This document discusses prostate cancer (PCa), including:
- Risk factors for PCa include increasing age, family history, and lifestyle factors.
- PCa is diagnosed through digital rectal exam, prostate-specific antigen (PSA) testing, and prostate biopsy.
- PCa is staged using the TNM system and graded using the Gleason score.
- Treatment options depend on risk stratification and include active surveillance, surgery, radiation therapy, hormone therapy, and cryotherapy. Patient preferences and health must be considered.
Biomarkers of prostate cancer with stagingroysudip900
This document discusses biomarkers and recent grading systems for prostate carcinoma. It begins by introducing prostate cancer as the second most commonly diagnosed malignancy in men. It then discusses several biomarkers used for diagnosis and prognosis, including prostate-specific antigen (PSA) and related factors like PSA density and kinetics. Newer biomarkers discussed include PCA3, TMPRSS2-ERG gene fusion, and circulating tumor cells. The document also covers recent grading systems like the Gleason score and 2014 ISUP grade groups which stratify prognosis.
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.
Prostate cancer is the second most common cancer in men worldwide. While early detection and treatment of localized prostate cancer can lead to many years of survival, the disease often progresses to an advanced or metastatic stage where it becomes resistant to hormonal therapies and has limited treatment options. New drugs like abiraterone and enzalutamide that target androgen signaling pathways have improved survival for men with metastatic castration-resistant prostate cancer, but optimal treatment sequencing remains unclear as the disease continues to evolve.
Chemoprevention aims to prevent prostate cancer using pharmaceutical agents. Some key points about chemoprevention of prostate cancer include:
- Finasteride and dutasteride, 5-alpha reductase inhibitors, have been shown to reduce the risk of prostate cancer, especially low-grade cancer, but may increase the risk of higher grade cancers.
- Selenium and vitamin E supplements have been studied but did not show a clear benefit and in some cases increased risk.
- Dietary factors like lycopene from tomatoes and phytoestrogens from soy products are thought to possibly reduce prostate cancer risk but evidence is limited.
- Larger randomized controlled trials of pharmaceutical agents like the PCPT and REDU
This document summarizes guidelines for diagnosis and treatment of prostate cancer. It discusses various staging tests including digital rectal exam, PSA levels, and biopsy. For localized disease, active surveillance is recommended for very low risk while radical prostatectomy or radiotherapy are options for low to intermediate risk. For high risk disease, radiotherapy dose escalation to 74-80 Gy is recommended. Brachytherapy or external beam radiotherapy with brachytherapy boost are discussed. Androgen deprivation therapy is indicated for high risk, locally advanced or metastatic disease.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
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.
Nuovi trattamenti locali non invasivi del carcinoma della prostatadott. Comeri Giancarlo
The document discusses prostate cancer treatments including HIFU (high-intensity focused ultrasound). HIFU uses ultrasound waves to coagulate prostate tissue without direct contact, allowing treatment in a single session without incisions. Studies show HIFU achieves negative biopsy results in 90% of low-risk prostate cancer patients within 6 months with few side effects and good long-term cancer control and survival rates. HIFU is presented as a minimally-invasive alternative to surgery or radiation for localized prostate cancer.
Biomarkers of prostate cancer with stagingroysudip900
This document discusses biomarkers and recent grading systems for prostate carcinoma. It begins by introducing prostate cancer as the second most commonly diagnosed malignancy in men. It then discusses several biomarkers used for diagnosis and prognosis, including prostate-specific antigen (PSA) and related factors like PSA density and kinetics. Newer biomarkers discussed include PCA3, TMPRSS2-ERG gene fusion, and circulating tumor cells. The document also covers recent grading systems like the Gleason score and 2014 ISUP grade groups which stratify prognosis.
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.
Prostate cancer is the second most common cancer in men worldwide. While early detection and treatment of localized prostate cancer can lead to many years of survival, the disease often progresses to an advanced or metastatic stage where it becomes resistant to hormonal therapies and has limited treatment options. New drugs like abiraterone and enzalutamide that target androgen signaling pathways have improved survival for men with metastatic castration-resistant prostate cancer, but optimal treatment sequencing remains unclear as the disease continues to evolve.
Chemoprevention aims to prevent prostate cancer using pharmaceutical agents. Some key points about chemoprevention of prostate cancer include:
- Finasteride and dutasteride, 5-alpha reductase inhibitors, have been shown to reduce the risk of prostate cancer, especially low-grade cancer, but may increase the risk of higher grade cancers.
- Selenium and vitamin E supplements have been studied but did not show a clear benefit and in some cases increased risk.
- Dietary factors like lycopene from tomatoes and phytoestrogens from soy products are thought to possibly reduce prostate cancer risk but evidence is limited.
- Larger randomized controlled trials of pharmaceutical agents like the PCPT and REDU
This document summarizes guidelines for diagnosis and treatment of prostate cancer. It discusses various staging tests including digital rectal exam, PSA levels, and biopsy. For localized disease, active surveillance is recommended for very low risk while radical prostatectomy or radiotherapy are options for low to intermediate risk. For high risk disease, radiotherapy dose escalation to 74-80 Gy is recommended. Brachytherapy or external beam radiotherapy with brachytherapy boost are discussed. Androgen deprivation therapy is indicated for high risk, locally advanced or metastatic disease.
This document discusses prostate specific antigen (PSA) and its clinical uses. It provides information on:
- What PSA is and how it is produced by the prostate
- How PSA levels are measured and can be affected by various factors
- How PSA is used for screening, diagnosis, staging of prostate cancer
- How PSA levels after treatment can provide prognostic information and indicate recurrence
- The limitations and controversies around PSA screening
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.
Nuovi trattamenti locali non invasivi del carcinoma della prostatadott. Comeri Giancarlo
The document discusses prostate cancer treatments including HIFU (high-intensity focused ultrasound). HIFU uses ultrasound waves to coagulate prostate tissue without direct contact, allowing treatment in a single session without incisions. Studies show HIFU achieves negative biopsy results in 90% of low-risk prostate cancer patients within 6 months with few side effects and good long-term cancer control and survival rates. HIFU is presented as a minimally-invasive alternative to surgery or radiation for localized prostate cancer.
