancer in men over 65. Early prostate cancer may have no symptoms, while advanced cases can spread to bones.
The prostate gland is a pyramid-shaped organ that weighs approximately 20 grams and measures 3x4x2 cm. It has three zones - the peripheral zone (70%), central zone (25%), and transitional zone (5-10%). Prostate cancer develops in the peripheral zone, while benign prostatic hyperplasia (BPH) develops in the transitional zone. The prostate receives its blood supply from various arteries, most commonly the internal pudendal artery (34%). Knowing the detailed arterial anatomy is important for procedures like prostate artery embolization (PAE) to treat conditions like BPH and prostate cancer. Imaging tools like CT angiography and cone beam CT can help the interventional radiologist map the arterial supply before
The document discusses prostate cancer including anatomy, staging, Gleason scoring, treatment options, and side effects. It covers imaging like CT and MRI scans to visualize the prostate and surrounding structures. Radiation treatments like IMRT, Tomotherapy, Cyberknife and seed implants are described in detail, noting their ability to precisely target the prostate gland and avoid nearby organs to minimize side effects. Typical radiation protocols are provided for low and higher risk prostate cancer cases.
The document discusses prostate cancer, including its anatomy, staging, Gleason scoring, and treatment options. It provides details on radiation therapy techniques like IMRT and Tomotherapy that tightly target the prostate gland while avoiding surrounding organs to minimize side effects. Brachytherapy seed implantation is also covered. Treatment protocols vary based on cancer risk but commonly involve a combination of radiation types and sometimes hormone therapy.
The document discusses the anatomy and functions of the prostate gland. It is located below the bladder and in front of the rectum. The prostate secretes fluid that nourishes sperm. Common prostate problems include enlarged prostate (BPH), prostate cancer, and prostatitis. BPH causes urinary symptoms due to pressure on the urethra. Prostate cancer develops from gland cells and can spread to other organs if not detected early. Diagnosis involves exams, tests like PSA, and biopsies. Treatment depends on the condition but may include medications, surgery, radiation, or watchful waiting.
Prostate Cancer: Causes, Diagnosis, and Treatment Options Bruce B ... Prost...MedicineAndHealthCancer
Prostate cancer is one of the most common cancers in men. Treatment options include non-curative therapies like hormone therapy or potentially curative therapies like radical prostatectomy, radiation therapy, and cryoablation. Cryoablation, also known as cryotherapy, involves using argon gas to freeze and destroy the prostate tissue with probes inserted through the skin between the scrotum and rectum under ultrasound guidance. It aims to kill all cancer cells while sparing nearby nerves to reduce side effects like erectile dysfunction and incontinence compared to other treatments. Studies show 89% of men treated with cryoablation were cancer-free after 7 years with low risks of complications.
The document discusses prostate cancer including its anatomy, epidemiology, diagnosis, staging, treatment and outcomes. Key points include:
- Prostate cancer is the most commonly diagnosed cancer in men. Risk factors include age, family history, and ethnicity. Screening includes PSA testing and biopsy.
- Treatment depends on risk classification based on PSA, Gleason score, and stage. Options include active surveillance, surgery, radiation therapy and hormone therapy.
- Studies show dose escalation radiation therapy and use of IMRT/3D conformal radiation improve biochemical control rates with acceptable toxicity compared to conventional radiation. Adjuvant hormone therapy with radiation improves outcomes for intermediate-high risk disease.
Most prostate cancers are slow growing and do not manifest during a man's lifetime. While many men are found to have microscopic prostate cancer at autopsy, most die with rather than from prostate cancer. Prostate cancer most commonly presents as adenocarcinoma in the peripheral zone of the prostate and has local spread through the prostate capsule or seminal vesicles and distant spread via lymph nodes or hematogenously to bones and lungs. Imaging like ultrasound, CT, MRI, and bone scans are used to diagnose and stage prostate cancer.
This document summarizes statistics on prostate cancer incidence and mortality rates in the United States from 1975 to 2009. It also discusses results from several major clinical trials comparing prostate cancer screening to no screening, and radical prostatectomy to observation for localized prostate cancer. The key findings are:
1) Prostate cancer incidence peaked in 1992 but mortality rates have been declining since the 1990s.
2) Large screening trials show screening increases prostate cancer diagnosis but does not reliably decrease prostate cancer mortality.
3) The PIVOT trial found that among men with localized prostate cancer, radical prostatectomy resulted in a 2.9% lower rate of death from any cause and a 2.6% lower rate of death from prostate
Located between the bladder and rectum, the prostate is a gland made up of two lobes and surrounded by a layer of tissue.
http://www.prostate-health-center.com
The document summarizes benign prostatic hyperplasia (BPH), testicular cancer, and prostate cancer. It describes the etiology, epidemiology, pathophysiology, risk factors, signs and symptoms, diagnostic workup, and treatment for each condition. It compares the pathophysiology, clinical presentation, diagnostic workup and treatment of BPH and prostate cancer. BPH and prostate cancer are both common prostate disorders in aging men, but have different causes, presentations and treatments. Testicular cancer most often appears as a painless testicular mass in younger men and requires orchiectomy for diagnosis and treatment.
MR imaging is useful for staging prostate cancer once diagnosis is established through biopsy. It allows for identification of extracapsular extension, seminal vesicle invasion, and lymph node involvement. The departmental cases demonstrated various MRI findings of prostate cancer, including low T2 signal in the peripheral zone, restricted diffusion, and increased choline on MR spectroscopy. MRI is more sensitive and specific than other imaging modalities for local staging of prostate cancer when combined with MR spectroscopy.
