Understanding Prostate Cancer       Robert Miller MD      www.aboutcancer.com
Prostate Cancer Most  common cancer in men (28%  cancers in men) Lifetime risk in 1 in 6 white men and 1 in  5 African A...
Age Distribution of Men Diagnosed with      Prostate Cancer 2000-2010                      39%40%35%                      ...
Understanding prostate cancer Anatomy Importance  of Stage Significance of the PSA Importance of the Gleason Score
The prostategland has acapsule aroundit, and cancersarise close to thecapsule, thecancer mayinvade throughthe capsule orex...
Prostate Anatomy…the nerves that can results inimpotence are on the side of the gland
There are lymph nodes that may be involved, it is rare to havelymph node spread in low or intermediate risk patients
Prostate Cross Section Anatomybladder                   Prostate rectum
Prostate Cross Section Anatomy
Prostate CT Anatomy        Bladder              Prostate              Rectum
Prostate MRI Anatomy
Prostate MRI Anatomy
Prostate Stages
Most men with a low PSA (less than 10)and a low Gleason score (less than 7) havecancer cells in the gland too small to fee...
Too small to feel = Stage I (T1c)
T1c = too small to feel and biopsied because of an      elevated PSA
rectum           If youbladder           can feel a           lumpcancer     then it’s           called T2prostate
T2 lesion = big enough to feel
MRI = extra capsular spread
T3 if spread to the seminal vesicles
T3 if spread to the seminal vesicles
T3 if spread to the seminal vesiclesBiopsy of seminal vesicles = Gleason 9 adenocarcinoma
Stage IV if spread to the lymph nodes or                  bone
Stage IV: spread to the lymph nodes
Stage IV: spread to the   bones on Sodium  Fluoride PET scan
Prostate Cancer Stage
Prostate Cancer Stage
Prostate Cancer Stage
Prostate Cancer Cure Rate After RadicalProstatectomy Based on Pathologic Stage
Understanding prostate cancer Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
Prostate Cancer Cure Rate After RadicalProstatectomy Based on PSA Prior to              Surgery
Cure Rate with Surgery Based on PSA      and Gleason Score (GS)
PSA (prostate specific antigen) and        radiation results                   Relapsed after   PSA Level                 ...
Note that the PSA levels slowly decline      after completing radiation
Understanding prostate cancer Anatomy Importance  of Stage Significance of the PSA Importance of the Gleason Score
Understanding a Pathology                         Report1. Histology: adenocarcinoma2. Number of cores involved/ total num...
Prostate cancers are called ADENOCARCINOMA (which just means cancer fromglandular tissue). The more the cancer cell is sim...
Prostate Cancer Cure Rate After RadicalProstatectomy Based on Pathologic Grade       (i.e. how mutated the cancer cells ap...
Gleason Scoring SystemFrom the biopsy, the pathologist gradesthe appearance of the cells. From leastserious (slow growing ...
Gleason Scoring SystemThe second number is the next mostcommon pattern seen. So a 4+3 is moreserious than 3+4 even though ...
Gleason ScoringSystem
The higher the Gleason Score, the         lower the cure rates after surgery9590                                      5 Ye...
The higher the Gleason Score, the     lower the cure rates after radiation95                                5 year cure ra...
www.aboutcancer.com   Most Common Cancers   * brain   * breast   * colon/rectum   * gynecologic   * head and neck (mouth, ...
Variable   ScorePSA        50Gleason    8Stage      T1c
Calculators (Partin Tables) can be used topredict the odds of extra- capsular spread
Biochemical Recurrence-free SurvivalPrediction Model Duke Prostate Center.
Prostate Cancer Risk Groupscombine all 3 things, the stage, thePSA level and the Gleason score,system used by the NCCN•Low...