Prostate cancer is the most common cancer among men. It develops in the prostate gland. Some key risk factors include age, family history, and ethnicity. Staging of prostate cancer involves determining the extent of spread using the TNM system. Treatment options depend on staging and include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Common side effects of treatment include erectile dysfunction, urinary incontinence, and loss of sexual desire. Nursing care focuses on managing side effects, preventing infections, maintaining skin integrity, and providing psychosocial support.
1) Post-operative radiotherapy (PORT) can reduce the risk of prostate cancer recurrence after radical prostatectomy for patients with adverse features like positive surgical margins or extracapsular extension.
2) Large randomized trials have shown that adjuvant radiotherapy (ART) within 6 months of surgery improves outcomes compared to observation or early salvage radiotherapy initiated at first signs of recurrence.
3) Salvage radiotherapy is an option for patients with rising PSA after surgery but no metastases, and can improve biochemical progression-free survival and cancer-specific survival when initiated promptly at low PSA levels.
Prostate cancer molecular bio markers seminarHarshaR35
This document discusses various molecular biomarkers for prostate cancer that have been approved by regulatory agencies or are under investigation. It begins by providing background on prostate cancer statistics and the rationale for biomarkers. It then discusses currently approved blood-based biomarkers like PSA, PHI, and 4Kscore. Circulating tumor cells and cell-free DNA are also mentioned. Finally, it briefly summarizes urine-based biomarkers like PCA3 and potential new serum protein panels. In general, the document reviews both established and emerging liquid and tissue-based biomarkers that could improve prostate cancer screening, diagnosis, and monitoring.
PSA prostatic specific antigen modalities.pptxKarimElattar4
PSA is a glycoprotein produced by prostate cells that is found in high levels in semen and blood. While elevated PSA can indicate prostate cancer, it is not cancer-specific and levels can also be increased in benign prostate conditions. PSA is used to screen for, diagnose, stage, and monitor prostate cancer treatment, but has limitations including false positives requiring biopsy and inability to distinguish cancer from benign conditions. Multiple factors can affect PSA levels, and modifications like PSA velocity and molecular forms may provide more accurate cancer detection.
PET SCAN IN UROLOGY
Molecular imaging such as PET scans allow visualization of biochemical processes in the body. PET scans using radiotracers like 18F-FDG have various applications in urology including detecting cancers of the prostate, kidney, bladder, testes, and penis. 68Ga-PSMA PET/CT in particular has high sensitivity for detecting prostate cancer, even at low PSA levels. PET scans provide diagnostic information and can guide treatment planning and monitoring.
Carcinoma of unknown primary (CUP) refers to metastatic cancers where the primary site cannot be identified. It accounts for 2-3% of cancers. Diagnostic workup includes biopsy of the most accessible site and immunohistochemistry (IHC) to identify lineage and potential primary sites. Management depends on specific clinical and pathological features. For cervical adenopathy presentations, combined modality therapy with surgery and radiation is recommended, along with unilateral tonsillectomy to identify potential head and neck primaries. Identification of the primary site can improve treatment by limiting radiation fields.
Newer diagnostic tools in oncology such as liquid biopsies provide non-invasive approaches to diagnosing and monitoring cancer. Liquid biopsies analyze biomarkers found in bodily fluids and can detect circulating tumor cells, circulating tumor DNA, RNA, and exosomes shed by tumors into the bloodstream. These liquid biomarkers offer advantages over traditional tissue biopsies by being less invasive, able to capture the heterogeneity of tumors, and allow for real-time monitoring of treatment response and disease progression. Emerging technologies now allow liquid biopsies to provide genomic information that can help classify and treat cancers based on their molecular profiles rather than the organ or tissue of origin.
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.
Prostate cancer is the most commonly diagnosed cancer and second leading cause of cancer death among men over 65 in Western countries. Risk factors include increasing age, family history, and diet. Histopathological grading uses the Gleason grading system to determine tumor differentiation and prognosis. Treatment options depend on disease stage and include local therapies like surgery and radiation for early disease, hormone therapy for advanced or metastatic disease, and chemotherapy for hormone-refractory prostate cancer.
Early detection of carcinoma prostate by Dr. U.K.Shrivastava (MS,FAIS,DHA), ...YeanWen Ooi
1. Prostate cancer screening using PSA testing and digital rectal exams can help detect prostate cancer early when treatment may be more effective.
2. PSA levels above age-specific ranges or abnormal rectal exams should prompt further testing like TRUS biopsy to check for prostate cancer.
3. While early detection may find more cancers, not all elevated PSA levels indicate cancer and some normal PSA levels can still hide cancers, so screening has limitations.
Tumor markers are substances found in blood, urine, or tissue that can indicate the presence of cancer. They include proteins, mutations, and DNA patterns from cancer cells. Ideal tumor markers are cancer-specific, correlate with tumor size, and predict recurrences before clinical detection. Common tumor markers include CEA for colorectal cancer, CA125 for ovarian cancer, PSA for prostate cancer, and HER2/neu for breast cancer response to targeted therapies. While tumor markers can help monitor cancer, they have limitations as cancer may not produce markers and benign conditions can elevate levels. Tumor marker tests alone cannot diagnose cancer.
Discuss the use of tumor markers in surgical practiceCHIZOWA EZEAKU
This document discusses the use of tumor markers in surgical practice. It defines tumor markers as substances present in or produced by a tumor that can be used to detect or monitor the presence of cancer. The document outlines the classification, clinical applications, limitations, and recent trends in the use of tumor markers. It provides examples of specific tumor markers used for various cancer types and recommendations for the optimal use and interpretation of tumor marker levels.
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.
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.
Tumor markers are substances produced by cancer cells or other cells in response to cancer that can be detected in bodily fluids or tissues. The ideal tumor marker would be highly sensitive and specific to a cancer, produced early in cancer progression, and correlated with tumor burden. Common tumor markers include AFP for liver and germ cell cancers, CEA for gastrointestinal cancers, PSA for prostate cancer, CA125 for ovarian cancer, and calcitonin for thyroid cancer. Tumor markers have applications in cancer screening, diagnosis, staging, determining prognosis, monitoring treatment response, and detecting recurrence.
