This document provides information about prostate cancer testing and treatment options. It discusses what the prostate is, risk factors for prostate cancer, common screening tests like the PSA test and digital rectal exam, biopsy procedures, and treatment options including active surveillance, surgery, radiation therapy, and other approaches. The goal is to help patients make informed decisions by understanding their diagnosis and available options.
Overview and Pharmacotherapy of Prostate Cancer (based on NCCN 2012 guideline...hyunik116
This presentation was the prostate cancer lecture for the oncology therapeutics course (31:725:560) that was presented to the class of 2014 PharmD students at the Ernest Mario School of Pharmacy.
I really enjoyed researching and preparing this lecture for the students, and hope you also will find at least something useful in this presentation.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Prostate cancer cause defined symptom risk factorsRobyn Mello
The document discusses prostate cancer, including its definition as a cancer that develops in the prostate gland, which produces seminal fluid. It notes that prostate cancer is a prevalent form of cancer that is usually slow-forming and remains confined to the prostate gland, allowing for better treatment success if discovered early. It describes symptoms, risk factors like age and family history, screening tests like the PSA test and digital rectal exam, stages of prostate cancer, types of standard treatment including watchful waiting, surgery, radiation, and hormone therapy, latest clinical trials, and potential side effects of treatment.
Prostate cancer is a major health issue, with a new case being diagnosed every 3 minutes in the US and a death occurring every 15 minutes. Risk factors include age, family history, race, and lifestyle. Diet appears to play an important role, with increased risks seen with high fat intake and animal products, while vegetables, soy, nuts and seeds are protective. Chemoprevention aims to use natural compounds to prevent or delay cancer progression, with immune enhancers like vitamins A, C, D, and selenium showing promise. Simple lifestyle changes around nutrition, exercise, and other factors may help reduce prostate cancer risk and progression.
This document provides guidelines for the management of prostate cancer. It discusses incidence and risk factors, tumor distribution in the prostate, common sites of metastasis, pathology classification, staging, screening guidelines, risk classification, treatment options for different risk groups, monitoring after treatment, recurrence, advanced disease treatment, and prognosis. The guidelines were written by Dr. Ankita Singh Patel and provide a comprehensive overview of prostate cancer management.
This slide deck is about Prostate cancer. It is amongst the leading cause of cancer deaths in adult males. This slide deck will provide you with necessary information regarding the symptoms, risk, diagnosis, and possible treatment of prostate cancer. I hope the readers find this slide deck useful & informative
The document discusses carcinoma of the prostate, including:
1. It provides information on prostate anatomy and the distribution and risk factors of prostate cancer.
2. Early detection is important as survival rates are 99% for localized cancer but only 31% once it has spread; screening involves digital rectal exams and PSA tests beginning at age 40-50.
3. Treatment options depend on the stage and grade of cancer, and include watchful waiting, surgery, radiation therapy, and hormone therapy.
Overview and Pharmacotherapy of Prostate Cancer (based on NCCN 2012 guideline...hyunik116
This presentation was the prostate cancer lecture for the oncology therapeutics course (31:725:560) that was presented to the class of 2014 PharmD students at the Ernest Mario School of Pharmacy.
I really enjoyed researching and preparing this lecture for the students, and hope you also will find at least something useful in this presentation.
An introduction to week 1 of a free online course on enhancing prostate cancer care, delivered by Sheffield Hallam University in the UK (Oct-Nov 2014). Week 1 focuses on diagnosis.
Prostate cancer cause defined symptom risk factorsRobyn Mello
The document discusses prostate cancer, including its definition as a cancer that develops in the prostate gland, which produces seminal fluid. It notes that prostate cancer is a prevalent form of cancer that is usually slow-forming and remains confined to the prostate gland, allowing for better treatment success if discovered early. It describes symptoms, risk factors like age and family history, screening tests like the PSA test and digital rectal exam, stages of prostate cancer, types of standard treatment including watchful waiting, surgery, radiation, and hormone therapy, latest clinical trials, and potential side effects of treatment.
Prostate cancer is a major health issue, with a new case being diagnosed every 3 minutes in the US and a death occurring every 15 minutes. Risk factors include age, family history, race, and lifestyle. Diet appears to play an important role, with increased risks seen with high fat intake and animal products, while vegetables, soy, nuts and seeds are protective. Chemoprevention aims to use natural compounds to prevent or delay cancer progression, with immune enhancers like vitamins A, C, D, and selenium showing promise. Simple lifestyle changes around nutrition, exercise, and other factors may help reduce prostate cancer risk and progression.
This document provides guidelines for the management of prostate cancer. It discusses incidence and risk factors, tumor distribution in the prostate, common sites of metastasis, pathology classification, staging, screening guidelines, risk classification, treatment options for different risk groups, monitoring after treatment, recurrence, advanced disease treatment, and prognosis. The guidelines were written by Dr. Ankita Singh Patel and provide a comprehensive overview of prostate cancer management.
This slide deck is about Prostate cancer. It is amongst the leading cause of cancer deaths in adult males. This slide deck will provide you with necessary information regarding the symptoms, risk, diagnosis, and possible treatment of prostate cancer. I hope the readers find this slide deck useful & informative
The document discusses carcinoma of the prostate, including:
1. It provides information on prostate anatomy and the distribution and risk factors of prostate cancer.
2. Early detection is important as survival rates are 99% for localized cancer but only 31% once it has spread; screening involves digital rectal exams and PSA tests beginning at age 40-50.
3. Treatment options depend on the stage and grade of cancer, and include watchful waiting, surgery, radiation therapy, and hormone therapy.
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.
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 about prostate cancer, including:
- It is a cancer that occurs in the prostate gland and is one of the most common cancers in men. While some types grow slowly, others can spread quickly.
- Risk factors include age, family history, and race. Many times it causes no symptoms but can sometimes cause urinary or sexual issues.
- Diagnosis involves exams, blood tests, and biopsies. Treatment depends on stage but can include surgery, radiation, hormone therapy, chemotherapy, and active surveillance. Complications may include incontinence and erectile dysfunction. Prevention focuses on diet, exercise, and weight control.
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 document discusses prostate cancer including anatomy, staging, Gleason scoring, treatment options, and side effects. It covers imaging like CT and MRI scans to visualize the prostate and surrounding structures. Radiation treatments like IMRT, Tomotherapy, Cyberknife and seed implants are described in detail, noting their ability to precisely target the prostate gland and avoid nearby organs to minimize side effects. Typical radiation protocols are provided for low and higher risk prostate cancer cases.
Carcinoma of the prostate (CaP) is the most common cancer in American men and the second leading cause of cancer death. Most cases originate in the peripheral zone of the prostate. Risk factors include increasing age, African American race, family history, and high dietary fat intake. CaP is typically an adenocarcinoma and is graded using the Gleason system. Local spread can occur through the seminal vesicles, bladder, and rectum. Distant spread is usually to bones, lymph nodes, and lungs. Treatment depends on grade and stage, and may include surgery, radiation therapy, hormone therapy, or watchful waiting.
This document provides an overview of prostate cancer, including who is affected, risk factors, detection methods like PSA testing and biopsy, staging using the Gleason score and TNM system, and treatment options like surgery, radiation therapy, active surveillance, and androgen blockade. It discusses outcomes for different treatments and challenges in managing prostate cancer recurrence after initial therapy.
The document discusses prostate cancer and benign prostatic hyperplasia (BPH). It covers the incidence, risk factors, pathology, clinical findings, diagnosis and evaluations, as well as treatments for both conditions. For prostate cancer, it addresses staging and grading. It describes treatments for localized disease and recurrent disease after treatment. For BPH, it discusses symptoms, signs, tests, differential diagnosis, and medical and surgical treatment options.
Why are some men at greater risk for prostate cancer?Marc Laniado
Age is the most important risk factor for prostate cancer. Having relatives with prostate or breast cancer increases risk. Certain rare genes like BRCA2 can raise the risk of important prostate cancer by 7 times. Black men are more likely to get prostate cancer than Asian men. A healthy diet and exercise can help reduce the risk of prostate cancer.
Medical management of prostate cancer can include active surveillance, radiation therapy, surgery, hormone therapy, and chemotherapy depending on the cancer's risk level and stage. Investigations may involve PSA testing, biopsy, imaging, and disease staging. Androgen deprivation therapy is an important treatment option and can be accomplished through surgical or chemical castration. Docetaxel and cabazitaxel chemotherapy may provide benefits for advanced or metastatic disease.
Prostate Cancer: Causes, Diagnosis, and Treatment Options Bruce B ... Prost...MedicineAndHealthCancer
Prostate cancer is one of the most common cancers in men. Treatment options include non-curative therapies like hormone therapy or potentially curative therapies like radical prostatectomy, radiation therapy, and cryoablation. Cryoablation, also known as cryotherapy, involves using argon gas to freeze and destroy the prostate tissue with probes inserted through the skin between the scrotum and rectum under ultrasound guidance. It aims to kill all cancer cells while sparing nearby nerves to reduce side effects like erectile dysfunction and incontinence compared to other treatments. Studies show 89% of men treated with cryoablation were cancer-free after 7 years with low risks of complications.
1) Prostate cancer screening is controversial because while screening can reduce prostate cancer mortality, it also leads to overdiagnosis and overtreatment of indolent cancers.
2) The PSA test is an imperfect screening test that does not perfectly predict who needs a biopsy or aggressive treatment. Newer tests may help better identify high-risk cancers.
