This document discusses prostate cancer screening, diagnosis, staging, and treatment options. It covers PSA testing and digital rectal exams for screening. Biopsies and PSMA PET scans are used for diagnosis and staging. Risk stratification helps determine treatment, which may include radical prostatectomy, radiotherapy, hormone therapy drugs like abiraterone acetate and enzalutamide, chemotherapy like docetaxel, or bone-directed drugs for metastases. Complications of prostatectomy include blood transfusions, infections, incontinence, and erectile dysfunction. Radiotherapy and hormone therapies can cause side effects like fatigue, fluid retention, and liver enzyme changes.

1. PROSTATE CANCER
UPDATES
Dr. Rajib Bhattacharjee
MBBS, MD
Consultant Oncologist
# 9674446399

6. Screening

7. What is PSA (Prostate Specific
Antigen)?
• A Serine protease (enzyme)
found in the prostate
• Secreted by prostate
epithelial cells
• Found in ejaculate
• As diagnostic tool for:
– Screening
– Staging
– Prognostic indicator
– Surveillance

10. Free/Total PSA Ratio:
A Way to Improve Specificity
• Prostate cancer maybe associated with more protein-bound
PSA (less free PSA) than in BPH
– F/T ratio is lower in patients with prostate cancer
– Can improve test specificity
– Useful when total PSA in 4-10 ng/ml range

11. Digital Rectal Examination
– DRE (digital rectal exam)
has a 50% positive
predictive value
–DRE alone is not a
good screening
tool
– BUT it is an important
part of screening

12. Anatomy

13. 12 core TRUS guided Biopsy

16. PSMA PET CT Scan

17. Staging

18. Risk Stratification

19. Treatment Options Simplified

20. Radical Prostatectomy
Complications
•<10% risk of blood transfusion
•Wound infection
•Rectal injury (<1%)
•Urinary incontinence (~10%)
•Erectile dysfunction (variable but common)
•Anesthetic related

21. Radiotherapy

22. Metastatic Prostate Cancer

23. Androgen Mediated Carcinogenesis

28. Abiraterone Acetate
Side Effects
Dizziness
Fatigue
Fluctuations in BP
Fluid retention
Hypokalemia
Elevation of liver
enzymes

29. ABIRATERONE in hormone sensitive disease
LATITUDE Trial

30. DOCETAXEL in hormone sensitive disease
CHAARTED Trial

32. • Low volume disease
• <4 bone metastasis
• No visceral metastasis
Abiraterone
• High volume disease
• >4 bone metastasis
• Visceral metastasis
Docetaxel

36. ENZALUTAMIDE

39. Bone Directed Therapy
Zoledronic Acid
Denosumab