Overview and Pharmacotherapy of Prostate Cancer (based on NCCN 2012 guideline...hyunik116
This presentation was the prostate cancer lecture for the oncology therapeutics course (31:725:560) that was presented to the class of 2014 PharmD students at the Ernest Mario School of Pharmacy.
I really enjoyed researching and preparing this lecture for the students, and hope you also will find at least something useful in this presentation.
Prostate cancer is the second most common cancer in men worldwide. Nurses play an important role in educating patients about prostate cancer screening, treatment options including surgery, radiation, hormone therapy, and caring for patients undergoing various treatments. Key responsibilities of nurses include assessing patients for side effects, providing wound and catheter care after surgery, instructing patients on skin care during radiation, and helping patients manage symptoms of treatments like hot flashes and incontinence to maximize quality of life. A multidisciplinary team approach with nursing support is important for optimal prostate cancer care.
This document discusses prostate cancer awareness and provides information about prevention, symptoms, treatment options and stages. It notes that prostate cancer is the second leading cause of cancer death in American men and that early detection is vital for survival. It describes exams like the digital rectal exam and PSA testing that are used to detect prostate cancer early before symptoms appear. If cancer is found, it explains treatment options depending on the stage, like watchful waiting, surgery, radiation and hormone therapy. It stresses the importance of education and consulting doctors to make informed healthcare decisions.
1) The rectum is the distal part of the large intestine located in the pelvic cavity. It extends from the rectosigmoid junction to the anal canal.
2) It has several flexures including anterior-posterior sacral and perineal flexures. It also has lateral flexures that correspond to transverse rectal folds.
3) The rectum receives its blood supply from the superior, middle, and inferior rectal arteries and drains into the superior, middle, and inferior rectal veins.
- A 60 year old smoker presented for a routine physical and was found to have an abnormality on chest x-ray
- The next appropriate test would be a CT scan of the chest with IV contrast to further characterize any lung lesions found on CXR
- A CT-guided biopsy would not be the next test, as further imaging is needed first to identify and stage any potential lung cancer before invasive testing
The best answer is A) CT chest with IV contrast to further evaluate and characterize any lung abnormalities found on CXR before considering an invasive biopsy.
This document discusses the functional anatomy of several types of cancers, including oral cavity cancers like tongue cancer, liver cancer, breast cancer, and pelvic cancers like cervical cancer, prostate cancer, and colon and rectum cancers. It describes the vascular supply, lymphatic drainage, and anatomical relationships of these organs and how cancers can spread through these pathways. Key details provided include the blood supply and lymphatic drainage patterns of the tongue and how tongue cancer spreads, as well as how liver, breast, cervical, prostate and other pelvic cancers metastasize to distant sites.
A basic approach towards carcinoma of prostate , symptoms, investigations , diagnosis, staging, treatment and follow up along with recent advances in surgeries, vaccines and immunotherapy.
Overview of Carcinoma Prostate and GeneticsDrAyush Garg
The prostate is a walnut-sized gland located below the bladder and in front of the rectum. It produces fluid that protects and transports sperm. The primary function of the prostate is to produce seminal fluid. Prostate cancer is common and can range from early stage to locally advanced to metastatic. Diagnosis involves a physical exam, PSA level, biopsy, and imaging tests. Treatment options depend on the stage and grade of cancer.
The prostate is a gland that produces seminal fluid. Prostate cancer is the second most common cancer in men. The prostate has four zones - peripheral, transition, central and anterior fibromuscular. Prostate cancer usually arises in the peripheral zone and is typically an adenocarcinoma. Diagnosis involves a digital rectal exam, prostate-specific antigen testing, transrectal ultrasound of the prostate and biopsy. Staging involves evaluating if the cancer is organ-confined or has spread locally or metastasized. Treatment options depend on risk stratification and may include active surveillance, surgery, radiation therapy or hormone therapy.
anatomy of Prostate and prostate carcinomaRojan Adhikari
This document discusses prostate cancer including its anatomy, epidemiology, diagnosis, and management. Some key points:
1. Prostate cancer most commonly arises from the peripheral zone of the prostate and affects men older than 50 years of age.
2. Diagnosis involves evaluation of PSA levels, digital rectal exam, and transrectal ultrasound-guided biopsy of the prostate.
3. Treatment depends on cancer stage, grade, and risk level. Options include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy.
The document provides information on the anatomy and function of the prostate gland. It discusses that the prostate sits at the base of the bladder and produces seminal fluid. It grows during puberty and again around age 50. The document also covers prostate zones, blood supply, lymphatic drainage and common presentations of prostate cancer such as elevated PSA levels or urinary symptoms. Prostate cancer risk factors, diagnosis using PSA, digital rectal exam and biopsy are summarized. Staging of prostate cancer is discussed including the TNM system and Gleason grading scale.
This document provides information on the anatomy, epidemiology, etiology, pathology, clinical manifestations, staging, diagnosis, Gleason scoring, and treatment of prostate cancer. It describes the prostate as a walnut-sized gland located in front of the rectum and below the bladder. It discusses the risk factors for prostate cancer such as family history and diet. The document outlines the staging system for prostate cancer and lists diagnostic tests including PSA levels, biopsy, and imaging. It also explains Gleason scoring and common treatment options such as surgery, radiation therapy, hormone therapy, and chemotherapy.
1. Neuroendocrine tumors (NETs) arise from neuroendocrine cells throughout the body and share features like secretory granules and hormone production. Pancreatic NETs (PNETs) comprise 1-2% of pancreatic tumors.