Current Diagnosis And Management Of Prostate Cancerfondas vakalis
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.
This document provides information on testicular cancer, including its incidence, histology, lymph node drainage patterns, staging classifications, workup, and management guidelines. Some key points:
- Testicular cancers constitute 1% of all cancers and germ cell tumors are the most common solid tumors in men aged 15-35.
- Lymph node drainage patterns differ for right and left testes, with retroperitoneal lymph nodes being the most common site of spread.
- Germ cell tumors are the most common type and are classified based on their histologic components.
- Staging involves the TNM classification and serum tumor marker levels. Workup includes imaging, tumor marker tests, and radical orchi
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.
This document provides an overview of prostate cancer, including its anatomy, epidemiology, risk factors, clinical presentation, diagnosis, management, and prognosis. Key points include: prostate cancer most commonly affects men over age 50; screening involves PSA testing and digital rectal exam; treatment options depend on cancer stage and include surgery, radiation therapy, hormone therapy and chemotherapy; prognosis is best for cancers confined to the prostate with low PSA levels and grade.
This document discusses voiding dysfunction and benign prostatic hyperplasia (BPH). It notes that BPH is very common in men over 60, affecting over 40% with symptoms. It impacts quality of life by interfering with daily activities. The prevalence increases significantly with age. Symptoms can include both irritative (storage) symptoms like urgency and obstructive (voiding) symptoms like hesitancy. The pathophysiology involves both static anatomical enlargement of the prostate and dynamic increased smooth muscle tone. Overactive bladder (OAB) symptoms affect a substantial proportion of men with BPH and lower urinary tract symptoms.
The document discusses the overactive bladder condition, defining it as urgency with or without urge incontinence along with frequency and nocturia in the absence of other pathological conditions. It provides information on the prevalence of overactive bladder which increases with age, discusses diagnostic tests like cystometry, and outlines treatment options including behavioral therapy, medication like oxybutynin, and minimally invasive procedures.
Prostate cancer is the most common cancer among men. It develops in the prostate gland. Some key risk factors include age, family history, and ethnicity. Staging of prostate cancer involves determining the extent of spread using the TNM system. Treatment options depend on staging and include active surveillance, surgery, radiation therapy, hormone therapy, and chemotherapy. Common side effects of treatment include erectile dysfunction, urinary incontinence, and loss of sexual desire. Nursing care focuses on managing side effects, preventing infections, maintaining skin integrity, and providing psychosocial support.
1) Post-operative radiotherapy (PORT) can reduce the risk of prostate cancer recurrence after radical prostatectomy for patients with adverse features like positive surgical margins or extracapsular extension.
2) Large randomized trials have shown that adjuvant radiotherapy (ART) within 6 months of surgery improves outcomes compared to observation or early salvage radiotherapy initiated at first signs of recurrence.
3) Salvage radiotherapy is an option for patients with rising PSA after surgery but no metastases, and can improve biochemical progression-free survival and cancer-specific survival when initiated promptly at low PSA levels.
Prostate cancer molecular bio markers seminarHarshaR35
This document discusses various molecular biomarkers for prostate cancer that have been approved by regulatory agencies or are under investigation. It begins by providing background on prostate cancer statistics and the rationale for biomarkers. It then discusses currently approved blood-based biomarkers like PSA, PHI, and 4Kscore. Circulating tumor cells and cell-free DNA are also mentioned. Finally, it briefly summarizes urine-based biomarkers like PCA3 and potential new serum protein panels. In general, the document reviews both established and emerging liquid and tissue-based biomarkers that could improve prostate cancer screening, diagnosis, and monitoring.
PSA prostatic specific antigen modalities.pptxKarimElattar4
PSA is a glycoprotein produced by prostate cells that is found in high levels in semen and blood. While elevated PSA can indicate prostate cancer, it is not cancer-specific and levels can also be increased in benign prostate conditions. PSA is used to screen for, diagnose, stage, and monitor prostate cancer treatment, but has limitations including false positives requiring biopsy and inability to distinguish cancer from benign conditions. Multiple factors can affect PSA levels, and modifications like PSA velocity and molecular forms may provide more accurate cancer detection.
PET SCAN IN UROLOGY
Molecular imaging such as PET scans allow visualization of biochemical processes in the body. PET scans using radiotracers like 18F-FDG have various applications in urology including detecting cancers of the prostate, kidney, bladder, testes, and penis. 68Ga-PSMA PET/CT in particular has high sensitivity for detecting prostate cancer, even at low PSA levels. PET scans provide diagnostic information and can guide treatment planning and monitoring.
Carcinoma of unknown primary (CUP) refers to metastatic cancers where the primary site cannot be identified. It accounts for 2-3% of cancers. Diagnostic workup includes biopsy of the most accessible site and immunohistochemistry (IHC) to identify lineage and potential primary sites. Management depends on specific clinical and pathological features. For cervical adenopathy presentations, combined modality therapy with surgery and radiation is recommended, along with unilateral tonsillectomy to identify potential head and neck primaries. Identification of the primary site can improve treatment by limiting radiation fields.
Newer diagnostic tools in oncology such as liquid biopsies provide non-invasive approaches to diagnosing and monitoring cancer. Liquid biopsies analyze biomarkers found in bodily fluids and can detect circulating tumor cells, circulating tumor DNA, RNA, and exosomes shed by tumors into the bloodstream. These liquid biomarkers offer advantages over traditional tissue biopsies by being less invasive, able to capture the heterogeneity of tumors, and allow for real-time monitoring of treatment response and disease progression. Emerging technologies now allow liquid biopsies to provide genomic information that can help classify and treat cancers based on their molecular profiles rather than the organ or tissue of origin.
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.
Prostate cancer is the most commonly diagnosed cancer and second leading cause of cancer death among men over 65 in Western countries. Risk factors include increasing age, family history, and diet. Histopathological grading uses the Gleason grading system to determine tumor differentiation and prognosis. Treatment options depend on disease stage and include local therapies like surgery and radiation for early disease, hormone therapy for advanced or metastatic disease, and chemotherapy for hormone-refractory prostate cancer.