3) Most prostate cancers grow slowly and will not cause harm. Screening identifies many localized or regional cancers with nearly 100% 5-year survival rates.
Management of prostate cancer involves assessing risk levels based on PSA, Gleason score, and percentage of positive biopsy cores. Treatment options include active surveillance for low risk prostate cancer with potential delayed treatment if cancer progresses. Radical prostatectomy is the gold standard for localized prostate cancer and provides the possibility of cure with minimal side effects when performed by an experienced surgeon. While providing excellent cancer control, radical prostatectomy carries risks of erectile dysfunction and urinary incontinence.
Basic information for discussion with a healthcare professional is provided here together with some background:
• An enlargement or the presence of tumors in the gland below a man’s bladder that produces fluid for semen ie, the prostate, may suggest benign prostatic hyperplasia (BPH) or prostate cancer
o Almost 8% of new cancer cases worldwide are attributed to this highly curable disease (proportion of patients surviving after 5 years = 98.9%)
o In the USA alone, prostate cancer is the most common non-skin cancer, diagnosed more often in African-American (1 in 5 cases) than white men (1 in 6 cases)
o Prostate cancer is strongly correlated with age, starting at about 50 years old and rising over the ensuing decades
o While debates over under- or over-treatment of prostate cancer continue, it is clear that management of the disease costs the USA an aggregate annual loss in productivity of $3.0 billion
o Moreover, prostate cancer is the third-leading cause of cancer-related deaths in the USA, mainly due to advanced or metastatic disease
This document provides an overview and updates on prostate cancer pharmacotherapies. It discusses the anatomy and physiology of the prostate, risk factors for prostate cancer like diet and genetics, screening methods including PSA tests and digital rectal exams, diagnostic workup involving imaging and biopsies, tumor staging using Gleason scores and TNM classification, and treatment strategies at different stages including radiation, surgery, and hormone therapies. Controversies around PSA screening and increasing legal risks for failure to diagnose are also reviewed.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
Prostate cancer is a carcinoma of the prostate gland that may spread to other parts of the body like bones and lymph nodes. It begins as small clumps of cancerous cells within the prostate that multiply and spread over time. Risk factors include age, family history, obesity, lower vitamin D levels, and elevated testosterone. Symptoms can include issues with urination or pain. Imaging tests like CT, MRI, ultrasound, and bone scans are used to detect prostate cancer and check for metastasis. A prostate biopsy removes tissue samples to examine for cancer cells under a microscope in order to determine diagnosis and appropriate treatment.
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.
Modelling your way out of the poo: predicting the impact of early diagnosis o...David Halsall
Diagnosing and treating cancer cost £6bn per year, a disease that will affect one in three of us during our lifetime. Despite year-on-year improvements in cancer treatment the UK still trails other OECD counties for cancer outcomes. Better prevention, screening and early detection were identified in the 2011 NHS Cancer Outcome Strategy as ways to reduce the growth in incidence of cancer and improve one and five year survival. from diagnosis. Bowel cancer detection and treatment has improved but still lags when compared with other developed nations. A major program of bowel cancer screening has been rolled out in England with the aim of detecting and removing pre-cancerous polyps. A national advertising campaign has been used to raise awareness of cancer symptoms to encourage patients not to delay in contacting their doctor when they have “blood in their poo”. A hybrid model has been developed to link through from the early patient behavioural aspects of cancer detection through to outcomes. The hybrid approaches uses a discrete event simulation to represent the pre-cancerous stages through to initial contact points with the NHS and then onto to diagnosis and staging by the multi multidisciplinary teams (MDT). From the stage of diagnosis a probabilistic pathways model was used to predict annual costs and mortality for up to 10 years after initial diagnosis. This approach permitted developing a total lifetime cost measure for patients with a cancer diagnosis and the ability to test out how this might change with different policy options. Early modeling results have assisted the better understanding of the medium and long term implications of policies on bowel cancer and have helped set priorities to improve outcomes
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.
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 about prostate cancer, including:
- It is a cancer that occurs in the prostate gland and is one of the most common cancers in men. While some types grow slowly, others can spread quickly.
- Risk factors include age, family history, and race. Many times it causes no symptoms but can sometimes cause urinary or sexual issues.
- Diagnosis involves exams, blood tests, and biopsies. Treatment depends on stage but can include surgery, radiation, hormone therapy, chemotherapy, and active surveillance. Complications may include incontinence and erectile dysfunction. Prevention focuses on diet, exercise, and weight control.
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 document discusses prostate cancer including anatomy, staging, Gleason scoring, treatment options, and side effects. It covers imaging like CT and MRI scans to visualize the prostate and surrounding structures. Radiation treatments like IMRT, Tomotherapy, Cyberknife and seed implants are described in detail, noting their ability to precisely target the prostate gland and avoid nearby organs to minimize side effects. Typical radiation protocols are provided for low and higher risk prostate cancer cases.
Carcinoma of the prostate (CaP) is the most common cancer in American men and the second leading cause of cancer death. Most cases originate in the peripheral zone of the prostate. Risk factors include increasing age, African American race, family history, and high dietary fat intake. CaP is typically an adenocarcinoma and is graded using the Gleason system. Local spread can occur through the seminal vesicles, bladder, and rectum. Distant spread is usually to bones, lymph nodes, and lungs. Treatment depends on grade and stage, and may include surgery, radiation therapy, hormone therapy, or watchful waiting.
This document provides an overview of prostate cancer, including who is affected, risk factors, detection methods like PSA testing and biopsy, staging using the Gleason score and TNM system, and treatment options like surgery, radiation therapy, active surveillance, and androgen blockade. It discusses outcomes for different treatments and challenges in managing prostate cancer recurrence after initial therapy.
The document discusses prostate cancer and benign prostatic hyperplasia (BPH). It covers the incidence, risk factors, pathology, clinical findings, diagnosis and evaluations, as well as treatments for both conditions. For prostate cancer, it addresses staging and grading. It describes treatments for localized disease and recurrent disease after treatment. For BPH, it discusses symptoms, signs, tests, differential diagnosis, and medical and surgical treatment options.
Why are some men at greater risk for prostate cancer?Marc Laniado
Age is the most important risk factor for prostate cancer. Having relatives with prostate or breast cancer increases risk. Certain rare genes like BRCA2 can raise the risk of important prostate cancer by 7 times. Black men are more likely to get prostate cancer than Asian men. A healthy diet and exercise can help reduce the risk of prostate cancer.
Medical management of prostate cancer can include active surveillance, radiation therapy, surgery, hormone therapy, and chemotherapy depending on the cancer's risk level and stage. Investigations may involve PSA testing, biopsy, imaging, and disease staging. Androgen deprivation therapy is an important treatment option and can be accomplished through surgical or chemical castration. Docetaxel and cabazitaxel chemotherapy may provide benefits for advanced or metastatic disease.
Prostate Cancer: Causes, Diagnosis, and Treatment Options Bruce B ... Prost...MedicineAndHealthCancer
Prostate cancer is one of the most common cancers in men. Treatment options include non-curative therapies like hormone therapy or potentially curative therapies like radical prostatectomy, radiation therapy, and cryoablation. Cryoablation, also known as cryotherapy, involves using argon gas to freeze and destroy the prostate tissue with probes inserted through the skin between the scrotum and rectum under ultrasound guidance. It aims to kill all cancer cells while sparing nearby nerves to reduce side effects like erectile dysfunction and incontinence compared to other treatments. Studies show 89% of men treated with cryoablation were cancer-free after 7 years with low risks of complications.
1) Prostate cancer screening is controversial because while screening can reduce prostate cancer mortality, it also leads to overdiagnosis and overtreatment of indolent cancers.
2) The PSA test is an imperfect screening test that does not perfectly predict who needs a biopsy or aggressive treatment. Newer tests may help better identify high-risk cancers.
3) Most prostate cancers grow slowly and will not cause harm. Screening identifies many localized or regional cancers with nearly 100% 5-year survival rates.
Management of prostate cancer involves assessing risk levels based on PSA, Gleason score, and percentage of positive biopsy cores. Treatment options include active surveillance for low risk prostate cancer with potential delayed treatment if cancer progresses. Radical prostatectomy is the gold standard for localized prostate cancer and provides the possibility of cure with minimal side effects when performed by an experienced surgeon. While providing excellent cancer control, radical prostatectomy carries risks of erectile dysfunction and urinary incontinence.
Basic information for discussion with a healthcare professional is provided here together with some background:
• An enlargement or the presence of tumors in the gland below a man’s bladder that produces fluid for semen ie, the prostate, may suggest benign prostatic hyperplasia (BPH) or prostate cancer
o Almost 8% of new cancer cases worldwide are attributed to this highly curable disease (proportion of patients surviving after 5 years = 98.9%)
o In the USA alone, prostate cancer is the most common non-skin cancer, diagnosed more often in African-American (1 in 5 cases) than white men (1 in 6 cases)
o Prostate cancer is strongly correlated with age, starting at about 50 years old and rising over the ensuing decades
o While debates over under- or over-treatment of prostate cancer continue, it is clear that management of the disease costs the USA an aggregate annual loss in productivity of $3.0 billion
o Moreover, prostate cancer is the third-leading cause of cancer-related deaths in the USA, mainly due to advanced or metastatic disease
This document provides an overview and updates on prostate cancer pharmacotherapies. It discusses the anatomy and physiology of the prostate, risk factors for prostate cancer like diet and genetics, screening methods including PSA tests and digital rectal exams, diagnostic workup involving imaging and biopsies, tumor staging using Gleason scores and TNM classification, and treatment strategies at different stages including radiation, surgery, and hormone therapies. Controversies around PSA screening and increasing legal risks for failure to diagnose are also reviewed.
