1) Prostate cancer risk factors include increasing age, family history, and lifestyle factors like smoking and high fat diets.
2) Screening methods include digital rectal exam and PSA testing, though screening recommendations vary.
3) Treatment options depend on cancer severity and include watchful waiting, surgery, radiation, hormone therapy, and cryotherapy. Long-term side effects can include incontinence and impotence.
The prostate is the gland below a man's bladder
that produces fluid for semen. Prostate cancer is common among older men. It is
rare in men younger than 40. Risk factors for developing prostate cancer
include being over 65 years of age, family history, being African-American, and
some genetic changes.
Symptoms of prostate cancer may include:
-- Problems passing urine, such as pain,
difficulty starting or stopping the stream, or dribbling
-- Low back pain
-- Pain with ejaculation
Your doctor will diagnose prostate cancer
by feeling the prostate through the wall of the rectum or doing a blood test
for prostate-specific antigen (PSA). Other tests include ultrasound, x-rays, or
a biopsy.
Treatment often depends on the stage of the
cancer. How fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Men with prostate cancer have many treatment
options. The treatment that's best for one man may not be best for another. The
options include watchful waiting, surgery, radiation therapy, hormone therapy,
and chemotherapy. You may have a combination of treatments.
The prostate is the gland below a man's bladder
that produces fluid for semen. Prostate cancer is common among older men. It is
rare in men younger than 40. Risk factors for developing prostate cancer
include being over 65 years of age, family history, being African-American, and
some genetic changes.
Symptoms of prostate cancer may include:
-- Problems passing urine, such as pain,
difficulty starting or stopping the stream, or dribbling
-- Low back pain
-- Pain with ejaculation
Your doctor will diagnose prostate cancer
by feeling the prostate through the wall of the rectum or doing a blood test
for prostate-specific antigen (PSA). Other tests include ultrasound, x-rays, or
a biopsy.
Treatment often depends on the stage of the
cancer. How fast the cancer grows and how different it is from surrounding
tissue helps determine the stage. Men with prostate cancer have many treatment
options. The treatment that's best for one man may not be best for another. The
options include watchful waiting, surgery, radiation therapy, hormone therapy,
and chemotherapy. You may have a combination of treatments.
early detection helps ......................................................................................................................................................................................................................................................................................................
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
early detection helps ......................................................................................................................................................................................................................................................................................................
Mills-Peninsula Health Services 2013 Cancer Symposium presentation - Brad Ekstrand, MD/PhD, California Cancer Care Mills-Peninsula Health Services San Mateo, CA
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Prostate Cancer
• Risk Factors
– Age-median age of diagnosis is 72yo
– Smoking
– High Fat/ Western diet
– Family History-8-9% of all cancers due to
inherited gene higher for younger men
• Incidence of prostate cancer increases with age
so that up to 70-80% of men in their 80-90’s
have autopsy evidence of prostate cancer
3. Prostate Cancer
• Most common non cutaneous malignancy in
men
– Second leading cancer killer of men
Prostate Breast
180,400 cases/yr 182,000 cases/yr
36% of new ca cases 32% of new ca cases
40,400 deaths 46,000 deaths
1/6 chance of dvlp. 1/8 chance of dvlp.
Hormone dependence hormone dependence
4. Prostate Cancer
• Prostate Cancer Development
– Develops from the epithelium
• Possibly from the basal cell layer
– Requires androgens to develop
• Patients castrated before puberty do not develop BPH or
Prostate cancer
– Increased cell proliferation and decreased
apoptosis
– BPH is not a risk factor
5. Prostate Cancer
• What’s in a name?
• PIN-prostatic intraepithelial neoplasia
– May be a precursor lesion to prostate cancer
• Characterized by cytologically atypical cells with architecturally
benign glands
• Approximately 20% of patients with PIN will go on to have a
subsequently positive biopsy
• ASAP-atypical small acinar proliferation
– Atypical glands and cells but can’t quite call it cancer
• Up to 50% will have a future positive biopsy
6. Prostate Cancer
Uniform round glands
Single cell layer (loss
of basal cells)
Some prominent
nucleoli
Perineural invasion
7. Prostate Cancer
• Grading
– Gleason grade 1-5
– 2 most predominant patterns
combined to give Gleason
score
– 2-4 well differentiated
– 5-7 intermediate
– 8-10 poorly differentiated
– Gleason scores very
predictive of metastases and
outcome
• Remember high grade PCa
may not make much PSA
9. Prostate Cancer
• Develops in the
peripheral zone of the
prostate
– 75% peripheral zone, 15-
20% transition zone, 5%
central zone, essentially
none in AFMS
– Biopsies directed toward
the peripheral zone
11. Prostate Cancer
• Diagnosis
– Screening-Who should be screened?