2. PNETs can be functional, producing symptoms from hormone hypersecretion, or nonfunctional. Major functional types are insulinomas, gastrinomas, VIPomas, and glucagonomas. Nonfunctional PNETs are usually larger and have worse prognosis than functional tumors.
3. Treatment involves surgical resection for localized disease. For advanced or metastatic disease, options include somatostatin analogs, hepatic artery embolization, targeted drugs, and
Prostate cancer is the second most common cancer and sixth leading cause of cancer deaths among men worldwide. Incidence increases with age, peaking in men aged 75-79, and African American men have a higher risk than white men. Additional risk factors include family history, obesity, and diet high in fat and red meat. Prostate cancer typically spreads locally and via lymph nodes before potentially spreading to bone, with the lumbar spine being a common site of metastasis. Staging involves a PSA test, digital rectal exam, prostate biopsy, and imaging. Treatment depends on risk level, and may include active surveillance, surgery, radiation therapy, hormone therapy, or combinations of these.
Prostate cancer is the most common cancer in men. It arises from the epithelial cells of the prostate gland. Diagnosis is confirmed through biopsy of suspicious areas identified during digital rectal exam and imaging. Treatment options depend on disease stage and grade. For localized disease, options include watchful waiting, surgery, and radiation. Hormone therapy is the primary treatment for advanced or metastatic disease. Outcomes depend on clinical factors like stage and grade at diagnosis. Screening through PSA testing and DRE can facilitate early detection and improved prognosis.
CARCINOMA PROSTATE- Dr Manoj Kumar B, PGIPGIMER, AIIMS
The document discusses carcinoma of the prostate, including its anatomy, epidemiology, etiology, natural history, clinical manifestations, diagnostic workup, imaging, and management. It provides detailed information on prostate anatomy, risk factors for prostate cancer, methods of evaluation including PSA levels, biopsy, and various imaging modalities like ultrasound, CT, and MRI.
It is not for practicing, only general description of prostate cancer.......of my presentation . for explanation study authentic books also .....and webs.
Prostate cancer power point presentationYahyaGhannam
This document discusses prostate cancer, including:
1. Prostate cancer is one of the most common cancers in men and usually grows slowly initially remaining confined to the prostate gland.
2. The main types of prostate cancer are adenocarcinoma and rare subtypes like small cell carcinoma and sarcomas.
3. Diagnostic tests include a digital rectal exam, PSA testing, MRI/CT scans, transrectal ultrasound, and biopsy to determine Gleason score.
Benign prostatic hyperplasia (BPH) is a common benign tumor in older men that results from proliferation of cells in the prostate. It affects the transition zone of the prostate and causes obstruction of urine flow. Common symptoms include hesitancy, weak stream, urgency and frequency. Diagnosis is based on history, physical exam and symptom scoring. Treatment options range from watchful waiting for mild cases to medications, minimally invasive procedures or surgery for more severe cases. Alpha blockers and 5-alpha reductase inhibitors are first line medical therapies that work by relaxing prostate smooth muscle tone.
Three doctors presented on renal cell carcinoma. Some key points:
- Renal cell carcinoma arises from renal tubular cells and is the most common type of kidney cancer.
- Presentation may include hematuria, loin pain, and palpable abdominal mass. Metastasis can cause cough or bone pain.
- Diagnosis involves imaging like CT scan and lab tests. Surgery is the main treatment but immunotherapy and targeted drugs are also used.
- Prognosis depends on stage - early stage has good prognosis but late stage with metastasis has poorer outlook.
Mr. Yousef Sa'afeen, a 65-year-old previously healthy non-smoker, was diagnosed with prostate cancer after presenting with urinary symptoms. Biopsy showed adenocarcinoma with a Gleason score of 4+5=9, positive perineural invasion and lymphovascular space invasion, and PSA of 147 ng/ml. He also presented with bone metastases. After evaluation, he was determined to be a high-risk patient appropriate for management of his metastatic disease. Treatment options were discussed including surgery, radiation, hormone therapy and chemotherapy based on his risk category and stage of disease.
The document summarizes information about the prostate gland and benign prostatic hyperplasia (BPH). It discusses the anatomy and function of the prostate gland. It describes how the size of the prostate increases with age due to BPH in many men. Common symptoms of BPH include frequent urination and weak urine stream. Treatment options for BPH include watchful waiting, medications, and surgery. The risk of prostate cancer also increases with age and it is a major health concern for older men.
Prostatic cancer is the most commonly diagnosed malignancy in men beyond middle age. The prostate gland is located below the bladder and surrounds the urethra. Cancer usually develops in the peripheral zone and can spread locally or metastasize through the lymphatic system or bloodstream, commonly to bone. Diagnosis involves a PSA test, digital rectal exam, and biopsy. Treatment options depend on stage but may include surgery, radiation, hormone therapy, or active surveillance. Prognosis depends on stage and grade, with early-stage disease having an excellent long-term survival.
Similar to Anatomy, pathology an staging work up of prostate cancer (20)
This document discusses end-of-life care and palliative care. It notes that the majority of deaths in India occur in misery, and quality of death in India ranks poorly compared to other countries. Palliative care aims to improve quality of life for patients through effective pain and symptom management as well as psychosocial support. It discusses principles of palliative care including open communication, addressing total pain, use of opioids and other adjuvants for pain management, and withdrawal symptoms from opioids. The document also covers advance directives, best interest decisions, double effect, and when to stop life-prolonging treatment for terminally ill patients.