Early detection of carcinoma prostate by Dr. U.K.Shrivastava (MS,FAIS,DHA), ...YeanWen Ooi
1. Prostate cancer screening using PSA testing and digital rectal exams can help detect prostate cancer early when treatment may be more effective.
2. PSA levels above age-specific ranges or abnormal rectal exams should prompt further testing like TRUS biopsy to check for prostate cancer.
3. While early detection may find more cancers, not all elevated PSA levels indicate cancer and some normal PSA levels can still hide cancers, so screening has limitations.
Tumor markers are substances found in blood, urine, or tissue that can indicate the presence of cancer. They include proteins, mutations, and DNA patterns from cancer cells. Ideal tumor markers are cancer-specific, correlate with tumor size, and predict recurrences before clinical detection. Common tumor markers include CEA for colorectal cancer, CA125 for ovarian cancer, PSA for prostate cancer, and HER2/neu for breast cancer response to targeted therapies. While tumor markers can help monitor cancer, they have limitations as cancer may not produce markers and benign conditions can elevate levels. Tumor marker tests alone cannot diagnose cancer.
Discuss the use of tumor markers in surgical practiceCHIZOWA EZEAKU
This document discusses the use of tumor markers in surgical practice. It defines tumor markers as substances present in or produced by a tumor that can be used to detect or monitor the presence of cancer. The document outlines the classification, clinical applications, limitations, and recent trends in the use of tumor markers. It provides examples of specific tumor markers used for various cancer types and recommendations for the optimal use and interpretation of tumor marker levels.
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.
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.
Tumor markers are substances produced by cancer cells or other cells in response to cancer that can be detected in bodily fluids or tissues. The ideal tumor marker would be highly sensitive and specific to a cancer, produced early in cancer progression, and correlated with tumor burden. Common tumor markers include AFP for liver and germ cell cancers, CEA for gastrointestinal cancers, PSA for prostate cancer, CA125 for ovarian cancer, and calcitonin for thyroid cancer. Tumor markers have applications in cancer screening, diagnosis, staging, determining prognosis, monitoring treatment response, and detecting recurrence.
Current Diagnosis And Management Of Prostate Cancerfondas vakalis
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.
This document provides information on testicular cancer, including its incidence, histology, lymph node drainage patterns, staging classifications, workup, and management guidelines. Some key points:
- Testicular cancers constitute 1% of all cancers and germ cell tumors are the most common solid tumors in men aged 15-35.
- Lymph node drainage patterns differ for right and left testes, with retroperitoneal lymph nodes being the most common site of spread.
- Germ cell tumors are the most common type and are classified based on their histologic components.
- Staging involves the TNM classification and serum tumor marker levels. Workup includes imaging, tumor marker tests, and radical orchi
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.
This document provides an overview of prostate cancer, including its anatomy, epidemiology, risk factors, clinical presentation, diagnosis, management, and prognosis. Key points include: prostate cancer most commonly affects men over age 50; screening involves PSA testing and digital rectal exam; treatment options depend on cancer stage and include surgery, radiation therapy, hormone therapy and chemotherapy; prognosis is best for cancers confined to the prostate with low PSA levels and grade.
Similar to pca prstate cancer management ppt.pptx (20)
This document discusses voiding dysfunction and benign prostatic hyperplasia (BPH). It notes that BPH is very common in men over 60, affecting over 40% with symptoms. It impacts quality of life by interfering with daily activities. The prevalence increases significantly with age. Symptoms can include both irritative (storage) symptoms like urgency and obstructive (voiding) symptoms like hesitancy. The pathophysiology involves both static anatomical enlargement of the prostate and dynamic increased smooth muscle tone. Overactive bladder (OAB) symptoms affect a substantial proportion of men with BPH and lower urinary tract symptoms.
The document discusses the overactive bladder condition, defining it as urgency with or without urge incontinence along with frequency and nocturia in the absence of other pathological conditions. It provides information on the prevalence of overactive bladder which increases with age, discusses diagnostic tests like cystometry, and outlines treatment options including behavioral therapy, medication like oxybutynin, and minimally invasive procedures.
FEMALE INCONTINENCE and management 2003.pptKarimElattar4
Dr. Hatem Wagih Aly presents an overview of female urinary incontinence. There are several types including stress, urge, mixed, situational, and overflow incontinence. Stress incontinence can be caused by genuine stress incontinence, mixed incontinence, pelvic organ prolapse, stress induced detrusor overactivity, urethral hypermobility, intrinsic sphincter deficiency, or neurogenic causes. Urge incontinence can result from bladder overactivity, neurogenic causes, myogenic factors, inflammation/infection, bladder hypersensitivity, obstruction, pelvic organ prolapse, previous surgery, urethral abnormalities, or detrusor sph
laser in urology in different urology diseases.pptxKarimElattar4
Laser physics and types of lasers are summarized. Lasers produce intense beams of coherent, monochromatic radiation. Key lasers described include CO2, Nd:YAG, KTP, alexandrite, diode, Ho:YAG. Thermal, mechanical, photochemical and tissue welding effects of lasers are explained. Clinical applications of various lasers are discussed for BPH treatment, renal tumors, lithotripsy, bladder cancer, penile cancer and urethral strictures. Lasers are also used to ablate skin lesions and reconstructive procedures through tissue welding.
Neuromodulation in treatment of neurogenic bladder.pptxKarimElattar4
Sacral neuromodulation involves electrically stimulating sacral nerve roots to modulate bladder function and treat urinary incontinence and retention. It works by activating afferent nerves in the sacral nerve roots that connect to spinal cord pathways controlling micturition. There are two stages - an initial temporary test using an external pulse generator followed by implantation of a permanent internal pulse generator if the test is successful. Potential indications include overactive bladder, urinary retention, and pelvic pain. The document discusses various neuromodulation techniques and mechanisms of action in treating different lower urinary tract dysfunctions.
Azoospermia how to manage azoospermia.pptxKarimElattar4
The document discusses various causes of azoospermia including:
1. Hypothalamic-pituitary causes such as gonadotropin deficiencies and exogenous hormone use.
2. Testicular causes including chromosomal abnormalities, genetic mutations, infections, radiation exposure, and undescended testes.