• American Urological Association, American
Cancer Society: recommend offering PSA
and DRE to men at risk (ie, with a >10-year
life expectancy)
• US Preventive Services Task Force: don’t
even offer DRE or PSA
– Arguments against screening
• Detection of clinically insignificant cancers
• Expensive-Initial estimates of screening men
aged
50 to 70 years for prostate cancer $25 billion
during first year alone
• Not effective in decreasing mortality from the
disease
12. Prostate Cancer
• Screening
– Prostate, Lung, Colorectal, Ovarian (PLCO)
screening study in the US (148,000 men and
women randomized to screening or community
standard of follow-up)
– Europe: Rotterdam screening trial
– Results of both: 10 years from now
13. Prostate Cancer
• Screening
– Evidence that screening works
• Fall in mortality now seen:
– SEER*
– Olmsted County, MN†
– Canada/Quebec‡
– US Department of Defense (DOD)
– Tyrol, Austria
– Mortality fall not seen (where PSA screening
not performed) Mexico
SEER=Surveillance, Epidemiology and End Results
*Levy IG. Cancer Prev Control. 1998;2:159;
†Roberts RO, et al. J Urol. 1990;161:529-533;
‡Meyer F, et al. J Urol. 1999;161:1189-1191
14. Prostate Cancer
• PSA
– 25% positive predictive value to detect disease
– predictive of tumor stage
– Most predictive factor for biochemical recurrence
– Excellent tumor marker for detecting recurrent disease
• Free PSA
– Portion of PSA which is not complexed to alpha-1
antichymotrypsin
– Measured as ratio of Free/Total PSA
– Decreased by 50% in patients on Proscar
• Therefore ratio still remains useful
15. Prostate Cancer
• Advantages and Disadvantages of Using
Molecular forms of PSA
– Advantage: eliminates about 10%–20% of
negative prostate biopsies in men with PSA of
4.0–10.0 ng/mL
– Disadvantage: misses some (about 5%–10%) of
cancers that would be detected with PSA alone
Catalona WJ, et al. JAMA. 1998;279:1542-1547.
Barr MJ. N Engl J Med. 2001;344:1373-1377.
16. Prostate Cancer
• PSA velocity
– Defined as >.75ng/ml year
• Age specific PSA
Age Recommended Reference
(years) Range for Serum PSA (ng/mL)
40–49 0.0–2.5
50–59 0.0–3.5
60–69 0.0–4.5
70–79 0.0–6.5
Oesterling JE, et al. JAMA. 1993;270:860-864.
17. Prostate Cancer
• Screening
– Digital Rectal Exam
• DRE abnormal in 6%–15% of men
• About 25% of cancers found with DRE alone
• Still plays a role
19. Prostate Cancer
• Diagnosis Detection Rates of Systematic Schemes
– Transrectal ultrasound
and Biopsy
• Traditionally Sextant
Biopsy Used 89%
89%
80%
• More recently 10-12 core
biopsy advocated
– Cores may be sent
separately to help 96%
95%
91%
identify margin at risk Chang JJ, et al. J Urol. 1998;160:2111-2114.
Presti JC Jr, et al. J Urol. 2000;163:163-166.
20. Prostate Cancer
Staging
T1a-<5% on TURP
T1b>5% on TURP
T1c-non palpable diagnosed by PSA
T2a-palpable one lobe
T2b-both lobes
T3a-extraprostatic
T3b-seminal vesicle involvement
T4 adjacent structures
24. Prostate Cancer
• Diagnosis-Other diagnostic tools
– Bone Scans-limited usefulness with PSA<20
“High Threshold”
100
80
60
Predicted
Probability
40
of Positive
Bone Scan (%)
20
0
1 5 10 15 20 25 30 35 45 80 200
Trigger PSA (ng/mL)
Cher, et al. J Urol. 1998;160:1387.
25. Prostate Cancer
• Predictive Models
– Preoperative Nomograms
• Available at Nomograms.org
• Available for pre treatment, post
RRP, and radiation
• PSA continues to be a driving
variable
– Partin tables
• Recently updated, also useful
for prediction of outcomes
Partin et al. Urology 2001
28. Prostate Cancer
• Watchful Waiting
– Waiting for what?
• 70-80% of me in 80’s have prostate cancer not all men
need to be treated
• Look at PSA doubling times
• Look at comorbid conditions
• May rebiopsy in one year and follow PSA
29. Prostate Cancer
• Hormonal Therapy
– LHRH agonists and
antagonists
– Block production of
tesosterone
– Anti-androgens block the
androgen receptor
30. Prostate Cancer
• Hormonal Therapy
– Casodex Monotherapy-150mg per day
• Initial results seem to show equal efficacy to LHRH
agonists (US data still pending)
• Side effects
– Gynecomastia and nipple tenderness a significant problem
causing high withdrawal from studies
– Improvement in side effects of osteoporosis, hot flashes seen
with LHRH agonists.
