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Prostate cancer health talk
1. DR EZENWA E V.
MBBS, FMCS, FWACS,
MPH
CONSULTANT
UROLOGIST UBTH
PROSTATE CANCER AWARENESS
2. What we’ll be talking about
What is prostate /prostate cancer?
How common is prostate cancer?
What causes it?
How does it manifest?
Tests to find prostate cancer early
Treatment for prostate cancer
Prevention of prostate cancer
Conclusion
3. What is prostate gland / prostate
cancer?
Prostate Gland:
- Found below the
bladder
and in front of the
rectum
-The size of a walnut or
golf ball
- Makes the fluid that is
part of semen
Prostate Cancer
- Malignant
transformation
of the cells of the
prostate
4. DISEASES OF THE PROSTATE
Prostatitis (infection and
inflammation)
Benign prostatic hyperplasia
/enlargement (BPH)
Carcinoma of the prostate
5. How common is prostate
cancer?
[1]Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN
estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
doi: 10.3322/caac.21492.
[2]Stephen Odunayo Ikuerowo et al. Prevalence and characteristics of prostate cancer among participants of a
community-based screening in Nigeria using serum prostate specific antigen and digital rectal examination. Pan African
Medical Journal. 2013;15:129. [doi: 10.11604/pamj.2013.15.129.2489]
Worldwide: Second after lung cancer 1,276,106
new cases (2018) [1]
Occurs more often in African-American men.
Reasons - differences in social, environmental and
genetic factors
Nigeria - 1 in every 100 men (1046 per 100,000
men).[2]
Commonest cause of male cancer death in Nigeria
Rarely diagnosed in men younger than 40 years,
uncommon in men younger than 50 years.
Nigeria – late presentation
6.
7. What causes prostate cancer?
- RISK FACTORS
Age is the strongest risk factor
- 63% of prostate cancer occurs in men over the
age of 65.
Male sex - Testesterone
Race
- More common in African men than other men (X3)
Family history- (X2.5)
Genes
- Account for about 5-10% of prostate cancer
Others
- Diet – diaries, red meat, fatty food
8.
9. HOW DOES IT MANIFEST?
NO SYMPTOMS – following screening.
WITH SYMPTOMS – Difficulty with passing urine,
bloody
urine
WITH COMPLICATIONS
- low backache, weakness of the limb,
weight loss,
inability to pass urine, kidney failure,
low blood
level, chest pain, cough, yellowness
of
12. Tests to find prostate cancer early
PSA (prostate-specific antigen)
PSA is a protein produced by
cells of the prostate gland.
PSA test measures the level of
PSA in the blood.
Normal level: (0-4ng/ml)
PCA3 ( Urine)
DRE (digital rectal exam)
Doctor feels the surface of
the prostate gland for bumps,
hard spots, and any other
abnormalities
Prostate biopsy
13.
14. PSA AND PROSTATE CANCER
[*]Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, et al.
Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0
ng per milliliter. N Engl J Med. 2004 May 27. 350 (22):2239-46
No PSA level guarantees the absence of prostate
cancer.
The risk of disease increases as the PSA level
increases, from about
- 8% with PSA levels of ≤1.0 ng/mL [*]
- 25% with PSA levels of 4-10 ng/mL
- 50% for levels over 10 ng/mL [1]
15. What can increase the PSA
level?
Prostate cancer
BPH (benign prostatic hyperplasia)
- Enlargement of the prostate gland (not cancer)
Age
- PSA level tends to go up with age
Prostatitis
- Infection/inflammation on the prostate gland
Ejaculation
- Increases PSA levels for a short time
- Men are asked to abstain from ejaculation for 2
days before
testing
Clearly, factors other than prostate cancer can
increase PSA level.
18. Screening Protocol :(ACS Screening
Guidelines)
Does not recommend routine screening in any
age group.
Asymptomatic men with at least a 10-year life
expectancy should be given an opportunity to
make an informed decision with their health care
provider after receiving information on the
uncertainties, risks and benefits of screening
Age 45 for those at high risk, including African
Americans and men with a first-degree relative
(father, brother, son) diagnosed with prostate
cancer before age 65
Age 40 for those at higher risk (more than one
first-degree relative diagnosed with prostate
19. Screening Protocol :(ACS Screening
Guidelines)
Men who decide to be screened should be tested with
- PSA test.
- A digital rectal exam (DRE)
If screening does not detect cancer, the time between
subsequent screenings depends on the results of the
blood test, as follows:
PSA < 2.5 ng/ml – Retesting may be done every 2
years
PSA ≥2.5 ng/ml – Retesting should be done annually
20. Treatment
Depends on:
- the stage / grade of the disease ( Risk assessment).
- age / life expectancy
Options
- Active surveillance
- Watchful waiting
- Surgery
- Radiotherapy
- Hormone ablation
- Chemotherapy
- Anti- androgens
- others – Cryotherapy, HIFU
21. Side Effects of Treatment
Erectile dysfunction
Low libido
Urinary incontinence
22. Can prostate cancer be
prevented
• Diets
- mainly of vegetables, fruits and fish. Tomatoes
(because of their lycopene content), green tea, and soy
have all been hypothesized to be beneficial.
- Avoid Obesity
- Low-fat diet
- Nutritional supplements also have not proved beneficial in
research studies eg Selenium and Vitamin E
- some protective effect with vitamin D
• Physical activity appears to lower prostate cancer risk.
23. Increased frequency of Ejaculation
reduces prostate cancer !!
Study Aim*: To asses if ejaculation
frequency throughout adulthood is related
to prostate cancer risk in a large US-based
study.
Outcome: Men reporting higher (21 times
per month) compared to lower ejaculatory
frequency ( 4 -7 times per month) in
adulthood were less likely to be
subsequently diagnosed with prostate
cancer.
*Jennifer R. Rider, Kathryn M. Wilson, Jennifer A. Sinnott, Rachel S. Kelly, Lorelei A. Muccia, Edward L.
Giovannucci. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-
up.
Eur Urol 2016;70:974–82
29. Controversy
[*] Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, et al. Radical
prostatectomy versus observation for localized prostate cancer. N Engl J
Med. 2012 Jul 19. 367(3):203-13
Among men with localized prostate cancer
detected during the early era of PSA testing,
radical prostatectomy did not significantly reduce
all-cause or prostate-cancer mortality, as
compared with observation, through at least 12
years of follow-up. Absolute differences were less
than 3 percentage points.[*]
30. Benefits of Early Detection
[*] Cost analyses of prostate cancer screening: frameworks for discussion. Investigators of
the American Cancer Society-National Prostate Cancer Detection Project. Littrup PJ,
Goodman AC, Mettlin CJ, Murphy GP.
J Urol. 1994 Nov;152(5 Pt 2):1873-7.
Early detection and potential for curative care
Poor outcome with advanced disease
More virulent disease among Africans
Avoidance of side effects of managing advanced
disease
Cost effective [*]
32. Conclusion
Prostate cancer is very common among
Nigerian men
It runs in families
Need for screening which should start at
the age of 40
Test for screening is available and safe
Treatment for cancer of the prostate
when diagnosed is available .
Healthy diet, physical exercise and
maintaining right weight are important