Understanding Prostate Cancer       Robert Miller MD      www.aboutcancer.com
Prostate video 1
Prostate video 1
Prostate video 1
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  1. 1. Understanding Prostate Cancer Robert Miller MD www.aboutcancer.com
  2. 2. Prostate Cancer Most common cancer in men (28% cancers in men) Lifetime risk in 1 in 6 white men and 1 in 5 African American Median Age at diagnosis is 67 (but 3% in 40’s and 22% in 50’s)
  3. 3. Age Distribution of Men Diagnosed with Prostate Cancer 2000-2010 39%40%35% 28%30% 22%25%20%15% 7%10% 3%5% 1%0% 30 40 50 60 70 80 90 Age
  4. 4. Understanding prostate cancer Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
  5. 5. The prostategland has acapsule aroundit, and cancersarise close to thecapsule, thecancer mayinvade throughthe capsule orextend up intothe seminalvesicles
  6. 6. Prostate Anatomy…the nerves that can results inimpotence are on the side of the gland
  7. 7. There are lymph nodes that may be involved, it is rare to havelymph node spread in low or intermediate risk patients
  8. 8. Prostate Cross Section Anatomybladder Prostate rectum
  9. 9. Prostate Cross Section Anatomy
  10. 10. Prostate CT Anatomy Bladder Prostate Rectum
  11. 11. Prostate MRI Anatomy
  12. 12. Prostate MRI Anatomy
  13. 13. Prostate Stages
  14. 14. Most men with a low PSA (less than 10)and a low Gleason score (less than 7) havecancer cells in the gland too small to feel orsee on CT scans
  15. 15. Too small to feel = Stage I (T1c)
  16. 16. T1c = too small to feel and biopsied because of an elevated PSA
  17. 17. rectum If youbladder can feel a lumpcancer then it’s called T2prostate
  18. 18. T2 lesion = big enough to feel
  19. 19. MRI = extra capsular spread
  20. 20. T3 if spread to the seminal vesicles
  21. 21. T3 if spread to the seminal vesicles
  22. 22. T3 if spread to the seminal vesiclesBiopsy of seminal vesicles = Gleason 9 adenocarcinoma
  23. 23. Stage IV if spread to the lymph nodes or bone
  24. 24. Stage IV: spread to the lymph nodes
  25. 25. Stage IV: spread to the bones on Sodium Fluoride PET scan
  26. 26. Prostate Cancer Stage
  27. 27. Prostate Cancer Stage
  28. 28. Prostate Cancer Stage
  29. 29. Prostate Cancer Cure Rate After RadicalProstatectomy Based on Pathologic Stage
  30. 30. Understanding prostate cancer Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
  31. 31. Prostate Cancer Cure Rate After RadicalProstatectomy Based on PSA Prior to Surgery
  32. 32. Cure Rate with Surgery Based on PSA and Gleason Score (GS)
  33. 33. PSA (prostate specific antigen) and radiation results Relapsed after PSA Level Radiation 0.1 to 4 4% 4 to 10 7% 10 to 20 22% 20 - 50 48% over 50 67%
  34. 34. Note that the PSA levels slowly decline after completing radiation
  35. 35. Understanding prostate cancer Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
  36. 36. Understanding a Pathology Report1. Histology: adenocarcinoma2. Number of cores involved/ total number of cores3. Gleason score: 3 + 34. Perineural invasion
  37. 37. Prostate cancers are called ADENOCARCINOMA (which just means cancer fromglandular tissue). The more the cancer cell is similar to a normal prostate cells, the lessdangerous, so well differentiated (Gleason 2 – 5) are much better than intermediategrade (Gleason 6 – 7) and much better than poorly differentiated (Gleason 8-10) cancercells
  38. 38. Prostate Cancer Cure Rate After RadicalProstatectomy Based on Pathologic Grade (i.e. how mutated the cancer cells appear)
  39. 39. Gleason Scoring SystemFrom the biopsy, the pathologist gradesthe appearance of the cells. From leastserious (slow growing or Grade 1) tothe fastest growing and most dangerousor grade 5).The first number is the most commonpattern seen from 1 to 5
  40. 40. Gleason Scoring SystemThe second number is the next mostcommon pattern seen. So a 4+3 is moreserious than 3+4 even though they bothare Gleason 7.So the slowest is a score of 2 and thefastest (most dangerous) is a score of10.
  41. 41. Gleason ScoringSystem
  42. 42. The higher the Gleason Score, the lower the cure rates after surgery9590 5 Year85 Survival80 10 Year75 Survival7065605550 6 7 8 Gleason Score
  43. 43. The higher the Gleason Score, the lower the cure rates after radiation95 5 year cure rate radiation radiation plus hormones90858075706560 3+3 3+4 4+4 4+5 5+5 Gleason Score
  44. 44. www.aboutcancer.com Most Common Cancers * brain * breast * colon/rectum * gynecologic * head and neck (mouth, tongue, oral, etc.) * lung * metastatic * prostate * skin cancer Other Specific Cancers Radiation or Chemotherapy or Surgery Support and Resources All Other Cancer Topics and cancer calculators Other Topics Best Web Sites
  45. 45. Variable ScorePSA 50Gleason 8Stage T1c
  46. 46. Calculators (Partin Tables) can be used topredict the odds of extra- capsular spread
  47. 47. Biochemical Recurrence-free SurvivalPrediction Model Duke Prostate Center.
  48. 48. Prostate Cancer Risk Groupscombine all 3 things, the stage, thePSA level and the Gleason score,system used by the NCCN•Low risk: (T1c, T2a Gleason 6, PSA <10)•Intermediate risk: (T2b, T2c, Gleason 7, PSA 10-20)•High risk: (T3, Gleason 8-10 or PSA > 20)
  49. 49. Understanding Prostate Cancer Robert Miller MD www.aboutcancer.com
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