3. Post-testicular causes like reproductive tract obstructions from various structural abnormalities or infections.
Evaluations for azoospermia include semen analysis, hormone levels, genetic testing, ultrasound, and sometimes procedures like biopsy. Specific conditions mentioned are Klinefelter syndrome, cystic fibrosis, and microdeletions of the Y chromosome.
basics of Urological imaging focusig on kub.pptKarimElattar4
This document discusses various imaging modalities used to examine the abdomen, including conventional X-rays, ultrasound, CT, nuclear imaging, MRI, and angiography. It focuses on plain X-rays of the abdomen, describing how to evaluate an abdominal X-ray by assessing technical details and examining bones, solid organs like the liver and kidneys, hollow organs like the stomach and bowel, calcified structures, stones, and foreign bodies. The summary provides guidance on what to look for on an abdominal X-ray to identify abnormalities.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
3. Introduction
• Prostate cancer is the most common visceral cancer in males in Europe.
• Prostate cancer is the second most common cancer in men worldwide.
• second leading cause of cancer-related deaths in the United States.
• 3rd highest cause of cancer-related death (lung, colon) worldwide.
• Risk factors:
راجل
عجوز
من
إفريقيا
عيلته
فيها
وبيعمل
جميع
متع
الحياة
:
•
بيدخن
•
وباكل
دهون
كتير
•
وبيسكر
•
وبيمارس
الجنس
وقطع
ال
vas
فجاله
إلتهاب
فى
البروستاتا
4. Pathology of Pca
Precurses of prosatic adenocarcinoma:
• atypical small acinar proliferation (ASAP)
• Prostatic intraepithelial neoplasia “PIN”
ADENOCARCINOMA
Other prostatic tumors:
• Small cell carcinoma
• Squamous carcinoma
• TCC
• rhabdomyosarcoma
7. Grading System
Gleason score
• The most commonly used system for grading adenocarcinoma of the prostate
is the Gleason score.
• The system describes a score between 2 and 10, with 2 being the least
aggressive and 10 the most aggressive.
• This score is the sum of the two most common patterns (grades 1-5) of
tumour growth found.
8. Clinical picture:
Asymptomatic:
>80% asymptomatic (elevated PSA or abN DRE) as majority of PCa arises in
periphery
locally advanced:
LUTS, hydronephrosis, ED (N↑B invasion), hematospermia, decreasd ejaculate
volume
Metastatic disease:
bone pain, renal failure, lower limb edema, malignant RPF
Paraneoplastic syndromes as
anemia
hyperCa
hyperPO4
Cushing’s } ectopic ACTH
gynecomastia } increased βhCG
9. For diagnosis:
1. Digital rectal examination (DRE)
2. PSA
3. TRUS Biopsy
For staging:
local staging (T):
• CT scan
• MRI
Nodal staging (N)
• CT scan
• MRI
• laparoscopic pelvic LND
Metastasis (M)
• PXR
• bone scan
• CT scan
• MRI
• Positron-emission tomography.
10. 1 - Digital rectal examination (DRE)
• Most PCa are located in the peripheral zone of the prostate and may be
detected by DRE when the volume is about 0.2 mL or larger.
• The risk of a positive DRE turning out to be cancer is heavily dependent on
the PSA value.
11. 2 - Prostate-specific antigen (PSA)
• PSA is glycoprotein produced by the prostatic secretory epithelial cells which
line the acini and the ducts of the prostate gland.
• Is found in high concentrations in semen and is thought to cause liquefaction
of the seminal coagulum.
• Organ specific but not cancer-specific.
• PSA level is a better predictor of cancer than suspicious findings on DRE or
TRUS.
• Thus, the detection of non-palpable PCa is dependent on the serum level of
PSA.
• There is no universally accepted lower cut-off value, although > 4 ng/mL has
been used in many studies.
12. SOURSES
Prostatic sources
Non-prostatic sources:
• Breast: some types of breast cancers and secreted in breast milk
• Ovaries: some types of ovarian cancers
• Some 1ry lung carcinomas and renal cell carcinoma
• Amniotic fluid
In non prostatic tissues PSA exist in the free form and in clinically non
significant amount
13. • Serum levels may be elevated with BPH, prostatitis and other non-malignant
conditions.
• PSA level is a better predictor of cancer than suspicious findings on DRE or TRUS.
• Thus, the detection of non-palpable PCa is dependent on the serum level of
PSA.
• There is no universally accepted lower cut-off value, although > 4 ng/mL has
been used in many studies.
Risk of PCa in relation to low PSA values
PSA level(ng/mL) Risk of pCa
0-0.5 6.6%
0.6-1 10.1%
1.1-2 17.0%
2.1-3 23.9%
3.1-4 26.9%
14. The following modifications of serum PSA value, may improve the
specificity of PSA in the early detection of PCa:
PSA density
• serum PSA divided by prostatic volume in mL (as estimated by TRUS).
• PSAD > 0.15 determining the need for prostate biopsies.
Age-specific reference ranges
PSA molecular forms
serum PSA complexed antichymotrypsin (PSA-ACT)
Free alpha-2-macroglobulin (PSA-
AMG)
The free/total PSA ratio (f/t PSA) :
• most widely used in clinical practice to differentiate BPH from PCa.
• Cut off value: 25%
PSA velocity
• Rising of the serum PSA level per year.
• (PSAV > 0.75 determining the need for prostate biopsies)
PSA (ng/mL)
Age range (yr)
0-2.5
40-49
0-3.5
50-59
0-4.5
60-69
0-6.5
70-79
15. Other PCa Tumour Markers:
PSMA3 (prostate-specific membrane Ag).
