prostate cancer health talk

1. DR EZENWA E V.
MBBS, FMCS, FWACS,
MPH
CONSULTANT
UROLOGIST UBTH
PROSTATE CANCER AWARENESS

2. What we’ll be talking about
 What is prostate /prostate cancer?
 How common is prostate cancer?
 What causes it?
 How does it manifest?
 Tests to find prostate cancer early
 Treatment for prostate cancer
 Prevention of prostate cancer
 Conclusion

3. What is prostate gland / prostate
cancer?
 Prostate Gland:
- Found below the
bladder
and in front of the
rectum
-The size of a walnut or
golf ball
- Makes the fluid that is
part of semen
 Prostate Cancer
- Malignant
transformation
of the cells of the
prostate

4. DISEASES OF THE PROSTATE
 Prostatitis (infection and
inflammation)
 Benign prostatic hyperplasia
/enlargement (BPH)
 Carcinoma of the prostate

5. How common is prostate
cancer?
[1]Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN
estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
doi: 10.3322/caac.21492.
[2]Stephen Odunayo Ikuerowo et al. Prevalence and characteristics of prostate cancer among participants of a
community-based screening in Nigeria using serum prostate specific antigen and digital rectal examination. Pan African
Medical Journal. 2013;15:129. [doi: 10.11604/pamj.2013.15.129.2489]
 Worldwide: Second after lung cancer 1,276,106
new cases (2018) [1]
 Occurs more often in African-American men.
 Reasons - differences in social, environmental and
genetic factors
 Nigeria - 1 in every 100 men (1046 per 100,000
men).[2]
 Commonest cause of male cancer death in Nigeria
 Rarely diagnosed in men younger than 40 years,
uncommon in men younger than 50 years.
 Nigeria – late presentation

7. What causes prostate cancer?
- RISK FACTORS
 Age is the strongest risk factor
- 63% of prostate cancer occurs in men over the
age of 65.
 Male sex - Testesterone
 Race
- More common in African men than other men (X3)
 Family history- (X2.5)
 Genes
- Account for about 5-10% of prostate cancer
 Others
- Diet – diaries, red meat, fatty food

9. HOW DOES IT MANIFEST?
 NO SYMPTOMS – following screening.
 WITH SYMPTOMS – Difficulty with passing urine,
bloody
urine
 WITH COMPLICATIONS
- low backache, weakness of the limb,
weight loss,
inability to pass urine, kidney failure,
low blood
level, chest pain, cough, yellowness
of

10. Stages of Prostate cancer
Stage 1 Stage
2 Stage 3 Stage 4

11. Sites of spread

12. Tests to find prostate cancer early
 PSA (prostate-specific antigen)
PSA is a protein produced by
cells of the prostate gland.
PSA test measures the level of
PSA in the blood.
Normal level: (0-4ng/ml)
 PCA3 ( Urine)
 DRE (digital rectal exam)
Doctor feels the surface of
the prostate gland for bumps,
hard spots, and any other
abnormalities
 Prostate biopsy

14. PSA AND PROSTATE CANCER
[*]Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al.
Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0
ng per milliliter. N Engl J Med. 2004 May 27. 350 (22):2239-46
 No PSA level guarantees the absence of prostate
cancer.
 The risk of disease increases as the PSA level
increases, from about
- 8% with PSA levels of ≤1.0 ng/mL [*]
- 25% with PSA levels of 4-10 ng/mL
- 50% for levels over 10 ng/mL [1]

15. What can increase the PSA
level?
 Prostate cancer
 BPH (benign prostatic hyperplasia)
- Enlargement of the prostate gland (not cancer)
 Age
- PSA level tends to go up with age
 Prostatitis
- Infection/inflammation on the prostate gland
 Ejaculation
- Increases PSA levels for a short time
- Men are asked to abstain from ejaculation for 2
days before
testing
Clearly, factors other than prostate cancer can
increase PSA level.