Role of Radiotherapy in Primary and Metastatic Liver Tumors Anil Gupta
Radiotherapy, specifically stereotactic body radiation therapy (SBRT), is an emerging treatment for both primary and metastatic liver tumors. SBRT can deliver very high ablative doses of radiation to tumors in a short duration while sparing surrounding healthy liver tissue due to its high conformal dosimetry and steep dose gradients. For hepatocellular carcinoma, SBRT has shown local control rates of 70-80% with acceptable toxicity. SBRT is also being investigated as an alternative to transarterial chemoembolization or radiofrequency ablation for early stage tumors. For liver metastases, SBRT has demonstrated high local control rates comparable to resection or radiofrequency ablation with minimal toxicity to the liver. Further refinement of
Review of advisories and contingency plan for covid 19 pandemic in radiothera...Anil Gupta
The document reviews advisories and contingency plans for radiotherapy facilities during the COVID-19 pandemic. It summarizes guidelines from various radiation oncology societies on risk stratification of cancer patients, prioritization of treatments, and treatment modifications. It also discusses specific recommendations for tumor sites like head and neck, breast, and gynecological cancers. Screening of patients and staff, treatment scheduling and coordination between departments is emphasized. Treatment principles of remote, avoid, defer, and shorten treatments are recommended to balance cancer and COVID-19 risks.
Contouring in breast cancer current practice and future directions Anil Gupta
Contouring guidelines for breast cancer radiation therapy aim to define target volumes to adequately treat while minimizing toxicity. The RTOG and ESTRO guidelines provide consensus on contouring clinical target volumes (CTVs) for the breast/chest wall, lymph nodes, and organs at risk. However, some recurrences occur outside these guidelines. A study mapping 243 nodal recurrences found most were within RTOG or ESTRO CTVs, but out-of-field recurrences were often in the lateral and posterior supraclavicular region, particularly for young, triple-negative patients. While contouring guidelines provide standardization, individualized risk assessment may be needed to optimize local control versus toxicity.
Principles of beam direction and use of simulators Anil Gupta
Beam direction devices such as collimators, lasers, and immobilization techniques are used during radiation therapy treatment planning to accurately direct the radiation beam toward the tumor target. This ensures better tumor control with minimal damage to surrounding healthy tissues. Treatment planning using radiation therapy simulators, including CT and MRI simulators, allows visualization of internal anatomy and precise delineation of targets and organs at risk to develop optimized 3D conformal or intensity-modulated radiation therapy plans. Accurate patient positioning and immobilization during both simulation and treatment are critical for reproducible and precise radiation delivery.
Clinical response of skin and mucosa to radiationAnil Gupta
- Early radiation effects occur within weeks and involve rapidly dividing tissues like skin and mucosa. Late effects take months or years and involve slowly dividing tissues like lung and heart.
- Skin and mucosal reactions are graded from 1-5 based on their severity, with grade 3 being severe enough to require hospitalization. Systems like CTCAE and RTOG/EORTC are used to classify adverse events.
- Preventative measures for skin involve moisturizing and protecting from sun exposure. Mucositis prevention includes oral hygiene and soft diets.
- Management depends on reaction severity and involves wound dressings, pain medication, and dietary adjustments. Breaks in radiation may be needed for severe
Bladder preservation for CA Urinary BladderAnil Gupta
This document summarizes the case of a 74-year-old male patient with urinary bladder cancer who underwent bladder preservation treatment. He initially presented with hematuria and imaging found two bladder lesions, one of which was muscle-invasive. He received neoadjuvant chemotherapy followed by radical radiotherapy to the bladder, achieving a good response. Over 2.5 years of follow-up, he has remained with no evidence of disease and an intact, functional bladder. The document then discusses bladder cancer treatment approaches and evidence for bladder preservation with chemoradiotherapy as an alternative to radical cystectomy for select patients.
Principles of radiotherapy in gastric carcinomaAnil Gupta
This document discusses principles of radiotherapy for gastric carcinoma. It summarizes that post-operative radiotherapy can reduce local recurrence rates after surgery for gastric cancer, although no survival benefit has been proven. Newer radiation techniques like IMRT and VMAT may further reduce doses to organs-at-risk compared to 3D conformal radiotherapy. Pre-operative radiotherapy can also improve resectability in some inoperable cases.
Evolution of treatment strategies of brain tumorsAnil Gupta
The document discusses the evolution of treatment strategies for brain gliomas. It begins by providing background on gliomas and their classification. It then discusses advances in surgery, including neuronavigation, fluorescent guided resection, and intraoperative imaging. It also covers the evolution of radiotherapy techniques from early 2D approaches to modern 3D conformal radiotherapy and intensity modulated radiotherapy. Adjuvant therapies like chemotherapy and targeted drugs are also mentioned. Overall the document traces the development of surgical and radiation based approaches for glioma treatment over time.
How the role of radiotherapy has evaluated in pancreatic cancer. Now it has become indispensable for treatment in pancreatic cancer. Radiotherapy can be used in the form of EBRT/SBRT/IORT.