Screening for prostate cancer remains controversial due to the high risk of overdiagnosis and overtreatment. While screening can find early-stage cancers, most prostate cancers grow slowly and will not cause harm. Screening often leads to unnecessary biopsies, treatments and side effects like impotence and incontinence without clear benefits. Younger, low-risk men are unlikely to benefit from PSA screening, while older men or those at higher risk may benefit if screening finds aggressive cancers early. Active surveillance is often preferred over immediate treatment for low-risk prostate cancers found by screening. Overall, more research is still needed to determine which men would benefit most from prostate cancer screening.
Prostate cancer is a carcinoma of the prostate gland that may spread to other parts of the body like bones and lymph nodes. It begins as small clumps of cancerous cells within the prostate that multiply and spread over time. Risk factors include age, family history, obesity, lower vitamin D levels, and elevated testosterone. Symptoms can include issues with urination or pain. Imaging tests like CT, MRI, ultrasound, and bone scans are used to detect prostate cancer and check for metastasis. A prostate biopsy removes tissue samples to examine for cancer cells under a microscope in order to determine diagnosis and appropriate treatment.
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.
Modelling your way out of the poo: predicting the impact of early diagnosis o...David Halsall
Diagnosing and treating cancer cost £6bn per year, a disease that will affect one in three of us during our lifetime. Despite year-on-year improvements in cancer treatment the UK still trails other OECD counties for cancer outcomes. Better prevention, screening and early detection were identified in the 2011 NHS Cancer Outcome Strategy as ways to reduce the growth in incidence of cancer and improve one and five year survival. from diagnosis. Bowel cancer detection and treatment has improved but still lags when compared with other developed nations. A major program of bowel cancer screening has been rolled out in England with the aim of detecting and removing pre-cancerous polyps. A national advertising campaign has been used to raise awareness of cancer symptoms to encourage patients not to delay in contacting their doctor when they have “blood in their poo”. A hybrid model has been developed to link through from the early patient behavioural aspects of cancer detection through to outcomes. The hybrid approaches uses a discrete event simulation to represent the pre-cancerous stages through to initial contact points with the NHS and then onto to diagnosis and staging by the multi multidisciplinary teams (MDT). From the stage of diagnosis a probabilistic pathways model was used to predict annual costs and mortality for up to 10 years after initial diagnosis. This approach permitted developing a total lifetime cost measure for patients with a cancer diagnosis and the ability to test out how this might change with different policy options. Early modeling results have assisted the better understanding of the medium and long term implications of policies on bowel cancer and have helped set priorities to improve outcomes
This document discusses the histopathological evaluation of prostate needle biopsies. It begins by covering normal prostate histology, including the components and cell types present. Variations of normal tissue are then reviewed. Key features that indicate prostate cancer are described, such as mucinous fibroplasia, glomerulation, and perineural invasion. Architectural patterns commonly seen in cancer, like infiltrative growth and cribriform structures, are also outlined. The document provides guidance on distinguishing between benign and malignant findings in prostate biopsies.
This document provides an overview of abdominal anatomy and pathologies. It discusses the locations of key organs like the liver, gallbladder, and pancreas. It also summarizes common conditions that affect these organs like gallbladder issues, pancreatitis, and hernias. The document further discusses pelvic anatomy and related pathologies for both male and female reproductive systems. It provides summaries of prostate and testicular conditions as well as abnormalities related to sexual differentiation.
The presentation briefly describe details regarding different types of cancers prevalance in Pakistan and the opportunity this country offer in Cancer Research Projects by the availability of mostly chemo naive cancer patients
Surgical (or Non-Surgical) Managment of Thyroid Cancer in the Era of "Over-Di...OSUCCC - James
This document discusses the rising rates of thyroid cancer diagnosis and treatment in the United States, and strategies to address the issue of potential over-diagnosis and over-treatment. It notes that while new thyroid cancer cases have tripled in recent decades, mortality rates have remained stable, suggesting many of these additional diagnoses are indolent cancers that do not require aggressive treatment. The document advocates for more conservative surgical management and observation for small, low-risk cancers. It also proposes renaming some indolent cancers and limiting unnecessary imaging to help reduce over-treatment. While these approaches could help address the problem of over-diagnosis, challenges remain in differentiating cancers requiring treatment from those that can be safely observed.
This document describes transrectal ultrasound (TRUS)-guided prostate biopsy techniques. It begins with background on the anatomy of the prostate and ultrasonographic imaging. TRUS-guided biopsy is considered the mainstay for prostate cancer detection and involves using a biopsy gun to obtain core samples under ultrasound guidance. Various biopsy schemes are described, including the original sextant technique and more extensive schemes involving additional cores. Factors such as patient preparation, anesthesia, and antibiotic prophylaxis for biopsies are also outlined. The document provides an overview of TRUS-guided prostate biopsy procedures and technical considerations.
El documento describe la anatomía y el desarrollo embriológico de la próstata, así como su localización y función. Explica que la próstata se compone de tejido glandular y no glandular, y describe las diferentes zonas glandulares. También cubre el cáncer de próstata, incluida su patogenia, epidemiología, tipos, clasificación, factores de riesgo, síntomas y métodos de diagnóstico como el tacto rectal y las pruebas de PSA.
El documento describe la anatomía y ecografía de la próstata, así como la biopsia prostática. Resume que la próstata se divide en cinco zonas y que el ultrasonido transrectal es el estudio de imagen más común para evaluarla. Explica que las biopsias prostáticas se usan para diagnosticar cáncer de próstata y que existen diferentes técnicas como la biopsia en sextantes o por saturación para obtener muestras.
This document discusses prostate cancer awareness and provides information about prevention, symptoms, treatment options and stages. It notes that prostate cancer is the second leading cause of cancer death in American men and that early detection is vital for survival. It describes exams like the digital rectal exam and PSA testing that are used to detect prostate cancer early before symptoms appear. If cancer is found, it explains treatment options depending on the stage, like watchful waiting, surgery, radiation and hormone therapy. It stresses the importance of education and consulting doctors to make informed healthcare decisions.
Benign prostatic hyperplasia - symptomes and treatmentAreej Abu Hanieh
BPH, or benign prostatic hyperplasia, is a non-cancerous enlargement of the prostate gland caused by changes in hormone balance and cell growth as men age. It occurs when the prostate blocks part of the urethra, causing problems with urination. Symptoms range from mild to serious and include frequent, urgent, and interrupted urination. Diagnosis involves exams, tests to check urine and rule out infection or cancer. Treatment options include lifestyle changes, medications like alpha-blockers to relax the prostate or 5-alpha-reductase inhibitors to shrink the prostate, and surgery for severe cases. While not cancer, left untreated BPH can damage the kidneys.
Este documento describe el cáncer de próstata, incluyendo su localización, epidemiología, factores de riesgo, genes de susceptibilidad, factores ambientales, clasificación, estadificación, cuadro clínico, diagnóstico, tratamiento y manejo dependiendo del riesgo. El cáncer de próstata se localiza principalmente en la zona periférica y tiene altos índices en países desarrollados. Los factores de riesgo incluyen la edad, raza y factores hereditarios. El tratamiento depende del riesgo
Este documento trata sobre la anatomía y el cáncer de próstata. Resume la estructura de la próstata, los factores de riesgo para el cáncer de próstata como la edad y la raza, y los métodos de diagnóstico como el examen rectal, el PSA y la biopsia. También cubre la clasificación del cáncer de próstata y las opciones de tratamiento para el cáncer localizado y avanzado como la cirugía, radioterapia y terapia hormonal.
The document discusses prostate cancer including its anatomy, epidemiology, diagnosis, staging, treatment and outcomes. Key points include:
- Prostate cancer is the most commonly diagnosed cancer in men. Risk factors include age, family history, and ethnicity. Screening includes PSA testing and biopsy.
- Treatment depends on risk classification based on PSA, Gleason score, and stage. Options include active surveillance, surgery, radiation therapy and hormone therapy.
- Studies show dose escalation radiation therapy and use of IMRT/3D conformal radiation improve biochemical control rates with acceptable toxicity compared to conventional radiation. Adjuvant hormone therapy with radiation improves outcomes for intermediate-high risk disease.
Este documento describe la anatomía y función de la próstata, factores de riesgo para el cáncer de próstata, diagnóstico y detección del cáncer de próstata. Explica que el cáncer de próstata es un problema importante de salud pública en México y la segunda causa de cáncer más común en hombres. Detalla exámenes como el tacto rectal y los niveles de PSA que son importantes para la detección temprana de este cáncer.
This document summarizes statistics on prostate cancer incidence and mortality rates in the United States from 1975 to 2009. It also discusses results from several major clinical trials comparing prostate cancer screening to no screening, and radical prostatectomy to observation for localized prostate cancer. The key findings are:
1) Prostate cancer incidence peaked in 1992 but mortality rates have been declining since the 1990s.
2) Large screening trials show screening increases prostate cancer diagnosis but does not reliably decrease prostate cancer mortality.
3) The PIVOT trial found that among men with localized prostate cancer, radical prostatectomy resulted in a 2.9% lower rate of death from any cause and a 2.6% lower rate of death from prostate
This document discusses breast cancer and cervical cancer in India. It covers the problem statement of these cancers worldwide and in India, risk factors like age, family history, hormones, and HPV virus. It also discusses prevention through screening, hygiene, and treating pre-cancerous lesions early. The key aspects are that breast cancer is a leading cause of death in women and cervical cancer is most common in India, both have increased risks due to certain genetic and lifestyle factors, and prevention focuses on screening, education, and treating early-stage cancers.