PCA3:
detectable in urine sediments obtained after three strokes of prostatic
massage
Endoglin CD105 “under trial”
It is more accurate than PSA in discrimination of biopsy outcome
17. introduction
when selecting appropriate treatment for PCa you have to put in consideration
1) tumour’s potential aggressiveness
o staging } DRE, imaging, etc
o PSA } total, velocity, doubling time, density, free-to-total ratio, etc
o Gleason score
o N* of cores +ve
o volume of cancer in cores
o perineural or LV invasion
o ductal or neuroendocrine differentiation
2) patient’s general health/co-morbidities
3) patient’s life expectancy
4) QOL preferences of patient
18. Risk stratifi cation of clinically localized prostate cancer
Other
Clinical
stage
Gleason
sum
PSA
(ng/ml)
Risk group
<3 cores positive,
≤50 % tumor in any
core,
PSA density<0.15
T1c
6
<10
Very low
≤T2a
6
<10
Low
T2b
7
≥ 10 and < 20
Intermediate
Lymph node
positive
≥T2c
8
>20
High
20. Active surveillance
• The patient is followed up under close surveillance
until there is evidence of Progression
• intent to cure persists
• Goal is
o distinguish clinically insignificant PCa from life-threatening PCa while still
localized
o avoid overRx while administering curative Rx when indicated
• Recommendations for active surveillance no consensus
o DRE + PSA q3-6months
o repeat Bx 1yr from initial Bx
o Bx q1-2yrs thereafter
27. RADIATION THERAPY
A. external-beam radiotherapy.
B. Brachytherapy
A. External Beam
Technical points : some modification has been done improves local control,
without increasing the morbidity it include
• three-dimensional conformal radiotherapy (3D-CRT)
• intensity-modulated external-beam radiotherapy (IMRT) “gold standard”
B. Brachytherapy
It is implantation of radioactive seeds directly
in prostate to deliver high-dose radiation
28. Cryosurgery of the prostate (CSAP)
Idea uses freezing techniques to induce cell death.
30. Line of management in hormonal therapy
1. First-line hormonal treatment
long-lasting LHRH analogue or antagonist . “medical castration”
Orchidectomy “surgical castration”
2. 2nd line treatment Complete androgen blockade (CAB)
It is blocked adrenal androgens by adding an anti-androgen to either
surgical or pharmacological castration
31. COMPLICATIONS OF ANDROGEN ABLATION
1. Osteoporosis
2. hot flashes
3. sexual dysfunction (ED & loss of libido)
4. cognitive effects
5. Gynecomastia
6. Anemia
7. metabolic syndrome
32. Follow up regimen
• Ther routine follow up is by PSA measurement, disease-specific history
and DRE at the following intervals:
o 3, 6 and 12 months postoperatively,
o every 6 months thereafter until 3 years,
o then annually.
35. Incidence
*Fourth most common cancer in men
*Ninth most common cancer in women
*Represents 7% of all cancers and 3% of all cancer deaths
*Recurrence and routine surveillance/treatment make bladder cancer most
expensive malignancy to treat from diagnosis to death
*M:F = 3:1 (survival better in men)
*Peak incidence ages 60-70
*Majority (~93%) are urothelial cancer (transitional cell carcinoma)
37. Occupations at Risk
• Dry cleaners
• Painters
• Autoworkers
• Truck drivers
• Paper manufacturers
• Metal workers
• Plumbers
• Hairdressers
• Tire and rubber workers
• Chemical workers
• Petroleum workers
38. Pathology
*Transitional cell carcinoma (TCC) 90% of bladder cancers
1973 WHO grading
Urothelial papilloma
Grade 1: well differentiated
Grade 2: moderately differentiated
Grade 3: poorly differentiated
2004 WHO grading system
Papillary lesions:
o Urothelial papilloma (completely
benign lesion)
o Papillary urothelial neoplasm of low
malignant potential (PUNLMP)
o Low-grade (LG) papillary urothelial
carcinoma
o High-grade (HG) papillary urothelial
carcinoma
Flat lesions:
o Urothelial proliferation of uncertain
malignant potential (flat lesion without
atypia or papillary aspects)
o Reactive atypia (flat lesion with atypia)
o Atypia of unknown significance
o Urothelial dysplasia
o Urothelial CIS is always high grade
39. * Squamous cell carcinoma (SCC)
o ~ 5% bladder cancers
o Schistosomiasis esp Egypt (75%)
o Not chemosensitive or radiosensitive
oTreatment surgical – radical cystectomy
* Adenocarcinoma
o~ 2 % bladder cancers
oAssociated chronic UTI
oNot chemosensitive or radiosensitive
oTreatment surgical – radical cystectomy
41. * Carcinosarcoma
Aggressive, not chemosensitive or radiosensitive, 20% five year survival
* Small cell, neuroendocrine
Chemosensitive, Rx neo adjuvant chemo and cystectomy if responds, rare cure
* Leiomyosarcoma
Surgical treatment, cystectomy. 65% five year survival
* Pheochromocytoma
Younger, 20 – 40 years. Adrenergic blockade and care with TURBT
* Leukaemia and lymphoma
* Metastatic tumour
* Rare, more recently breast maetastases. Occasional direct infiltration colorectal
47. Presentation
• Gross hematuria most common
o Most commonly intermittent Gross 68-97%
o Microhematuria 11%
o Timing of hematuria Initial – suggests urethral source
o Terminal – suggests posterior urethra, bladder neck, prostate
o Continuous – suggests bladder etiology
• Irritative voiding symptoms (especially in absence of UTI)
• CP of complication:
o Kidney obstruction
loin pain
impaired renal function
o Chest and bone manifestation
48. Investigation:
Transabdominal US
characterisation of
o renal masses,
o detection of hydronephrosis, and
o visualisation of intraluminal masses in the bladder
Computed tomography urography
Gives more information than US (including status of lymph nodes and
neighbouring organs)
Urinary cytology
The examination of voided urine or bladder-washing specimens for
exfoliated cancer cells has high sensitivity in G3 and high-grade tumours
(84%), but low sensitivity in G1 and low-grade tumours (16%)
Diagnostic cystoscopy and biopsy
50. The diagnosis of papillary bladder cancer ultimately depends on
cystoscopic examination of the bladder and histological evaluation of the
resected tissue.
Perform TURB systematically in individual steps:
bimanual palpation under anaesthesia;
insertion of the resectoscope, under visual control with inspection of the
whole urethra;
inspection of the whole urothelial lining of the bladder;
biopsy from prostatic urethra (if indicated);
cold-cup bladder biopsies (if indicated);
resection of the tumour;
51. Perform resection in one piece for small papillary tumours (< 1 cm),
including part from the underlying bladder wall.
For tumours > 1 cm in diameter perform resection in fractions including:
• the exophytic part of the tumour,
• the underlying bladder wall with the detrusor muscle, and
• the edges of the resection area.
