Prostate cancer is the most common cancer in men and the second leading cause of cancer death. It occurs when cells in the prostate gland grow abnormally. There are often no early symptoms but some men experience urinary issues or discomfort. Treatment options include surgery, chemotherapy, cryotherapy, hormonal therapy, and watchful waiting. Screening tools include digital rectal exams, transrectal ultrasound, and PSA tests.

2. What is Prostate Cancer The most common type of cancer in men and second most frequent cause of cancer-related death in men Prostate cancer occurs when cells in the prostate gland grow out of control. Some prostate cancers grow very slowly and may not cause problems for years There are often no early prostate cancer symptoms, but some men have urinary symptoms and discomfort.

3. Treatment Options Prostate cancer treatment options are Surgery, Chemotherapy, Cryotherapy, Hormonal therapy, “ Watchful waiting."

5. Some of the organs and hormone involved in Prostate cancer

6. Initial Biopsy Clearly indicated in men with a life expectancy > 10 years who have an abnormal DRE +/- raised PSA Age adjusted PSA Age Seram PSA (ng/ml) 40 - 49 2.0 50-59 3.0 60-69 4.0 70-79 5.0

8. Screening Tools DRE TRUS PSA

9. Symptoms A frequent need to urinate, especially at night. Difficulty starting or stopping the urinary stream. A weak or interrupted urinary stream. A painful or burning sensation during urination or ejaculation. Blood in urine or semen .

10. Symptoms of advanced Prostate cancer Symptoms of advanced prostate cancer include: Dull, incessant deep pain or stiffness in the pelvis, lower back, ribs or upper thighs; arthritic pain in the bones of those areas. Loss of weight and appetite, fatigue, nausea, or vomiting. Swelling of the lower extremities

11. Stages of Prostate Cancer Prostate Cancer Stage I In stage I, prostate cancer is found in the prostate only. Stage I prostate cancer is microscopic, it can’t be felt on a digital rectal exam (DRE), and it isn’t seen on imaging of the prostate.

12. Stage II Prostate Cancer Stage II In stage II, the tumor has grown inside the prostate but hasn’t extended beyond it.

13. Stage III Prostate Cancer Stage III Stage III prostate cancer has spread outside the prostate, but only barely. Prostate cancer in stage III may involve nearby tissues, like the seminal vesicles .

14. Stage IV Stage IV Cancer has already spread, usually to distant lymph nodes, bones or other sites. This is usually determined by bone scan, Prostascint scan or other studies. Stage D cancer is not curable but is treatable

15. Tumor Grading When prostate cancer is found in a biopsy, it will be graded to estimate how quickly it is likely to grow and spread. The most commonly used prostate cancer grading system, called Gleason grading

16. Gleason Grading It evaluates prostate cancer cells on a scale of 1 to 5, based on their pattern when viewed under a microscope. Grade 3 Grade 5

17. Gleason Grading

18. Treatment The choice of what type of therapy is appropriate for a patient with Prostate Cancer is dependant on many factors including: the Gleason Grade; the Stage of the cancer; the patient's age ; the patients medical condition ; and the patient's desires .

19. Types of treatment On the basis of symptoms treatment is given to the patient like: Radical Prostatectomy External-beam Radiation Brachytherapy Cryotherapy PVP Hormonal Therapy

20. Cancer Treatment: Radical Prostatectomy Surgical removal of the prostate May be done with a retropubic, perineal, laproscopic or da vinci robotic approach.

23. Cancer Treatment: External-beam Radiation Radiation to the prostate from outside the body Evidence that higher doses are associated with better efficacy Newer techniques (such as 3-D conformal, Intensity Modulated Radiation Therapy (IMRT), Stereotactic Radio surgery (SRS) and Stereotactic Radiotherapy (SRT) ) hope to increase radiation delivery and to decrease toxicity.

25. Cancer Treatment: Brachytherapy Radiation implants placed directly into the prostate under ultrasound or ct guidance Very high dose radiation to the prostate with little radiation outside the prostatic bed Procedure completed in one day.

26. Cancer Treatment: Cryotherapy The goal of cryotherapy is to eradicate prostate cancer by freezing the prostate gland. Cryotherapy uses ultra-thin needles to produce ice balls of extreme sub-zero temperatures. The doctor uses ultrasound to accurately guide insertion of the needles, precisely control the size and shape of the ice balls and monitor the freezing and destroys the entire prostate.

27. Cryotherapy

28. Hormonal Therapy Hormonal Therapy is based on the fact that prostate cancer cells frequently use the male hormone, testosterone, as "fertilizer", and the absence of testosterone leads to the death or weakening, (apoptosis), of many, but not all, prostate cancer cells.

29. PVP PVP (Photo-Selective Vaporization of the Prostate) This procedure is also known as Greenlight HPS, Greenlight PV, Laser Prostatectomy, Laser TURP etc. Is a new advancement in laser prostate surgery and an alternative to traditional prostate surgery (TURP) for enlarged prostate. This laser treatment of the prostate is a new, minimally invasive surgical technique for treating Benign Prostatic Hyperplasia (BPH), or enlargement of the prostate.

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