The document provides an overview of cancer including its causes, risk factors, types, detection, and treatment. It discusses that cancer is characterized by uncontrolled cell growth and can be benign or malignant tumors. The top causes of cancer deaths in the US are lung cancer for men and breast cancer for women. Risk factors include smoking, diet, genetics, viruses, chemicals, and radiation exposure. Detection methods include exams, biopsies, and scans. Treatments involve surgery, chemotherapy, and immunotherapy.
The document discusses prostate cancer facts that men over 40 should know. It explains that prostate cancer is the most common non-skin cancer in American men and the second leading cause of cancer death. While symptoms may not always be present, early detection through annual PSA tests and digital rectal exams starting at age 40 or age 45 for those with risk factors can help find prostate cancer early and increase chances of survival. The document provides information on risk factors like age, race, family history and diet to help men understand their risk and need for screening.
This document provides information about prostate cancer including:
1) It discusses what the prostate gland is and risk factors for prostate cancer such as age, family history, diet, and race. African American men and those with a family history have a higher risk.
2) Early detection through annual PSA tests and digital rectal exams starting at age 40 is key, as having cancer detected early dramatically improves survival rates.
3) It recommends seeing a doctor annually for PSA tests and rectal exams to screen for prostate cancer and catch it as early as possible to improve treatment options. Knowing individual PSA levels allows men to monitor their prostate health over time.
This document discusses prostate cancer and provides information on screening and treatment. It begins by defining the prostate gland and prostate cancer. It then notes that prostate cancer is very common in Nigeria, being the most common cancer in men, and usually presents at a late stage. Screening involves PSA testing and digital rectal exams starting at age 40. If cancer is detected, treatment options depend on the stage and include surgery, radiation, hormone therapy and chemotherapy. Adopting a healthy lifestyle through diet and exercise may help prevent prostate cancer.
The PSA test measures levels of prostate-specific antigen in the blood to screen for prostate cancer. High PSA levels could indicate prostate cancer but can also be caused by other prostate conditions. There is conflicting advice about PSA testing and whether a man should get tested depends on discussing risks and benefits with their doctor. In addition to a PSA test, doctors may perform a digital rectal exam to check the prostate for abnormalities. The US Preventive Services Task Force currently recommends against PSA screening because many men are harmed by overtreatment while few benefit, as better tests and treatments are still needed.
New study confirms psa screening saves livesRebecca Sage
A new study confirms that PSA screening saves lives by showing a 21% overall survival advantage for prostate cancer and a 38% advantage for those screened for more than 10 years. However, the USPSTF recently recommended against routine PSA screening based on flawed studies. The updated data from the ERSPC highlights problems with the USPSTF process, which lacks transparency and oversight. Ultimately, the decision about prostate cancer screening and treatment should remain between patients and their doctors.
This document discusses cancer screening for seniors and whether it makes sense. It notes that reasons not to screen everyone include costs, potential harms from false positives or procedures, and factors related to life expectancy and health status. It provides examples of famous people who died of pancreatic cancer and notes that screening for pancreatic cancer is not recommended. It asks questions about the most common cancers, typical cancer ages, beneficial screening tests, and best screening advice. It discusses stopping screening at age 75 but continuing for those expected to live 10 more years. It provides resources on cancer screening guidelines.
Mon 8-00 Prostate Cancer Screening in the Post-USPSTF Era_0.pptxRonitEnterprises
This document discusses prostate cancer screening and recommendations. It begins with a case presentation of a 54-year-old man before discussing the US Preventive Services Task Force recommendations against PSA screening. It then reviews the goals of cancer screening, basics of PSA testing and prostate cancer, impact of the Task Force, and ways to improve screening through risk stratification using newer biomarkers, imaging, and genetic profiling to avoid overdiagnosis while identifying high-risk cancers.
Prostate cancer screening and early detection is an ongoing area of research and debate. While screening can detect prostate cancer earlier when it may be more treatable, it also leads to overdiagnosis and overtreatment. Several large clinical trials have had conflicting results on the benefits of prostate cancer screening. Guidelines from organizations also vary in their recommendations for screening. New biomarkers and imaging techniques are being studied to improve screening specificity and reduce unnecessary biopsies and treatment. Overall, the effectiveness of prostate cancer screening remains uncertain, and any decision to be screened requires informed discussion of risks and benefits.
This November, the Cancer Association of South Africa (CANSA) calls on men to be responsible for their health and to take advantage of cancer screening available at CANSA Care Centres. The five leading cancers affecting men * according to the 2016 National Cancer Registry (NCR) are prostate, colorectal, lung, non-Hodgkin’s lymphoma and bladder cancer. #CANSAscreening #MensHealth
https://cansa.org.za/mens-health/
This document summarizes a presentation given by Dr. Raphael Nyarkotey Obu on prostate cancer and the church's role in fighting the disease in Ghana. It discusses the anatomy and function of the prostate gland, risk factors for prostate cancer like aging and family history, symptoms of prostate cancer, screening and treatment options, prevention strategies like diet and exercise, and statistics on prostate cancer in Ghana. It also introduces Dr. Obu and his work founding the Men's Health Foundation of Ghana to increase awareness and screening for prostate cancer.
This document provides guidelines for regular health screenings and checkups for co-workers ages 40-64. It recommends screening for blood pressure, cholesterol, diabetes, colon cancer, dental/eye exams, immunizations, osteoporosis, physical exams, prostate cancer, and lung cancer. The guidelines aim to detect potential health issues early, encourage healthy habits, and help people stay well-informed about their health.
The document discusses the prostate gland and prostate cancer. It notes that prostate cancer is no longer just a disease of aging men, and young men in their 30s, 40s and 50s are now demonstrating prostate diseases. It provides information on the stages of the prostate gland throughout a man's life. Risk factors for prostate cancer mentioned include aging, family history, and race. The document discusses symptoms, screening options, treatment options and alternative treatments for prostate cancer. It also discusses causes of prostate cancer and preventive measures.
Week 6 DiscussionQuestion ARisk management is a matter of id.docxcockekeshia
Week 6 Discussion
Question A
Risk management is a matter of identifying the situations that could cause your project to fail. Common risks include loss of staff, decreased funding, decision point approvals not completed in a timely manner, and content not being available. Brainstorm three or four other risks that you have seen in your professional experience. If you are having trouble identifying projects, brainstorm with your classmates or contact your instructor.Once you have 3-4 risks, identify at least two ways to prevent each and two ways to resolve them, if they happen in spite of your preventions. Post your ideas.
Question B
How does the Work Breakdown Structure (WBS) help to minimize risks? How often should a risk analysis be conducted? Why are risks often overlooked?
1-Today I am going to talk to you about prostate cancer. The purpose of my presentation is to discuss the role of diagnostic imaging in prostate cancer patient. I will start my presentation by introducing the condition of the pathology, then I will mention the general symptoms, investigation staging and treatment of the condition. Then I will focus on the patient case study pathway. Finally, I will summarise my presentation and I will give you time for questions after the presentation.
2- Prostate cancer is a fatal disease that affects millions of men worldwide every year. Its clinical behavior ranges from low grade tumours that never develop to aggressive tumours those growths into metastases disease (Johnson et al, 2014). The cause of the disease has not been found, but several related risk factors have been known, such as genetics, age and diet. Prostate cancer is the highest prevalent non-skin malignant tumors diagnosis in male patients in the UK, accounting 24% of entirely new cancers. The main prospect of developing prostate cancer is related to advancing age, that has been seen diagnoses occurring in men over the age of 65 and is rare in those 40 years of age (Stephens et al, 2008)
3- prostate gland is a walnut' sized structure which located between the penis and the bladder and surrounds the urethra, just lies posteriorly to rectum. It has functional relation with urinary and reproductive systems and its main role is to produce the liquid part of semen. Prostate gland divided into three distinctive anatomic zonal components: the central zone, transitional zone and the peripheral zone which compromises 70% by volume (Tempany & Franco, 2012).
4- The preponderance of prostate cancers is adenocarcinomas that initially derived from the outer or peripheral zone of the prostate gland. In early stage, prostate cancer hardly shows symptoms and is mostly diagnosed by fortunate PSA test, but overtime patient may present to clinic with lower urinary tract symptoms such as: trouble starting urine, pain during urination, increased urgent of urination, poor stream, erection trouble so on (Wijesinha & Fridenberg, 2007)
5- The initial tests for diagnosing prostate cancer a.
Global Medical Cures™ | Prostate Cancer- TREATMENT CHOICES
DISCLAIMER-
Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
Cancer Awareness - Kaplan University Dept. of Public Healthsmtibor
Cancer awareness, including general definitions, detection, prevention, treatment, and risk factors. Emphasis on skin and prostate cancers and at-risk populations.
ROJoson PEP Talk: PROSTATE CANCER AWARENESSReynaldo Joson
This document outlines a prostate cancer awareness presentation titled "PROSTATE CANCER Awareness" given via Zoom on July 1, 2023 from 1400H to 1500H. The presentation aims to give laypeople an essential understanding of prostate cancer in managing their health. It covers topics like prostate cancer screening guidelines, diagnostic tests, treatment options, and prevention methods. The presenter requests feedback in the chat box and reminds participants to take an online test after for a certificate, with 50 certificates equivalent to a consultation voucher. The presentation concludes with a group photo before starting Q&A.