In patients with positive cytology, but negative cystoscopy, exclude:
• a UTUC, CIS in the bladder (random biopsies) and
• Tumour in the prostatic urethra (prostatic urethra biopsy).
52. Perform a second TURB in the following situations:
after incomplete initial TURB;
if there is no muscle in the specimen after initial resection, with the
exception of TaG1 tumours and primary CIS;
in all T1 tumours;
in all HG/G3 tumours, except primary CIS.
53. Disease management
1) Non muscle invasive bladder cancer
(NMIBC)
2) Muscle invasive bladder cancer (MIBC)
54. 1) Non muscle invasive bladder cancer (NMIBC)
Patient stratification into risk groups:
Depending on 6 criteria:
1. Number of tumours
2. Tumour diameter
3. Prior recurrence rate
4. Category Ta or T1
5. Concurrent CIS
6. Grade
55. Plane
Characteristics
Risk group
stratification
One immediate instillation
of intravesical
chemotherapy after TURB.
Primary, solitary, Ta, G1* (PUNLMP, LG), < 3
cm, no CIS
Low-risk
tumours
AS Low risk +
BCG treatment
Between low and high risk
Intermediate-
risk tumours
• Intravesical full-dose
BCG instillations for 1-3
years or
• cystectomy
Any of the following:
• T1 tumour
• G3** (HG) tumour
• CIS
• Multiple and recurrent and large (> 3 cm) Ta,
G1G2 tumours
(all conditions must be presented in this point)
High-risk
tumours
• Radical cystectomy
• intravesical full-dose
BCG instillations for 1-3
years.
T1G3/HG +
• bladder CIS,
• multiple and/or
• large T1G3/HG and/or
• recurrent T1G3/HG,T1G3/HG with CIS in
the prostatic urethra, unusual histology of
urothelial carcinoma, LVI
highest-risk
tumours
56. Effecacy
• Prevent reccurence not progression
• Cross linking agent inhibits DNA synthesis and other mechanisms (alkylating
agent)
• Higher response in CIS (58%) than papillary lesions (43%)
• Role of maintenance therapy uncertain
Side effects:
• Large molecule (334 kd) – minimal systemic absorption and effects
• Chemical cystitis: up to 40% pts
• Decreased bladder capacity
• Skin rash/palmer desquamation (contact dermatitis)
• Leukopenia or bladder contraction is rare
57. Mechanism of action:
Immunomodulatory agent induce inflammatory host response: release
of cytokines
Induction coarse:
• 1st instillation: 1-2 weeks after TURBT
• 6 weekly doses
Dwell time:
1-2 hours
Maintenance coarse:
3 weekly instillations at 3, 6 and 12 months then every 6 months for 3
years
60. Can decrease side effects 30-50% by one of following:
• Decrease dose to 1/3 or less
• Space intervals to 2 weeks instead of 1 week
• Decrease dwell time for BCG to 30 min
• Administer fluoroquinolone 6 and 12 h after each dose
• Use NSAID or COX-2 Inhibitor to potentiate favorable BCG immune response
Contraindication:
Absolute contraindications of BCG intravesical instillation are:
• during the first 2 weeks after TURB;
• in patients with visible haematuria;
• after traumatic catheterisation;
• G3 side effect.
61. Follow-up
The follow-up of Ta, T1 tumours and CIS is based on regular cystoscopy:
Patients with low-risk tumours:
• cystoscopyat 3 months.
• If negative, subsequent cystoscopy is advised 9 months later,
• then yearly for 5 years.
Patients with high-risk tumours:
• cystoscopy and urinary cytology at 3 months.
• If negative, subsequent cystoscopy and cytology should be repeated
every 3 months for a period of 2 years,
• and every 6 months thereafter until 5 years,
• and then yearly.
Patients with intermediate-risk tumours:
should have an in-between follow-up scheme using cystoscopy and cytology.
63. Muscle invasive bladder cancer (MIBC)
• Neoadjuvant chemotherapy
• Pre- and post-operative radiotherapy in MIBC
• Radical surgery and urinary diversion
• Unresectable tumours (T4b)
• Bladder-sparing treatments for localised disease
• Adjuvant chemotherapy
• Metastatic disease
64. Neoadjuvant chemotherapy
T2-T4a, cN0M0 bladder cancer
Cisplatin combination chemotherapy with at least one additional
chemotherapeutic agent eg Methotrexate, vinblastine, adriamycin plus
cisplatin (MVA(E)C)
• Tolerability of chemotherapy and patient compliance are expected to be
better pre-cystectomy.
• Patients might respond to NAC and reveal a favorable pathological status,
determined mainly by achieving pT0, pN0 and negative surgical margins.
65. Pre- and post-operative radiotherapy in MIBC
it can result in tumour downstaging after 4-6 weeks.
• In locally advanced BC (T3- T4, N0/N1, M0),
• the local recurrence rate seems to decrease with post-operative RT.
66. Radical surgery and urinary diversion
Indications
• Patients with MIBC T2-T4a, N0-Nx, M0.
• Other indications include:
o High-risk and recurrent superficial tumours,
o BCG-resistant Tis,
o T1G3as well as
o Extensive papillary disease that cannot be controlled with TURB and
intravesical therapy alone.
• Salvage cystectomy is indicated in:
o Non-responders to conservative therapy,
o Recurrence after bladder sparing treatment,
• Non-urothelial carcinoma
67. Technique and extent
• In men:
Standard RC :
Includes removal of the bladder, prostate, seminal vesicles, distal ureters,
and regional lymph nodes.
• In women:
standard RC:
Includes removal of the bladder, entire urethra and adjacent vagina,
uterus, distal ureters, and regional lymph nodes.
• Standard lymphadenectomy :
o cranially up to the common iliac bifurcation,
o with the ureter being the medial border, and
o including the internal iliac, presacral, obturator fossa and external iliac
nodes
68. Three alternatives are currently used after cystectomy:
• Abdominal diversion: Such as
o Ureterocutaneostomy,
o Ileal or colonic conduit, and
o Various forms of a continent pouch;
• Urethral diversion:
orthotopic urinary diversion
• Rectosigmoid diversions:
Such as uretero- (ileo-)rectostomy.