16. Biopsy confirms the diagnosis

17. NOTE:
 Stay off blood
thinners
 Ensure
prophylactic
antibiotics

18. Screening Protocol :(ACS Screening
Guidelines)
 Does not recommend routine screening in any
age group.
 Asymptomatic men with at least a 10-year life
expectancy should be given an opportunity to
make an informed decision with their health care
provider after receiving information on the
uncertainties, risks and benefits of screening
 Age 45 for those at high risk, including African
Americans and men with a first-degree relative
(father, brother, son) diagnosed with prostate
cancer before age 65
 Age 40 for those at higher risk (more than one
first-degree relative diagnosed with prostate

19. Screening Protocol :(ACS Screening
Guidelines)
 Men who decide to be screened should be tested with
- PSA test.
- A digital rectal exam (DRE)
 If screening does not detect cancer, the time between
subsequent screenings depends on the results of the
blood test, as follows:
 PSA < 2.5 ng/ml – Retesting may be done every 2
years
 PSA ≥2.5 ng/ml – Retesting should be done annually

20. Treatment
 Depends on:
- the stage / grade of the disease ( Risk assessment).
- age / life expectancy
 Options
- Active surveillance
- Watchful waiting
- Surgery
- Radiotherapy
- Hormone ablation
- Chemotherapy
- Anti- androgens
- others – Cryotherapy, HIFU

21. Side Effects of Treatment
 Erectile dysfunction
 Low libido
 Urinary incontinence

22. Can prostate cancer be
prevented
• Diets
- mainly of vegetables, fruits and fish. Tomatoes
(because of their lycopene content), green tea, and soy
have all been hypothesized to be beneficial.
- Avoid Obesity
- Low-fat diet
- Nutritional supplements also have not proved beneficial in
research studies eg Selenium and Vitamin E
- some protective effect with vitamin D
• Physical activity appears to lower prostate cancer risk.

23. Increased frequency of Ejaculation
reduces prostate cancer !!
 Study Aim*: To asses if ejaculation
frequency throughout adulthood is related
to prostate cancer risk in a large US-based
study.
 Outcome: Men reporting higher (21 times
per month) compared to lower ejaculatory
frequency ( 4 -7 times per month) in
adulthood were less likely to be
subsequently diagnosed with prostate
cancer.
 *Jennifer R. Rider, Kathryn M. Wilson, Jennifer A. Sinnott, Rachel S. Kelly, Lorelei A. Muccia, Edward L.
Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-
up.
Eur Urol 2016;70:974–82

24. Good food – Friuts and vegetable

25. Good Food - Soy

26. Good- EXERCISE

27. Bad Food – Charred Meat

28. Bad- Dairy Products

29. Controversy
[*] Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, et al. Radical
prostatectomy versus observation for localized prostate cancer. N Engl J
Med. 2012 Jul 19. 367(3):203-13
 Among men with localized prostate cancer
detected during the early era of PSA testing,
radical prostatectomy did not significantly reduce
all-cause or prostate-cancer mortality, as
compared with observation, through at least 12
years of follow-up. Absolute differences were less
than 3 percentage points.[*]

30. Benefits of Early Detection
[*] Cost analyses of prostate cancer screening: frameworks for discussion. Investigators of
the American Cancer Society-National Prostate Cancer Detection Project. Littrup PJ,
Goodman AC, Mettlin CJ, Murphy GP.
J Urol. 1994 Nov;152(5 Pt 2):1873-7.
 Early detection and potential for curative care
 Poor outcome with advanced disease
 More virulent disease among Africans
 Avoidance of side effects of managing advanced
disease
 Cost effective [*]

31. Attitude towards screening

32. Conclusion
 Prostate cancer is very common among
Nigerian men
 It runs in families
 Need for screening which should start at
the age of 40
 Test for screening is available and safe
 Treatment for cancer of the prostate
when diagnosed is available .
 Healthy diet, physical exercise and
maintaining right weight are important

33. THANKS FOR LISTENING

34. QUESTIONS