Similar to Prostate Cancer Testing & Surgical Options - By Peter J Gilling http://www.urobop.co.nz (19)
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. PN876703Rev.B7/13
What We Will Talk About Today
What is the prostate?
What is prostate cancer?
How common is it?
Risks & symptoms
Who should be screened, and why?
Questions to ask your doctor
Understanding your treatment & surgical options
3. PN876703Rev.B7/13
What Is The Prostate? What Does It Do?
Male sex gland
Adds the fluids to
carry sperm
The urethra (urine
channel/tube) runs
through the middle of
the prostate
Prostate
Rectum
Bladder
Urethra
Source: http://www.cancer.gov/cancertopics/wyntk/prostate/page2
4. PN876703Rev.B7/13
What Is Prostate Cancer?
Abnormal cells
growing out of control
Begins in the prostate
gland
Can spread and
invade tissues,
organs, and bones
Cancer
Cells
Source: Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; 14.
5. PN876703Rev.B7/13
How Common Is It?
How many men are affected by prostate cancer in
America?
A) 1 in 3 B) 1 in 6 C) 1 in 12 D) 1 in 24
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
2. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-key-statistics
QUICK FACT:1
Prostate cancer is the 2nd
leading cause of cancer
death in men.
Every 2.4 minutes, a man is newly diagnosed
Every 16 minutes, a man dies of prostate cancer
QUICK FACT:1
Prostate cancer is the 2nd
leading cause of cancer
death in men.
Every 2.4 minutes, a man is newly diagnosed
Every 16 minutes, a man dies of prostate cancer
Answer: B. about 1 in 6 men.1
(Compared to 1 in 8 women for breast cancer2
)
6. PN876703Rev.B7/13
Risk Factors For Prostate Cancer1,2
Age
More common in men age
40+
Family history
If your father, brother or
son have had prostate
cancer
Race
African-American men are more than twice as likely
to die from prostate cancer than Caucasian men.
MYTH: Prostate cancer is only
an old man’s disease.
NOT true!
FACT: Risk increases with
age, but men of ALL
ages should know
their personal risk
factors.
MYTH: Prostate cancer is only
an old man’s disease.
NOT true!
FACT: Risk increases with
age, but men of ALL
ages should know
their personal risk
factors.
1. http://www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm
2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-risk-factors
7. PN876703Rev.B7/13
Possible Symptoms Of Prostate Cancer
Trouble urinating
Weak urine flow
Frequent urination, especially
at night
Painful or burning urination
Blood in urine or semen
Pain in the back, hips or pelvis
that won’t go away
Painful ejaculation
MYTH: If you don’t have
symptoms, you don’t
have prostate
cancer.
Maybe.
FACT: Many men with
prostate cancer have
NO symptoms at all.
Your doctor is often
the first one to
detect signs of
prostate cancer
during a check-up.
MYTH: If you don’t have
symptoms, you don’t
have prostate
cancer.
Maybe.
FACT: Many men with
prostate cancer have
NO symptoms at all.
Your doctor is often
the first one to
detect signs of
prostate cancer
during a check-up.
Source: http://www.cdc.gov/cancer/prostate/basic_info/symptoms.htm
8. PN876703Rev.B7/13
Prostate Cancer Can Be Treated!
Early detection and improved treatments have
helped to save lives1,2
In fact, the chance of dying from prostate
cancer has been lowered by 50% since the 1990s
when the PSA test became widely used in the
U.S.2
2+ million men are living today in the U.S. after
being diagnosed with prostate cancer3
1. What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf 2. Information Sheet: Prostate-Specific Antigen (PSA) Testing For the Early Detection of
Prostate Cancer. American Urological Association. 2012. http://www.auanet.org/content/media/USPSTF_information_sheet.pdf 3. CDC. Cancer survivors –
United States, 2007. MMWR 2011:60(09):269-272.
10. PN876703Rev.B7/13
If You Don’t Have Symptoms, How Do You
Know If You Have Prostate Cancer?
PSA (Prostate
Specific Antigen)
Blood Test
DRE is a physical
rectal exam to
look for bumps
Prostate Cancer Tests
Source: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
Doctors use prostate cancer tests to determine if you are
likely to have prostate cancer.
The results provide valuable information.
11. PN876703Rev.B7/13
PSA Test – What Does It Tell?
PSA = prostate-specific antigen (A protein produced by the
prostate and released into the blood)
It does not diagnose (confirm) prostate cancer
Your doctor is usually watching out for either a high PSA
level or a sudden/sharp rise
Source: What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf
High PSA Level
May be
prostate cancer
May be benign
(not cancer)
Sudden/Sharp
Rise in PSA Level
Likely to be
prostate cancer
OR
12. PN876703Rev.B7/13
Are You Confused About Whether You
Should Have PSA Tests?
You may have heard confusing talks in the media about the PSA test
The choice depends on your personal situation (age, risk factors, and
symptoms, etc.) and should be discussed with your doctor
The American Urological Association (AUA)’s current recommendation
to doctors and patients1
:
“The AUA strongly supports that men be informed of the risks and
benefits of prostate cancer screening before biopsy and the option of
active surveillance in lieu of immediate treatment for certain men
newly diagnosed with prostate cancer.”
1. Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; p6.
13. PN876703Rev.B7/13
Points to Discuss with Your Doctor As You
Make Your Decision on Testing
Benefits of Current Tests
Can find prostate cancers
early when they are easier
to cure
Can track changes in the
prostate over time
PSA test and DRE are
currently the only widely
available tests to look for
prostate cancer
Risks of Current Tests
Unclear test results can
cause confusion and
anxiety
PSA test and DRE are not
100% accurate
Source: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
14. PN876703Rev.B7/13
What Happens Next if Your PSA Level Is
Above Normal?
Your doctor may order a biopsy1
Based on your PSA test or DRE results
And consider other factors like your family history,
race, age, overall health and past biopsy results
A biopsy is the only way to confirm a cancer
diagnosis1
Doctor uses a thin needle to remove small pieces of
tissue (usually 12 samples) to look for cancer cells
It has small risks of pain, infection, and bleeding2
1. What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012
http://www.auanet.org/content/media/PSA_fact_sheet.pdf 2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
15. PN876703Rev.B7/13
Biopsy and Grading1
Biopsy
To confirm diagnosis
Thin needle to remove small
pieces (typically 12 samples)
Gleason score (2-10)
To grade aggressiveness of
the cancer cells
Add the scores from 2 areas
with the most cancer cells
Example: Gleason 7 (3+4)
Least
Aggressive
Most
Aggressive
Grading: Gleason Score
1
2
3
4
5
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis
16. PN876703Rev.B7/13
Understanding The Biopsy Results
Your doctor will use the biopsy results to see:
If you have prostate cancer or not
If it is slow growing or aggressive (fast growing)
Depending on the results, your doctor may:
Tell you that you don’t have prostate cancer
Repeat the biopsy
Compare to past biopsy results, if you had them
Order a bone scan, CT or MRI to see if the prostate
cancer is only in the prostate or has spread
Source: http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis
17. PN876703Rev.B7/13
Bone Scan, CT and MRI - Staging1
May use bone scan, CT and MRI
T1, T2: localized
T3, T4: spreads outside the prostate
T1 T2
T3 T4
1. http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2
18. PN876703Rev.B7/13
If you find out that you have prostate
cancer…
Understand ALL
Your Treatment & Surgical Choices
…because you have options
19. PN876703Rev.B7/13
It Is YOUR Decision, You Are In Control
It is your personal choice, together with your doctor, to
decide whether to treat & how to treat prostate cancer
What’s right for one patient may not be right for YOU
Your doctor will support you seeking a second opinion to
verify and/or gain more information as you need
20. PN876703Rev.B7/13
Ask Your Doctor Lots Of Questions
1. Is my cancer only in the prostate or also outside of it? Is it slow- or
fast-growing?
2. What are all the ways prostate cancer can be treated?
3. What is the chance of a cure?
4. What are the pros and cons of each treatment?
5. How long will the treatment and recovery take?
6. Will the side effects happen to me soon, or much later? Will they
get better or worse with time?
7. How soon can I control my bladder?
8. How soon will I be able to have sex again?
9. What can doctors do if my prostate cancer returns or spreads?
10. How much experience do you have with these treatments?
21. PN876703Rev.B7/13
A Few More Important Things To Consider
Your overall health
Your age
Any other serious health conditions?
Expect to live another 10 years or more?
Your own feelings about each treatment
Is a cure more important to you than anything else?
Want to avoid the chance of getting another cancer?
What side effects can you live with? For how long?
22. PN876703Rev.B7/13
Treatment & Surgical Options For Localized
Prostate Cancer
Active
Surveillance
Surgery Radiation
Other
Treatments
What it
means to
you
Live with your
prostate cancer,
and be tested
regularly
The prostate
and cancer cells
will be removed
The cancer cells
may be killed
but not removed
The cancer cells
may be killed
but not
removed
How it’s
done
• PSA and DRE
every 3-6
months
• Biopsy once a
year
• Robotic-
assisted
(minimally
invasive, often
nerve-sparing)
• Traditional
laparoscopic
surgery
(minimally
invasive)
• Traditional
open surgery
• Brachytherapy
(radioactive
seeds inside
the prostate)
• External
Radiation
IMRT
IGRT
Other EBRT
• Hormone
therapy (often
used with
radiation)
• Cryotherapy
(freezes; often
as a secondary
treatment)
• Chemotherapy
(uses drugs)
23. PN876703Rev.B7/13
Active Surveillance
Pros
Usually a good choice if
expected to live <10 years
and/or the prostate cancer is
slow growing
No down-time (besides doctor
visits for tests)
Avoid possible side effects of
surgery, radiation or other
treatments
Medical advances may make
future treatment more tolerable
Cons
More likely to die from prostate
cancer within 10 years vs. surgery1
May miss the chance to treat the
cancer before it spreads outside
the prostate
Regular biopsies can increase
the likelihood of erectile
dysfunction2
May not tolerate treatment if
wait until older
More than 40% of prostate
cancers are actually faster
growing than graded3
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50 2. Helfand, BT, et al. BJU International. Epub 2012 May 28. 3. Barqawi AB, et al. Int J
Clin Exp Pathol. 2011 Jun 20;4(5):468-75.