Journal club TACE vs SBRT in Hepatocellular carcinomaAnil Gupta
This study compared outcomes of stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) with 1-2 tumors. SBRT resulted in superior local control compared to TACE. There was no significant difference in overall survival between the groups. Freedom from in-liver progression was significantly higher with SBRT. Grade 3 adverse events occurred in 13% with TACE and 8% with SBRT. Larger and prospective studies are still needed to validate these findings.
approach to Urothelial carcinoma of upper tract in horse shoe kidneyAnil Gupta
Upper tract urothelial carcinoma arising in a horseshoe kidney presents unique treatment challenges. The patient underwent right heminephrectomy for a T1 low-grade tumor, with subsequent recurrences in the bladder and ureter. Close follow-up is important given the high risk of recurrence in UTUC, particularly in the bladder due to field cancerization effects. While adjuvant therapies have unclear benefits, intravesical BCG may help prevent recurrence in selected cases. Complete surgical resection remains the mainstay of treatment for UTUC in horseshoe kidneys.
This document discusses the treatment of ovarian carcinoma. It begins with an overview of the epidemiology, patterns of spread, symptoms, diagnostic workup and surgical staging of the disease. It then describes the histopathological classification and various chemotherapy regimens used as adjuvant treatment, including platinum-based drugs like cisplatin and carboplatin, and taxanes like paclitaxel. The standard first-line regimen for early-stage high-risk ovarian cancer is 6 cycles of paclitaxel and carboplatin given every 3 weeks.
This document discusses the role of chemotherapy in colon cancer. It begins with an introduction on the epidemiology and causes of colon cancer. It then covers staging of colon cancer using the AJCC TNM system and discusses prognostic factors. It describes the rationale for and trials supporting adjuvant chemotherapy for stages II and III colon cancer. It provides details on different chemotherapy drugs used for colon cancer including 5-fluorouracil, leucovorin, oxaliplatin, and irinotecan. It discusses various 5-FU regimens including Mayo, Roswell Park, bolus vs continuous infusion vs intermittent infusion schedules.
This document discusses the history and development of radiation protection. Some key points:
- The harmful effects of radiation were initially not well understood after X-rays were discovered in the late 19th century. Several early researchers and technicians suffered health effects.
- Over time, concepts like tolerance doses, maximum permissible doses, and the "as low as reasonably achievable" principle were developed to set safe radiation exposure limits.
- International organizations like the ICRP and IAEA were formed to make recommendations on radiation safety standards and regulation. National bodies like AERB regulate radiation protection in India.
- The principles of justification, optimization and dose limitation form the foundation of modern radiation protection practices and regulation. Exposure
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
4. Prost at e
● It is accessory gland of male
reproductive system
● In female represented by
periuretheral glands of skene
● Walnut shaped
● Weighs around 40 gram
● Gross anatomy
Apex
Base
Anterior surface
Posterior surface
Inferolateral surface
Base
Apex
Inferolateral
5. ● Covered by two layer
1) true capsule
- attached to prostate
- outside spread ECE→
2) false capsule
● Clinical importance
10. Blood Supply
Arterial supply
● Three main arteries:-
internal pudendal, inferior
vesical and middle rectal
arteries
● Clinical importance:- blood
loss during RP
11. Venous blood supply
Prostatic venous plexus lies
between the true and false
capsule
Deep dorsal vein of penis +
vesical veins
Vesico-prostatic plexus
Internal vertebral venous
plexus
BATESON'S
PLEXUS
( valveless)
12. Nerve Supply
● Controls urine flow
● Secretions discharged
after stimulation of S and
PS
● Radical prostectomy can
lead to erectile
dysfunction
● Nerve sparing radical
prostatectomy
13. Lymphatic drainage
● Regional lymph nodes
- Are nodes of true
pelvis( below bifurcation of
common iliac arteries)
-Pelvic, NOS
- Hypogastric
-Obturator
-Iliac (internal, externa)
- Sacral (lateral, presacral)
14. Met ast asis
● Osteoblastic bony mets (most common)
● Lung
● liver
● Distant lymph node
-Lie outside the confines of the true pelvis.
- Para-Aortic
-Common iliac
-Inguinal, deep & Superficial
-Supraclavicular
- Cervical
-Scalene
-Retroperitoneal, NOS
15. Lobar Classif icat ion
The prostatic urethra and theThe prostatic urethra and the
ejaculatory ducts divide prostateejaculatory ducts divide prostate
into 5 different lobesinto 5 different lobes
Anterior lobe:Anterior lobe:
-Anterior to urethra-Anterior to urethra
-Devoid of glandular tissue-Devoid of glandular tissue
Median or Middle lobe:Median or Middle lobe:
-Between urethra and ejaculatory-Between urethra and ejaculatory
ductsducts
-upper part is related to the-upper part is related to the
bladder trigonebladder trigone
16. Lateral lobes:
-Separated from each other
by prostatic urethra
-Continuous posteriorly
Posterior lobe:
-Posterior to urethra and
Below the ejaculatory ducts
-Palpable during DRE
1- Posterior lobe
2- Lateral lobe
3- Median lobe
4- Anterior lobe
17. Zone Classif icat ion
➢ Peripheral zone(PZ)-
-70% of glandular prostate
-most carcinomas arise from it
➢ Central zone:-
- 25% of the glandular prostate
➢ Transitional zone(TZ):-
-5% of glandular prostate
- BPH arises
➢ Anterior fibromuscular stroma :
18. ● Has three components;-
fibrous, muscular,
glandular
● lined by simple
columnar or
pseudostratified
epithelium
-neuroendocrine cells
-basal/stem cells
19. Size of t he gland
● Size changes with age.
● Grows rapidly during puberty, androgens in the body.
● A typical prostate is about 3 cm thick and 4 cm wide and
weighs about 20 grams,
● It can be much larger in older men.
23. Funct ions
● It produces a thick, clear fluid that makes the semen more
fluid and protects and nourishes sperm cells in the semen.