69. Conduits (small bowel or large bowel)
• Advantages:
o Simple and quick procedure (less OR time)
o Few inherent complications
o Time tested – longest F/U data
o Can compensate for short ureters
• Disadvantages:
o Visible stoma
o Negative body image
o Need for lifelong stoma care (external appliance)
o Anxiety of urinary leakage/odor
70. Continent Urinary Diversion
Patient Selection:
• Serum creatinine < 2
• Adequate Liver function
• Adequate bowel function
• Able and willing to perform self-catheterization
• Patient compliance (agrees to lifelong f/u)
• Absence of short gut syndrome/IBD Colonoscopy prior to using any colon
for diversion
77. ** Palliative cystectomy
** Supportive care
Obstruction of the UUT
• PCN
• Ureteral stenting
• Urinary diversion
Bleeding and pain
• Treatment of general causes
• Transurethral (laser) coagulation
• Radiation therapy
• Non-conservative options (Embolisation)
78. • Indication:
o PT3/4 and/or
o Lymph node positive (N+) disease
o ? Without clinically detectable metastases (M0).
o (If no neoadjuvant chemotherapy has been given).
• Regimen:
Three or four cycles of (cisplatin-based combination):
79. Chemotherapy:
Treatment of bone metastases
• Bisphosphonates:
• Zoledronic acid (ZA)
• Aggressive calcium and vitamin D supplementation
Targeted Therapy
80. 1) Initiation
• Mutation of Protooncogen
• Tumor suppressor gene
• Gene controling DNA repair
• Gene regulating apoptosis
2) Promotion
• Growth factors
• Angiogenesis
• Tolemerase
3) Progression
• Loosening of tumor cells
• Att of tumor cells to basement membrane
• Local degeneration of BM
83. • The most common type of kidney cancer is Renal Cell Cancer,
• also called Renal Adenocarcinoma or Hypernephroma.
• RCC represents 2% of overall cancer incidence and mortality
• 50,000 cases diagnosed and 13,000 deaths annually in the US
84. Epidemiology
Male predominance (1.6:1.0 M:F)
Highest incidence between age 60-80
• Median age of diagnosis is 66 years
• Median age of death 70 years
Highest incidence in Scandinavia and North America, lowest in Africa
No racial differences in the US
85. Risk Factors
Majority of RCC occurs sporadically
Tobacco smoking contributes to 24-30% of RCC cases
- Tobacco results in a 2-fold increased risk
Occupational exposure to cadmium, asbestos, petroleum
Obesity, HTN
Chronic phenacetin or aspirin use
Acquired polycystic kidney disease due to dialysis results in 30%
increase risk
86. Genetic Factors
VHL gene mutation associated with 60% sporadic RCC
2-4% of RCC associated with inherited disorder
Von Hippel-Lindau disease
AD familial cancer syndrome of
• retinal angiomas,
• CNS hemangioblastomas,
• pheochromocytomas and
• clear cell RCC.
87. Clinical Presentation
Variety of symptoms, most asymptomatic
Hematuria present 40% of patients
Classic triad: flank pain, hematuria, palpable abdominal mass occur
in 9% of patients
45% present with localized disease, 25% with locally advanced
disease, 30% with metastatic disease
Paraneoplastic syndromes
88. Paraneoplastic syndromes
Anemia- anemia of chronic disease 29-88%
Hepatic dysfunction in the absence of mets 21%
Hypercalcemia 15%
Cachexia and Fever 20%
Erythrocytosis: 1-5% produce erythropoietin
Secondary AA amyloidosis 3-5%
89. Diagnosis
No screening for the general population
Radiographic evaluation
Ultrasound: solid vs. cystic lesions
Contrast CT: test of choice to evaluate tumor size, location,
lymph node involvement
MRI: to evaluate collecting system and IVC involvement
90. Tissue Diagnosis
Tissue diagnosis obtained from
nephrectomy or biopsy of
metastatic lesion
Surgery indicated for solid renal
masses >1.5cm
Tumors <1.5cm require periodic
follow-up
95. Plane
1-localized disease: T1,T2,T3a
1. Radical nephrectomy
2. Laparoscopy
3.Nephron sparing surgery
4. Minimal invasive therapy
• Cryosurgery
• RFA
• Micro wane thermotherapy
• High intensity focused US
• Interstitial laser therapy
• High energy shock wave
96. 2- RCC with venous extension: T3B,T3C
• Radical nephrectomy
• Tumor thrombectomy
• Adjuvant immunotherapy
3- Locally invasive RCC T4
• Surgery
o Extended Radical nephrectomy. i.e: radical + excision of involved
(bowel,spleen, abdominal wall)
o Partial excision of large primary tumor (debulking)
5 year survival 5 %
• Pre & post operative radiotherapy replaced by immune
• Immunotherapy
• Trans arterial immbolization
(radioactive seed & chemotherapeutic agent)
97. 4- Metastatic RCC M1
Surgical:
• If tumor deposites are resectable( Radical nephrectomy, excision
of deposites)
• If not resectable
o Palliative nephrectomy if ( sever pain, hematuria,
paraneoplastic syndrome, compression of surrounding)
o Or trans arterial immbolization
Systemic
-immunotherapy
- chemotherapy
- radiotherapy
-hormonal therapy
98. Immunotherapy
Immunotherapy with IL-2 activates immune response against RCC
resulting in tumor remission rates 10-20% with median duration of
19-91 months
Severe toxicity including hypotension, MI, renal insufficiency,
pulmonary edema, hepatic dysfunction, CNS dysfunction
Treatment requires ICU monitoring
Used for patients that can tolerate side effects
99. Chemotherapy
RCC is only minimally responsive to chemotherapy
83 clinic trials involving over 4000 pts, overall response rate is only
6%
On-going clinical trials of combination chemotherapy including
Gemcitabine and 5-FU
Limited data reveals some response in non-clear cell RCC to
Carboplatin, Cisplatin plus Gemcitabine
100. Radiation Therapy
RCC relatively radioresistant
XRT has limited use in metastatic disease
-Painful bone or recurrent abdominal metastases
-Brain metastases