24. PN876703Rev.B7/13
Radiation
External Beam
Uses computer and CT scan to
target radiation at the cancer
cells from outside the body
Daily visits, usually for up to 9
weeks
Some healthy tissue may be
affected
Brachytherapy
Uses small radioactive “seeds”
implanted with a needle
throughout the prostate
1 day outpatient visit, may
require general anesthesia
The seeds stay in the prostate
permanently
1. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-radiation-therapy
Side effects may be slow to appear with radiation therapy, and may
include erectile dysfunction, urinary problems, bowel and bladder
problems, scarring, and fatigue.
Side effects may be slow to appear with radiation therapy, and may
include erectile dysfunction, urinary problems, bowel and bladder
problems, scarring, and fatigue.
25. PN876703Rev.B7/13
Radiation
Pros
Good chance for a cure for
appropriate patients
No hospital stay
Few restrictions after
treatment, if any
May be used after surgery if
cancer has spread outside of the
prostate
Cons
More likely to die from prostate
cancer within 10 years vs. surgery1,2
Increased fatigue during long
treatment3
Urinary and bowel problems could
last for years, and sexual potency
tends to get worse over time4-6
More likely to have another cancer
- your prostate can move during
treatment and radiation can hit
nearby tissues7,8
Very difficult to treat if the prostate
cancer returns after radiation
3. http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page8#SE3 4. Sanda MG, et al. N Engl J Med. 2008 Mar 20;358(12):1250-61. 5. Zelefsky MJ, et al.
J Urol. 2006 Oct;176(4 Pt 1):1415-9. 6. Alicikus ZA, et al. Cancer. 2011 Apr 1;117(7):1429-37. 7. Bhojani N, et al. Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):342-8. 8.
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50.
2. Cooperberg MR, et al. Cancer. 2010 Nov 15;116(22): 5226–5234.
26. PN876703Rev.B7/13
Surgery (Prostatectomy)
Pros
Best chance for a cure for
localized prostate cancer1-3
Short treatment
Sexual potency is back within 1
year for most patients4,5,
*
Urinary function is back within
1-3 months for most patients4,5,
*
If the cancer returns, there are
several back-up treatments
Cons
Possible short term change in
sexual potency and bladder
control, but normally recover
over time4-6
A small chance of having major
complications7
Hospital stay required (length
of stay depends on the type of
surgery chosen)*
Catheter in place 1-2 weeks
1. Merglen A, et al. Arch Intern Med. 2007 Oct 8;167(18):1944-50. 2. American Urological Association. Guideline for the Management of Clinically Localized
Prostate Cancer: 2007 Update. Reviewed and validity confirmed 2011. 3. Cooperberg MR, et al. Cancer. 2010 Nov 15;116(22): 5226–5234. 4. Rocco B, et al.
BJU Int. 2009 Oct;104(7):991-5. 5. Ficarra V, et al. BJU Int. 2009 Aug;104(4):534-9. 6. Sanda MG, et al. N Engl J Med. 2008 Mar 20;358(12):1250-61. 7.
Carlsson S, et al. Urology. 2010 May;75(5):1092-7.
*Results from robotic-assisted surgery for most patients. Traditional open surgery leads to longer recovery time.
27. PN876703Rev.B7/13
Other Treatments
Pros
Could be a choice if you
cannot have surgery or radiation
May help to manage cancers
that have spread outside the
prostate
Cons
Much more likely to die from
prostate cancer within 10 years
with hormone therapy vs.
surgery or radiation
May have weakened bones,
vomiting, diarrhea, hair loss,
impotence, or leaking from the
bladder or rectum
1. Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators,
Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer.
2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456 2. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-
hormone-therapy 3. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-cryosurgery 4.
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-chemotherapy
28. PN876703Rev.B7/13
Another Look At Treatment & Surgical
Options
IndefiniteIndefinite
Tested regularly; if the cancers
gets worse, doctors may repeat
the tests and/or recommend
other treatments.
Patients continue to
have monitoring tests
such as PSA, DRE and
biopsies.
Patients are more likely
to die from prostate
cancer within 10 years
compared to being
treated with surgery.1
1-3 Days1-3 Days
Hospital stay for most patients;
usually return to work or normal
activities in 2-3 weeks.2-6
Most patients recover
their sexual and
urinary functions
within 1 year after
surgery.2,3
The chance of living 10+
years is the highest with
surgery.1,7
2 Months2 Months
Daily visits to a radiation center
for most patients (e.g. IMRT: 5
days a week for a total of 40
visits); usually able to work but
may have increased fatigue.
Many patients begin
to have sexual,
urinary, and/or bowel
problems 1 year after
radiation.8-10
Patients are more likely
to die from prostate
cancer within 10 years
than patients treated
with surgery.1,7
More patients are likely
to get another cancer
within 10 years.11,12
Treatment Period 1 Year Later 10 Years Later
ActiveActive
SurveillanceSurveillance
SurgerySurgery
RadiationRadiation
References: see notes section.
29. PN876703Rev.B7/13
100-Kattan Score predicting risk of cancer return
(combines PSA, stage and Gleason score)
Surgery
Radiation
Hormone
Predicted10-Year
Cancer-SpecificDeath10-Year Risk of Death: Lowest with Surgery1
1. Cooperberg, M. R., et al. Cancer, 116: 5226–5234. doi: 10.1002/cncr.25456
30. PN876703Rev.B7/13
If Considering Surgery…
Talk to your doctor to understand the benefits and risks
and whether you are a candidate
Talk to patients who had surgery 6-12 months ago
Why? They can share a lot more about what happened to them
long after the surgery than those who had it more recently
Find a surgeon experienced in the surgery that you want
to consider
4 out of 5 patients now choose da Vinci®
Surgery, a minimally
invasive robotic-assisted surgery, when they choose to have
surgery for prostate cancer1
Source: http://www.cancer.gov/ncicancerbulletin/080911/page4
31. PN876703Rev.B7/13
Open Surgery
Benefits1
Open surgery has been performed for prostate
cancer for over 100 years. It has potentially lower
risk of bowel injury and typically a shorter
procedure time than open or lap surgery.
Risks1
Hospital re-admission, vessel, nerve ureter or
bladder injury, deep vein thrombosis, and in rare
cases there is the risk of mortality during or shortly
after the procedure.
1
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary
surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol.
2012 Jul;62(1):1-15. Epub 2012 Feb 24
32. PN876703Rev.B7/13
Laparoscopic Surgery
Benefits1
Provides many of the benefits of minimally invasive
surgery vs. open surgery including lower blood loss,
risk of mortality, ureteral injury and deep vein
thrombosis.
Risks1
Hospital re-admission, vessel, nerve ureter or
bladder injury, deep vein thrombosis, and in rare
cases there is the risk of mortality during or shortly
after the procedure.
1
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary
surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol.
2012 Jul;62(1):1-15. Epub 2012 Feb 24
33. PN876703Rev.B7/13
da Vinci®
Surgery
Potential Benefits Compared to Traditional Open Surgery
More precise removal of cancerous tissue1,2,3,4
Ability to perform nerve sparring surgery which enables:
Faster return of erectile (sexual) function: Studies show
patients who are potent prior to da Vinci Surgery experience a
faster return of erectile function than previously potent
patients who have open surgery5,6
Better chance for return of urinary continence: Recent studies
show more patients with da Vinci Surgery have full return of
urinary continence within 6 months as compared to patients
having open surgery4,5,6
*See references at end of presentation
34. PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Potential Benefits Compared to Traditional Open Surgery
(Cont.)
Less blood loss1,4,5,6,7,8,9,10
Less need for a blood transfusion1,4,6,7,8,9,11
Less pain9
Lower risk of complications1,4,7,8,11
Lower risk of wound infection1,7
Shorter hospital stay1,4,5,6,8,12
Less chance of hospital readmission1
Less chance of needing follow-up surgery1
Fewer days with catheter5
Less risk of deep vein thrombosis (life-threatening condition where a
blood clot forms deep in the body)1
Faster recovery10
and return to normal activities12
*See references at end of presentation
da Vinci
Surgery
Incisions
Open Surgery
Incision
35. PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Potential Benefits Compared to Traditional Laparoscopy
More patients return to pre-surgery erectile function at 12-month
checkup,
Faster return of urinary continence14
Lower risk of complications1
Less blood loss and need for a transfusion1,8
Less chance of nerve injury1
Less chance of inuring the rectum1
Shorter operation8
Less risk of deep vein thrombosis (life-threatening condition where a
blood clot forms deep in the body)1
Shorter hospital stay1,8
Less chance of hospital readmission1
Less chance of needing follow-up surgery1
*See references at end of presentation
36. PN876703Rev.B7/13
da Vinci®
Surgery (Cont.)