● It also plays a part in controlling the flow of urine
● Prevents urine flow during ejaculation
● Secrete a watery mixture of prostate-specific antigen (PSA),
prostatic acid phosphatase, fibrinolysin, and amylase into the
prostatic sinuses
24. Diseases of Prost at e
● Prostatitis
● Benign Prostate Hypertrophy(BPH)
● Prostate Cancer
Prostatic cancer 18%
Prostatitis 2%
BPH 80%
26. I nt roduct ion
● The number of new cases of prostate cancer was 129.4 per
100,000 men per year. The number of deaths is 20.7 per
100,000 men per year.
● Approximately 14.0 percent of men will be diagnosed with
prostate cancer at some point during their lifetime
● The highest rates of prostate cancer are in Scandinavia, where
it is the leading cause of male cancer death
● Histological cancers, found during autopsy are even more
30. ● Prostate is the second leading site of cancer among males in
large Indian cities like Delhi, Kolkatta, Pune
● Among the top ten leading sites of cancers in India
● 8th MC in men in India
● The incidence is increasing . Data shows that the number of
cases will become doubled by 2020
I ndia Scenario
31.
32. In PGI Chandigarh
● Out of 10019 male diagnosed with cancer 251 are
prostate cancer(2.5%)
● 84.6% were adenocarcinoma
(ICMR 2011-2013)
33. Cause of rise of incidence
● Increase in life expectancy
● Adoption of newer lifestyles
● Screening using prostate specific antigen
(PSA)
34. Risk Fact ors
● Age: Increases with age
●
EthnicityEthnicity: More in African Black men
● Family history: Increases risk
● Number of affected relatives increases the relative risk, notably
if the cancer is found in younger relatives
● Genetic alterations: These six prostate cancer susceptibility
genes identified RNASEL, ELAC2, MSR1, AR, CYP17,
SRD5A2
BRCA1, BRCA2, HNPCC, HPC1
● Obesity: A/W aggressive prostatic cancer
35. Decreased risk
● Low fat diet
● Regular exercise
● Maintenance of normal BMI
● Prophylactic Dutasteride (5a reductase inhibhitor)- REDUCE
trial
- reduced risk of low grade cancer
- increased risk of high grade cancer
Not approved by FDA for chemoprevention
36. No role
● Vitamin E and Selenium, alone or in combination failed to
reduce incidence (SELECT) trial
● Vitamin D and Calcium ingestion did not show any effect
incidence and mortality
● Alcohol use, blood group, body hair distribution, sexual
activity, urban versus rural, and vasectomy do not affect risk
● Benign prostatic conditions
● No viral origin has been found
39. Prost at ic I nt raepit helial Neoplasia
● Defined as nuclear atypia and architectural derangement without
compromise of the basement membrane.
Low Grade
- minimal atypia
High Grade
- large nucleus with
variation in size,
prominent nucleoli
CA PROSTATE
40. Hist ologic sub t ype
● Acinar adenocarcinoma 9 out of 10
● Remaining 1 out of 10
-Ductal adenocarcinoma
-Transitional cell (or urothelial) cancer
-Squamous cell cancer
-Neuroendcrine carcinoma
-Small cell cancer
-Sarcomas and sarcomatoid cancers
41. Sympt oms
● Early prostate cancer is asymptomatic
(found incidentally or during autopsy)
● Advanced disease symptoms include
- bladder outlet obstruction
- pelvic pain and haematuria
- bone pain, malaise, anaemia or pancytopenia
- renal failure
- may be asymptomatic
43. PSA
● Is a glycoprotein enzyme secreted into the seminal fluid
by the epithelial cells of prostate gland
● Found in blood in minute quantity
● Well established tumor marker that aids the diagnosis,
treatment and follow up of prostate cancer
● PSA era begins from 1986 when it was first commercially
available
● Is organ specific-- not disease specific
● Elevated prostatic injury, infarct, BPH and Ca prostate
44. ● Age specific reference range
40 to 49 yr 2.5 ng/ml
50 to 59 yr 3.5 ng.ml
60 to 69 yr 4.5 ng/ml
70 to 79 yr 6.5 ng/ml
● Normal PSA for all age is taken as 0-4 ng/ml
● PSA >10 suggestive of cancer
● PSA > 35 is almost diagnostic of cancer
● Senstivity 85%
● Specificity 65-70%
45. ● Free PSA:bound PSA- Used if PSA in between 4 to 10
Biopsy should be done if free PSA ≤ 10%
● PSA density- PSA produced per gram of prostate <0.15
ng/ml, if >0.18 biopsy should be done
● PSA velocity – Before diagnosis rate of change of PSA
>0.75 risk of prostate cancer
>2.0 aggressive cancer
46. PSA in follow up
● Onset of PSA rise- ≤12 months more chances of
metastasis
● PSA doubling time- ≤ 12 months more chances of
metastasis
● PSA failure/ biochemical failure/ treatment failure-
“three consecutive rises in PSA after a nadir, with the date of
failure being the point half way between the nadir date and
the first rise” (earlier)
‘‘an increase of 2 ng/ml or more above the nadir PSA”
(ASTRO)
● PSA bounce- Transient increase in PSA of 0.1 to 0.5
ng/ml or 15% PSA from pretreatment after
Brachytherapy or EBRT---> mean time 18 months
47. Digit al Rect al Examinat ion
● Position -->sim's lateral
position/ modified lithotomy/
knee chest/ standing up
● Characteristics
-anal tone
- size
- shape
- surface
- consistency
- mobility
- Discrete nodule
- pain and tenderness
Prostate
cancer
DRE
48. Typical finding ca prostate-
Hard, nodular, asymmetrical
may or may not be raised
above the surface of gland and
is surrounded by compressible
prostatic tissue
May be normal
Senstivity 70%
Specificity 50%
Only 25-50% with abnormal
DRE have cancer
DRE + PSA - 87%
SDRE
49. TRUS guided biopsy
● Patient preparation
● Done under local
infiltration anaesthesia
● In left lateral decubtits/
lithotomy position
50. SEXTANT
BIOPSY:
• one core, bilaterally,
each from base, mid,
and apex.