31. Prostate Cancer
• Hormone Therapy
– Typically hormone deprivation will cause PSA to
go very low and stay low for 18 months
– May add anti-androgen which may work for
another 3-6 months
– Antiandrogen Withdrawal
32. Prostate Cancer
• Disadvantages of Hormone Therapy
– Side effects
• Hot flushes
– Helped with soy, depo-provera, megace
• Osteoporosis-leading to pathologic fractures
– Start patients on Vit D 400IU and Calcium(Citracal) 500mg
per day when initiating treatment
– Bisphosphonate is DEXA scan shows osteoporosis
» Fosamax oral
» Zolendronic Acid-IV
• Other side effects: fatigue, impotence, anemia, etc..
33. Prostate Cancer
• Treatment-Surgical
– Radical Retropubic Prostatectomy
• Complications associated with RRP continue to decline
20 100
18 90
16 80
14 70
12 60
% Other %
10 50 Impotence
Complications
8 40
6 30
4 20
2 10
0 0
60 65 70 75 80 85 90
Study Year
Study Focus Severe incontinence
Stress incontinence
Impotence
Pulmonary embolism
Death
Thompson IM, et al. J Urol. 1999;162:107-112
34. Prostate Cancer
• Treatment Surgical
– Radical Prostatectomy
• Have come to realize the importance of surgical margins
Progression-free Probability
(Surgical Margin Status)
1.0
.9 84.6%
Negative
80.8%
.8
.7
TI-T2NxM0 tumors
.6
.5
41.6%
Positive
.4 36.4%
.3 Number of Patients
at Risk
.2
N=857 N=255 N=39
.1
N=126 N=22 N=1
0.0
0 5 10 15
Time (years)
36. Prostate Cancer
Radical Prostatectomy
– Sural Nerve Grafts
• Used to hopefully
help improve surgical
Pubis
margins by allowing
wider dissection Distal
• Restoration of erectile Urethra anastomosis
function in damaged
Right
nerves or resected
nerves nerve graft
Rectum
• Uses the sural nerve
most commonly, but Proximal
genitofemoral or anastomosis
Left
ilioinguinal can also
nerve graft
be used
37. Prostate Cancer
• Surgical Treatment
– Laparoscopic Prostatectomy
• Initial results from high volume centers look good
– High learning curve
» Results in up to 50% positive margins initially
– Need longer follow-up
– Erectile function and continence still need validation and
longer follow-up
– Sural nerve grafts can be done laparoscopically
» Typically use fibrin glue for anastomoses
• Probably will be reserved for a few centers
38. Prostate Cancer
• Surgical Treatment
– Perineal Prostatectomy
• Renewed interest with decreased morbidity shown by
laparoscopy
• Good data to support oncologic efficacy
• Nerve sparing possible, although no reports of sural
nerve grafts
• Decreased morbidity over RRP, mainly in blood loss
and transfusion requirements
39. Prostate Cancer
• Cryotherapy
– New generation of cyrotherapy units uses a template similar
to brachytherapy
• Allows for more accurate probe placement
40. Prostate Cancer
• Radiation Therapy
– External beam radiotherapy
• Dose escalation studies now pushing doses up into the
80-90Gy range
• IMRT allows better targeting
• Side Effects
– Incontinence-rare
– Impotence-common
– Rectal irritation
– Hematuria, bladder/urethral
irritation
41. Prostate Cancer
• Radiation
– Brachytherapy-
• Outpatient, low morbidity
– Incontinence rare
– Impotence occurs over 2 year period
– Urethral irritation, worsening of BPH symptom
• Best for low grade, low stage tumors in older patients
42. Prostate Cancer
• Biochemical Recurrence
• Approximately 30-40% of patients will
experience a rising PSA after local therapy≠
• 180,400 patients diagnosed with prostate cancer in 2000
• 2/3 (119,064) of these patients receive definitive local
therapy
• 30-40% (35,719-47,6259) recur
– Definition of biochemical recurrence varies
• Best data from Amling paper >0.4ng/ml*
≠Based on SEER statistics. 1998
*Amling CL, et al. J Urol 2001;165: 1146
43. Prostate Cancer
• Hormone Refractory Prostate Cancer
– Typically patients will remain hormone responsive
for median of 18 months
• Hormone deprivation options include
– LHRH agonists
– Antiandrogens
– Orchiectomy
– Estrogens
– On average from time of HRPC to death is median
of 2 years