Risks & Considerations Related to Prostatectomy & da Vinci
Surgery:
Potential risks of any prostatectomy procedure include:
Urinary and/or sexual dysfunction due to nerve damage
Rectal or bowel injury
Blocked artery in the lung
Blocked bowel
In addition, there are risks related to minimally invasive
surgery, including da Vinci Prostatectomy, such as hernia
(bulging tissue/organ) at incision site.1,11
*See references at end of presentation
37. PN876703Rev.B7/13
How is da Vinci®
Surgery Performed?
Surgeon controls the highly precise
instruments the entire time to:
View in 3D-HD with up to 10x
magnification
Remove the prostate & cancer
cells meticulously
Work around the important
nerves when indicated
da Vinci Surgery Operating Room
38. PN876703Rev.B7/13
Precision Matters: Better Cancer Control
with da Vinci Surgery
Cancer Control
T2 Positive Margin
Rate1
Open Surgery da Vinci®
Surgery .
1. Di Pierro GB, et al. Eur Urol. 2011 Jan;59(1):1-6. Epub 2010 Oct 21.
The lower
the positive
margins, the
better
39. PN876703Rev.B7/13
Precision Matters: Faster Return of Urinary
Continence with da Vinci Surgery
Continence Rates
at 3-Month1
Open
Surgery
da Vinci®
Surgery .
Continence Rates
at 12-Month1
Open
Surgery
da Vinci®
Surgery .
1. Rocco B, et al. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5. 12-month rate difference is statistically significant (P=0.014)
while 3-month rate-difference is not statistically significant (P=0.15)
Higher
is
better
40. PN876703Rev.B7/13
Precision Matters: Faster Return of
Sexual Function with da Vinci Surgery
Sexual
Function at 1-
Year1
Open
Surgery
da Vinci®
Surgery .
1. Ficarra V, et al. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5.
Higher
is
better
41. PN876703Rev.B7/13
Take Action
Know your personal risk factors and talk to your
family
Talk to your doctor about prostate cancer
screening
Discuss all treatment options with your doctor
Get a second opinion
Choose the option that’s right for YOU
44. PN876703Rev.B7/13
References – da Vinci Surgery Compared to
Traditional Open and Laparoscopic Surgery
1. Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates
of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic
prostatectomy. Eur Urol. 2012 Jul;62(1):1-15. Epub 2012 Feb 24
2. Weerakoon M, Sengupta S, Sethi K, Ischia J, Webb DR. Predictors of positive surgical margins at open and robot-assisted laparoscopic radical
prostatectomy: a single surgeon series. J Robotic Surg. 2011. http://dx.doi.org/10.1007/s11701-011-0313-4
3. Coronato EE, Harmon JD, Ginsberg PC, Harkaway RC, Singh K, Braitman L, Sloane BB, Jaffe JS. A multiinstitutional comparison of radical
retropubic prostatectomy, radical perineal prostatectomy, and robot-assisted laparoscopic prostatectomy for treatment of localized prostate
cancer. J Robotic Surg (2009) 3:175-178. DOI: 10.1007/s11701-009-0158-2.
4. Health Information and Quality Authority (HIQA), reporting to the Minister of Health-Ireland. Health technology assessment of robot-assisted
surgery in selected surgical procedures, 21 September 2011. http://www.hiqa.ie/system/files/HTA-robot-assisted-surgery.pdf
5. Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy
in a laparoscopically naive centre: a matchedpair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
6. Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-
assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5
7. Carlsson S, Nilsson AE, Schumacher MC, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical
prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7
8. Ho C, Tsakonas E, Tran K, Cimon K, Severn M, Mierzwinski-Urban M, Corcos J, Pautler S. Robot-Assisted Surgery Compared with Open Surgery
and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in
Health (CADTH); 2011 (Technology report no. 137).
9. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted
anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002 Nov;60(5):864-8
10. Miller J, Smith A, Kouba E, Wallen E, Pruthi RS. Prospective evaluation of short-term impact and recovery of health related quality of life in men
undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol. 2007 Sep;178(3 Pt 1):854-8;
discussion 859. Epub 2007 Jul 16
11. Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO,
Montorsi F, Menon M, Karakiewicz PI. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical
prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2012 Apr;61(4):679-85. Epub 2011 Dec 22
12. Hohwu L, Akre O, Pedersen KV, Jonsson M, Nielsen CV, Gustafsson O. Open retropubic prostatectomy versus robot-assisted laparoscopic
prostatectomy: A comparison of length of sick leave. Scand. J. Urol. Nephrol. Apr 7 2009:1-6.
13. Asimakopoulos AD, Pereira Fraga CT, Annino F, Pasqualetti P, Calado AA, Mugnier C. Randomized comparison between laparoscopic and robot-
assisted nerve-sparing radical prostatectomy. J Sex Med. 2011 May;8(5):1503-12. doi: 10.1111/j.1743-6109.2011.02215.x. Epub 2011 Feb 16.
14. Porpiglia F, Morra I, Lucci Chiarissi M, Manfredi M, Mele F, Grande S, Ragni F, Poggio M, Fiori C. Randomised Controlled Trial Comparing
Laparoscopic and Robot-assisted Radical Prostatectomy. Eur Urol. 2012 Jul 20. [Epub ahead of print]
15. National Cancer Institute. NCI Cancer Bulletin. Tracking the Rise of Robotic Surgery for Prostate Cancer. Aug. 9, 2011 Vol. 8/Number 16.
Available from: http://www.cancer.gov/ncicancerbulletin/080911/page4
Editor's Notes
Thank you for coming today to talk about prostate health
Today we will talk about what prostate cancer is, the risks and possible symptoms, who should be screened, and how it is diagnosed and treated. Today is all about arming everyone with knowledge, asking questions, and being able to make informed decisions!
Let’s start with the basics: What is the prostate? And what does it do?
As you can see from this diagram, the prostate is located directly below the bladder and surrounds the urethra, the tube that urine passes through. But in spite of its location, it’s not related to urination.
It’s actually a male sex gland, about the size of a walnut, that produces fluid that makes up part of the semen. The fluid is added to the sperm during ejaculation.
Source:
http://www.cancer.gov/cancertopics/wyntk/prostate/page2
Cancer is abnormal cells that have begun to grow out of control. Prostate cancer originates in the prostate gland.
In the U.S., 85% of prostate cancers are clinically localized, meaning that the cancer is isolated to the prostate gland and hasn’t spread to other parts of the body.1 Why are so many cases of prostate cancer localized? Because in developed nations like the U.S., routine screening results in early detection, before the cancer spreads.
1. Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; 14.
So, how common is it? How many men are affected by prostate cancer in the U.S.? What do you think?
The answer is B. Prostate cancer affects 1 in 6 men in the U.S., making it the most common non-skin cancer in America.1 Does it surprise you to know it is actually more common in men than breast cancer is in women?
Let’s talk about that for a moment. 1 in 6 men. Imagine that you’re at an football game. Assume that everyone in the crowd is male, say about 75,000 men. With the 1 in 6 odds, more than 12,000 of these fans would one day be diagnosed with prostate cancer.
Prostate cancer is the second leading cause of cancer death in American men.1
According to the American Cancer Society, an estimated 217,730 new cases of prostate cancer were diagnosed in 2010, and about 32,050 men died of prostate cancer. 1 That means there’s a new case every 2.4 minutes, and a man dies of prostate cancer every 16 minutes.
So, what should we do? It starts with being educated - know the risks for you specifically, and talk with your doctors about screening and treatment options.
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
2. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-key-statistics
Calculation:
There are 525,600 minutes in a year (365 days).
525,600 minutes / 217,730 new cases = 2.41399 minutes per new case
525,600 minutes / 32,050 deaths = 16.39938 minutes per death
Age is definitely a risk factor, as are family history and race. Let’s talk about age for a bit. Some people mistakenly think prostate cancer is only an old man’s disease. It is not true. While risk increases with age, men of all ages should know their personal risk factors, such as if their fathers and brothers have prostate cancer. Knowing your family history is important in determining your own risk, so talk to your father, brother and/or son.
African-American men have the highest rates of prostate cancer, and it is less common in Asian-American and Hispanic/Latino men.2 African-American men are also twice as likely as Caucasian men to die from the disease.2
References:
http://www.cdc.gov/cancer/prostate/basic_info/risk_factors.htm
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-risk-factors
Different people experience different symptoms for prostate cancer. Here are some symptoms of prostate cancer, however, some men do not experience any symptoms even though they have prostate cancer. On the other hand, not all of these symptoms indicate prostate cancer. There are benign conditions, such as benign prostate enlargement or benign prostatic hyperplasia (BPH) that may also require treatment. However, talk to your doctor if you notice any of these symptoms.
Source: http://www.cdc.gov/cancer/prostate/basic_info/symptoms.htm
References:
What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012 http://www.auanet.org/content/media/PSA_fact_sheet.pdf
Information Sheet: Prostate-Specific Antigen (PSA) Testing For the Early Detection of Prostate Cancer. American Urological Association. 2012. http://www.auanet.org/content/media/USPSTF_information_sheet.pdf
CDC. Cancer survivors – United States, 2007. MMWR 2011:60(09):269-272.
There are two routine tests used to look for prostate cancer, even when there are no symptoms.