• samples both PZ &
TZ.
EXTENDED CORE
BIOPSY SCHEMES
51. Complications
Often
● Hematuria (14 to 50%)
● Hematospermia (10 to 70%)
● Rectal bleeding
Sometimes
● Infection
Rarely
● Epididymitis
● Urinary incontinence
● hospitalization
● Confirmation of diagnosis
● OPD procedure
● Very less pain
54. St aging work up
● Baseline work up
Haemogram/LFT/KFT/CXR
● Essential work up
PSA/Biopsy/Gleason scoring
● Complimentary work up
CT/MRI(becomes essential in higher clinical stage)
PET CT
Bone Scan( essential if bone mets suspected)
Molecular testing
55. Gleason Score
● Scoring on the basis of differentiation of
adenocarcinomas of prostate
● Done by Pathologist on H & E stained microsopic slides
● Done by calculating two pattern in a slide
● Each pattern is given score of 1 to 5 based on
differentiation
● Primary grade -Largest area covering the pattern is
Secondary grade- The highest grade
● Lowest score is 2 and highest is 10
● One of the strongest factor for invasiveness and
metastatic potential
56. ● Gleason grade 1
● Single, separate, closely
packed, uniform round
glands arranged in a
circumscribed nodule with
pushing borders
57. ● Gleason grade 2
● Like grade 1 but more
variability in gland shape and
more stroma separating
glands, such that glands are
separated by less than one
gland's width
● Less circumscribed at
periphery, although no
infiltration into stroma or
between benign glands
58. ● Gleason grade 3
● Single, separate, much more
variable glands
● Well formed, relatively
uniform glands infiltrating
between benign glands;
glands may be angulated or
compressed, separated by > 1
gland diameter
59. ● Gleason grade 4
● Patterns of Gleason grade 4 prostatic
adenocarcinoma:
● (a) Most common is small acinar structures,
some with well formed lumina, fusing into
cords or chains.
● (b) Papillary or cribriform tumors with
irregular / invasive edges
60. ● Grade 5: two patterns
● 5a: Comedocarcinoma: papillary /
cribriform carcinomas with central
necrosis .
● 5b: Single-celled cancer, possibly
forming cords, possibly with vacuoles
(signet ring cells) but without
formation of a glandular lumen.
● Predicts higher rates of metastasis and
death
61.
62.
63. Current perspect ive of gleason
grading
● Score 6 or lower- watchful waiting
score 7 – critical decision making
score 8 or more- definitive therapy
● Rare use of assigning grade 1 or 2 in biopsy
● Gleason Index:- radical prostatectomy specimens with
multifocal disease, consisting of a dominant tumor referred to
as an index tumor, gleason score of index tumor is considered.
64. CT SCAN
●
Primary role
●
Size determination of the gland
●
Assess pelvic LN metastasis
●
Treatment planning in RT
●
EPE:
– Loss of periprostatic fat planes
– Bladder base deformity
– Obliteration of the normal angle b/w the SV and post. aspect of UB
●
LN involvement
– Abnormality in size
– Sensitivity 25%
– Reserved for patients with higher PSA values (>20-25 ng/ml)
– CT guided FNAC
65. ●
Limitation of CT
●
Lacks the soft tissue resolution needed to detect intraprostatic anatomic
changes due to primary tumor , capsular extension or SVI because the
neoplasm usually has the same attenuation as the normal prostate gland
●
Can't detect microscopic disease
●
False Positive- Artifact of Bx and plane b/w SV and UB base may be
obscured by rectal distension
66. MRI
●
Superior to CT in defining prostate apex, NVB and anterior rectal wall
●
Better delineation of periprostatic fat involvement
●
T1w- provides high contrast b/w water density
structures i.e. Prostate, SV and fat, NVB, perivesical
tissue and LNs
●
T2w fast spine echo- zonal anatomy, architecture of
SV
●
Ca Prostate: A focal, peripheral region of decreased signal intensity
surrounded by a normal(high intensity) peripheral zone
●
BHP: centrally located nodules of similar signal
●
Primary staging sensitivity- 69%
●
Endorectal surface coil MRI- accuracy of 54-72% staging the primary
and detects SVI and ECE
67.
68. MRI for screening
Still in development phase
PIRADS 1 – Very low (clinically significant cancer is highly unlikely to be
present)
PIRADS 2 – Low (clinically significant cancer is unlikely to be present)
PIRADS 3 – Intermediate (the presence of clinically significant cancer is
equivocal)
PIRADS 4 – High (clinically significant cancer is likely to be present)
PIRADS 5 – Very high (clinically significant cancer is highly likely to be
present)
69. PET Scan
● Used in the assessment of
metastases, detect
intraprostatic cancer.