One of the key screening tests is called a PSA. It’s a simple blood test that indicates the level of prostate-specific antigen, a protein produced by the prostate gland. Using this simple blood test, your doctor can see if there is a lot of PSA in the bloodstream, or just a little. A high PSA result alone isn’t a guarantee of cancer. What your doctor will be looking for – and what will raise a red flag – could include a sudden increase in your PSA score. By establishing a baseline, your doctor will be able to catch changes based on comparing your current stats to those of previous years.
The other test is DRE, or digital rectal exam, which is a physical exam to feel for abnormalities in the prostate.
A doctor may order a biopsy after evaluating the results from both tests, combined with your personal risk factors such as family history.
Source: http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
Source: What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012 http://www.auanet.org/content/media/PSA_fact_sheet.pdf
Reference:
Prostate-specific Antigen Best Practice Statement 2009 Update. American Urological Association Education and Research, Inc. 2009; p6.
References:
What Patients Should Know About Prostate Cancer Testing With the PSA Test. American Urological Association. 2012 http://www.auanet.org/content/media/PSA_fact_sheet.pdf
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-detection
A biopsy is ordered to confirm if cancer is present. Doctors use a thin needle to remove small pieces of cells from the prostate, typically taking 12 samples. These cells are then viewed under a microscope to check for cancer cells. The biopsy report will note: how many samples have cancerous cells; the type of cancerous cells that were found; and the location where the cells were found - either on the left or right side of the prostate.
The pathologist grades cancer aggressiveness, or how likely the cancer is to spread, often using Gleason Score. As you can see from the diagram above, the Grade 1 cells look fairly normal, consistent in shape and size. By the time you reach Grade 5, the cells look abnormal and irregular.
Then the 2 scores from two different areas with the most cancer cells are added together. For example, if the area with the most cancer cells is graded as a 3, and the second most cancerous area is a 4, you would add them together. 3 + 4 = 7. This is very important information to have when making treatment decisions.
1. http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-diagnosis
After diagnosis and grading, cancer is staged to see if it has spread to other parts of the body. This could involve tests such as bone scan, CT or MRI.
Stage 1 and stage 2 prostate cancers are localized within the prostate. They are low- to medium-risk cancers.
Stage 3 prostate cancer has begun to spread beyond the prostate, but only barely.
Stage 4 prostate cancer has spread beyond the prostate to the lymph nodes, bones or other organs.
The doctor will consider the Gleason score, measuring the cancer’s aggressiveness, plus the stage of the cancer to determine the best treatment for each patient’s specific cancer.
1. http://www.cancer.gov/cancertopics/pdq/treatment/prostate/Patient/page2
As we mentioned earlier, with active surveillance, it is about actively monitoring without actually treating it. Doctors may order screening tests every 3-6 months, and biopsies every 12 months. This may be recommended for men who have low grade prostate cancer and if they are expected to live less than 10 years.
There can still be side effects; repeated biopsies may increase the likelihood of erectile dysfunction.
References:
Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy C. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007 Oct 8;167(18):1944-50
Helfand, B. T., Glaser, A. P., Rimar, K., Zargaroff, S., Hedges, J., McGuire, B. B., Catalona, W. J. and McVary, K. T. Prostate cancer diagnosis is associated with an increased risk of erectile dysfunction after prostate biopsy. BJU International. Epub 2012 May 28. doi: 10.1111/j.1464-410X.2012.11268.x
Barqawi AB, Turcanu R, Gamito EJ, Lucia SM, O&apos;Donnell CI, Crawford ED, La Rosa DD, La Rosa FG. The value of second-opinion pathology diagnoses on prostate biopsies from patients referred for management of prostate cancer. Int J Clin Exp Pathol. 2011 Jun 20;4(5):468-75.
There are 2 main forms of radiation therapy used for prostate cancer.
The first is external beam radiation. A machine directs high-energy radiation at the affected cells, killing cancer cells by damaging their DNA. The beam is directed by a computer for precise delivery of the radiation. Treatments are typically only a few minutes long, but require visits to an outpatient center 5 days a week for up to 9 weeks.
Side effects from external radiation treatment may appear gradually. Patients can experience erectile dysfunction, urinary problems, bowel and bladder problems, scarring and fatigue that continues for some time after the treatment stops.
The second type of radiation treatment is brachytherapy. In brachytherapy, radiation is sealed in tiny pellets, or “seeds.” They are implanted in the affected area and left behind to give off radiation for a prescribed period of time. Brachytherapy is used in men with low-grade, slow-growing tumors. As with external beam radiation, side effects can be slow to develop. The most common are bowel problems or low-grade urinary problems, like frequent urination.
1. http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-radiation-therapy
References:
Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy C. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007 Oct 8;167(18):1944-50
Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators, Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456
http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you/page8#SE3
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61.
Zelefsky MJ, Chan H, Hunt M, Yamada Y, Shippy AM, Amols H. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol. 2006 Oct;176(4 Pt 1):1415-9.
Alicikus ZA, Yamada Y, Zhang Z, Pei X, Hunt M, Kollmeier M, Cox B, Zelefsky MJ. Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. Cancer. 2011 Apr 1;117(7):1429-37. doi: 10.1002/cncr.25467.
Bhojani N, Capitanio U, Suardi N, et al. The rate of secondary malignancies after radical prostatectomy versus external beam radiation therapy for localized prostate cancer: a population-based study on 17,845 patients. Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):342-8.
Zelefsky MJ, Housman DM, Pei X, et al. Incidence of Secondary Cancer Development After High-Dose Intensity-Modulated Radiotherapy and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):953-9. Epub 2011 Dec 13.
References:
Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy C. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007 Oct 8;167(18):1944-50
American Urological Association. Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update. Reviewed and validity confirmed 2011.
Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators, Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456
Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy in a laparoscopically naive centre: a matchedpair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5.
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61.
Carlsson S, Nilsson AE, Schumacher MC, et al. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7.
References:
Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators, Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-hormone-therapy
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-cryosurgery
http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-treating-chemotherapy
References:
Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy C. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007 Oct 8;167(18):1944-50
Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy in a laparoscopically naive centre: a matchedpair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5.
Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012 Jul;62(1):1-15. Epub 2012 Feb 24.
Miller J, Smith A, Kouba E, Wallen E, Pruthi RS. Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol. 2007 Sep;178(3 Pt 1):854-8; discussion 859.Epub 2007 Jul 16.
Hohwu L, Akre O, Pedersen KV, Jonsson M, Nielsen CV, Gustafsson O. Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave. Scand. J. Urol. Nephrol. Apr 7 2009:1-6.
Cooperberg, MR, Vickers, AJ, Broering, JM, Carroll, PR. and the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) Investigators, Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22): 5226–5234. doi: 10.1002/cncr.25456
Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008 Mar 20;358(12):1250-61.
Zelefsky MJ, Chan H, Hunt M, Yamada Y, Shippy AM, Amols H. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol. 2006 Oct;176(4 Pt 1):1415-9.
Alicikus ZA, Yamada Y, Zhang Z, Pei X, Hunt M, Kollmeier M, Cox B, Zelefsky MJ. Ten-year outcomes of high-dose, intensity-modulated radiotherapy for localized prostate cancer. Cancer. 2011 Apr 1;117(7):1429-37. doi: 10.1002/cncr.25467.
Bhojani N, Capitanio U, Suardi N, et al. The rate of secondary malignancies after radical prostatectomy versus external beam radiation therapy for localized prostate cancer: a population-based study on 17,845 patients. Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):342-8.
Zelefsky MJ, Housman DM, Pei X, et al. Incidence of Secondary Cancer Development After High-Dose Intensity-Modulated Radiotherapy and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):953-9. Epub 2011 Dec 13.
Let’s see another comparison, looking at 7,500 prostate cancer patients. Here, the graph shows the 10-year risk of death specifically because of prostate cancer. You can see here that surgery is a better option again, with the lowest death risk. In fact, relative to surgery, the cancer-specific death risk with radiation is more than 2 times higher, and with hormone treatment alone death risk is more than 4 times higher.1
P&lt;0.001
1. Cooperberg, M. R., Vickers, A. J., Broering, J. M., Carroll, P. R. and for the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) Investigators (2010), Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer, 116: 5226–5234. doi: 10.1002/cncr.25456
Let’s look at results from a few clinical studies. Here is a chart showing cancer control, comparing open surgery to da Vinci Surgery. Positive margins show how much cancer is on the edge of tissues removed. So, the lower the number, the better! da Vinci Surgery clearly gave the better results for cancer control.
P=0.0107
1. Di Pierro GB, Baumeister P, Stucki P, Beatrice J, Danuser H, Mattei A. A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre with a limited caseload. Eur Urol. 2011 Jan;59(1):1-6. Epub 2010 Oct 21.
What about urinary continence? That’s a big concern of patients with prostate cancer. da Vinci Surgery resulted in faster return of urinary function then open surgery.
3-month rate-difference is not statistically significant (P=0.15)
12-month rate difference is statistically significant (P=0.014).
The author stated: “For urinary continence, RARP provided a significantly better outcome than RRP in terms of return of continence, defined as no pad usage or at least one safety pad, at 3, 6 and 12 months (Table 2; P = 0.15, 0.011 and 0.014, respectively). The return of continence was significantly (P = 0.007) shorter in men undergoing RARP, with most of them becoming continent within the first 3 months after surgery.”
RARP = robotic-assisted radical prostatectomy
RRP = open retropubic RP
1. Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
Another big concern for men with prostate cancer is how a treatment option affects sexual function. Looking at this comparison of men who were competent prior to surgery, da Vinci Surgery led to a faster return of sexual function then open surgery.
P&lt;0.001
1. Ficarra V, Novara G, Fracalanza S, D’Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9. Epub 2009 Mar 5.