● PRINCIPLE:- measures
radiation from radioactive
atoms incorporated into
radiotracers that preferentially
accumulate at sites of tumor
● FDG PET is most commonly
used
● 18F-fluorocholine:-
- has higher uptake in cancer
sites
- less accumulation in the
bladder
- can differentiate with BPH
71. 99
Tc BONE SCAN
●
Clinically apparent metastatic disease limited to bone in 80-85%
of patients of metastatic ca prostate
●
A close correlation exists between pretreatment PSA level and
incidence of abnormal bone scan results
●
Osteoblastic secondaries
●
MC sites of metastasis
●
Vertebral column- 74%
●
Ribs- 70%
●
Pelvis- 60%
●
Femoral- 44%
●
Shoulder girdle-41%
73. ●
AJCC 7th
edition staging is used
● Minimum work up required
- DRE
- Biopsy
- PSA
- CT/MRI/Bone scan- if higher clinical stage, gleason
score, bony pain
● For pathological classification:- total prostatectomy
including regional lymph node dissection with full
histologic evaluation
74. T – Pr imar y t umor
● TX – Primary tumor cannot be
assessed
● T0 – No evidence of primary tumor
● T1 – Clinically inapparent tumor not
palpable or visible by imaging
● T1a – Tumor incidental histologic
finding in 5% or less of tissue
resected
● T1b – Tumor incidental histologic
finding in greater than 5% of tissue
resected
● T1c – Tumor identified by needle
biopsy (due to elevated prostate-
specific antigen [PSA] level); tumors
found in 1 or both lobes by needle
biopsy but not palpable or reliably
visible by imaging
75. ●T3 – Tumor extending through the
prostatic capsule; no invasion into the
prostatic apex or into, but not beyond, the
prostatic capsule
●T3a – Extracapsular extension (unilateral
or bilateral)
●T3b – Tumor invading seminal vesicle(s)
● T2 – Tumor confined within prostate
● T2a – Tumor involving less than half a lobe
● T2b – Tumor involving 1 lobe or less
● T2c – Tumor involving both lobes
76. ● T4 – Tumor fixed or invading
adjacent structures other than
seminal vesicles (eg, bladder
neck, external sphincter,
rectum, levator muscles, pelvic
wall)
77. Pat hological T st age
pT2 Organ confined
pT2a- Unilateral, one-half of one side or less
pT2b -Unilateral, involving more than one-half of side but
not both sides
pT2c -Bilateral disease
pT3- Extraprostatic extension
pT3a- Extraprostatic extension or microscopic invasion
of bladder neck**
pT3b- Seminal vesicle invasion
pT4- Invasion
Resection margins should be mentioned
There is no pT1
78. N St age – Lymph Nodes
● NX – Regional lymph
nodes (cannot be
assessed)
● N0 – No regional lymph
node metastasis
● N1 – Metastasis in
regional lymph node or
nodes
Pathological N stage is same
79. M st age- Met ast asis
● PM1c – More than 1 site of
metastasis present
● MX – Distant metastasis
cannot be assessed
● M0 – No distant metastasis
● M1 – Distant metastasis
● M1a – Non regional lymph
node(s)
● M1b – Bone(s)
● M1c – Other site(s)
83. D' amico Risk St rat if icat ion
● First one to give concept
● Predicts about chances of
recurrence after treatment
● Low risk- T1-T2a and GS
≤6 and PSA ≤10
● Intermediate risk- T2b
and/or GS =7 and/or PSA
>10–20
● High risk- ≥T2c or PSA
>20 or GS 8–10
● Does not take into
account other parameters
84. ● Uses Gleason score, serum PSA, and clinical
stage – to predict whether the tumor will be
confined to the prostate
85. The UCSF-CAPRA score
● UCSF developed the Cancer
of the Prostate Risk
Assessment score
● 0-2 low risk
3-5 intermediate risk
6-10 high risk
88. Screening
● The primary endpoint of screening:-
➢ The goal is not to detect more carcinomas, but reduction
in mortality from Pca.
➢ Improving the quality of life (QALY)
Done by checking serum PSA
- if >4.1, biopsy is done
89. AUA recommendations for screening
● No screening <40 yr
● No routine screening for average risk between 40 to 54 yr,
only for high risk
● Routine screening from 55 to 69 yr with shared decision
making
● 2 yr gap in between
● No screening for any man with life expectancy < 10yrs
● No screening >70yr
90. I s Screening really needed?
Out of 1000 screening (age 55-69)
210-230 would undergo
biopsy
100-120 negative
(1/3rd
will develop biopsy
related complication)
110 positive
(50 would develop
treatment related
complication, 1
would die)
0-1 death would be avoided
91. ● Harms
- unnecessary biopsies
- complications of biopsy
- overtreatment
- psychological
- needs huge investment from government
● Benefits
- Early detection and diagnosis
- incidence of metastatic disease at presentation declined
● US Preventative Service Task Force's does not
recommend prostate cancer screening
92. Conclusion
● CA Prostate is cancer of elderly
● It is slow growing, many remains latent for years
● Incidence rising
● Screening still controversial
● Diagnostic Triad: - PSA, DRE, TRUS guided biopsy
● Gleason score and PSA is taken into account for staging
by AJCC
● Management depends on stage, Risk Stratification, Life
expectancy, patient's preference and availabilty
● “Patient does not die due to prostate cancer ,they die
with it”
Unenhanced CT scan in 78-year-old man with prostate cancer, Gleason score of 34 at biopsy, PSA level of 21 ng/mL, and palpable tumor shows enlarged prostate with evidence of gross tumor ECE (arrow) along left posterolateral
margin of the gland.