Cancer of Prostate

 The prostate is a glandular organ of the male

reproductive system

 It is often described as the same size of a walnut,

normally about 3 cm long (slightly more than 1 inch); it
weighs about 30 g (1 ounce) and is located at the neck of
the bladder and in front of the rectum

 The prostate surrounds the urethra, which is a tubular

structure that carries the urine (produced by the kidney
and stored in the bladder)

 The main function of the prostate is to help in the

production of semen

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  Prostate Cancer is the second most common
cause of cancer and the sixth leading cause of
cancer death among men worldwide

 The worldwide burden is expected to grow to

1.7 million new cases and 499 000 new deaths
by 2030 simply due to the growth and aging of
the global population

 Usually grows slowly and initially remains

confined to the prostate gland, where it may
not cause serious harm

 However, some are aggressive and can spread

quickly

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  Age : 60% of cases of prostate cancer arise in men over 65 years of age
 Family history : Prostate cancer can run in families. Having a first degree relative with the
disease increases the risk 2 to 3 fold
 Race or ethnicity : More common in African-American men and Jamaican men of African
ancestry
 Nationality: Prostate cancer is more common in North America, Europe (especially
northwestern countries in Europe), the Caribbean, and Australia. It is less common in Asia,
Africa, and South and Central America. Multiple factors, such as diet and lifestyle, may account
for this
 Genetic factors : Mutations in a portion of the DNA called the BRCA2 gene can increase a man's
risk of getting prostate cancer
 Other factors : Diets high in red meats and fatty foods and low in fruits and vegetables appear
to be associated with a higher risk of developing Prostate Cancer
Obesity is also linked to a higher risk of the disease

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 Normal cells undergo transformation
Initially, small clumps of cancer cells remain
confined to otherwise normal prostate gland
Abnormal cells multiply & invade adjacent tissues
Formation of Tumor masses which increase in size
Invasion of remote organs via blood or lymphatics
Commonly metastasize to Bone & Lymph Nodes
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 Most common type of Prostate
Cancer is an Adenocarcinoma
 The most common non-
Adenocarcinoma is Transitional Cell
Carcinoma
 Other rare types include Small Cell
Carcinoma and Sarcoma of the
Prostate
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  The stages are :

 Stage 1 – the cancer is very small and completely within the prostate gland
 Stage 2 – the cancer is within the prostate gland, but is larger
 Stage 3 – the cancer has spread from the prostate and may have grown into the tubes that
carry semen
 Stage 4 – the cancer has spread into the lymph nodes or another part of the body,
including the bladder, rectum or bones; about 20-30% of cases are diagnosed at
this stage

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  During the early stages of prostate cancer there are usually no symptoms

 Mostly detected during a routine check up or blood test

 When symptoms do exist, they are usually one or more viz.:

 The patient urinates more often

 The patient gets up at night more often to urinate
 He may find it hard to start urinating

 He may find it hard to keep urinating once he has started

 There may be blood in the urine

 Urination might be painful

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  If the prostate cancer is advanced the
following symptoms are also possible:
 Bone pain, often in the spine (vertebrae),
pelvis, or ribs
 Leg weakness (if cancer has spread to the
spine and compressed the spinal cord)
 Urinary incontinence (if cancer has
spread to the spine and compressed the
spinal cord)
 Fecal incontinence (if cancer has spread
to the spine and compressed the spinal
cord)

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  Metastasis :
 The cancer can spread to other parts of the body through
-- the bloodstream or
-- the lymphatic system
 If the cancer spreads to the ureters, it may result in Kidney problem
 If the cancer spreads to the bones, there may be pain and fractures

 Incontinence : Prostate cancer itself or treatments can cause urinary incontinence

 Erectile dysfunction : due to the Prostate cancer or its treatment

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 The prognosis depend on the following :

 The stage of the cancer (level of PSA, Gleason score, grade of the tumor, how much of the
prostate is affected by the cancer, and whether the cancer has spread to other places in
the body)

 The patient’s age

 Whether the cancer has just been diagnosed or has recurred

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  Digital Rectal Examination
A digital rectal exam is an early, simple test to screen for Prostate cancer
It can catch the disease early, when it's most treatable

 Prostate-Specific Antigen Blood Test

When the results of this blood test are high, it may indicate cancer

 Prostate Ultrasound and Biopsy

Helps in confirming the diagnosis

 Cystoscopy
Cystoscopy measures the health of the urethra and bladder

 CT Scan
A procedure that makes a series of detailed pictures of areas inside the body, taken from
different angles. Used to check spread to the lymph nodes.

 MRIs
Used to examine the prostate and nearby lymph nodes, distinguishing between noncancerous
and cancerous areas

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  People with cancer should be cared for by a multidisciplinary team (MDT)
 This is a team of specialists who work together to provide the best care and treatment
 The team often consists of a specialist Oncosurgeon, an Oncologist (a radiotherapy and
chemotherapy specialist), a Radiologist, Pathologist.

 When deciding what treatment is best for the patient, doctors consider:
 the type and size of the cancer
 what grade it is
 patient’s general health
 whether the cancer has spread to other parts of your body

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  Tumors restricted to the Prostate gland only may be treated with
surgery to remove the tumor

 The following types of surgery are used:

 Radical prostatectomy : A surgical procedure to remove the Prostate, surrounding tissue
and seminal vesicles
 There are two types of radical prostatectomy, viz. ,
-- Retropubic Prostatectomy
-- Perineal Prostatectomy
 Robotic assisted Laproscopic Radical Prostatectomy : latest technique
 Transurethral resection of the prostate (TURP) :
-- This procedure is sometimes done to relieve symptoms caused by a tumor before other
cancer treatment is given
-- TURP may also be done in men whose tumor is in the prostate only and who cannot
undergo a Radical Prostatectomy
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  Hormone therapy is treatment to stop the body from producing the male hormone –
Testosterone
 Prostate cancer cells rely on testosterone to help them grow. Cutting off the supply of
hormones may cause cancer cells to die or to grow more slowly
 Used in men with advanced Prostate cancer to shrink the cancer and slow the growth of tumors
 In men with early-stage prostate cancer, hormone therapy may be used to shrink tumors before
radiation therapy. This can make it more likely that radiation therapy will be successful.
 Hormone therapy is sometimes used after surgery or radiation therapy to slow the growth of any
cancer cells left behind
 Side effects of hormone therapy may include erectile dysfunction, hot flushes, loss of bone mass,
and weight gain

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  Uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing
 There are different types of radiation therapy:
 External radiation therapy : uses a machine outside the body to send radiation toward the
cancer. The radiation beams are shaped to fit the tumor.
 Internal radiation therapy : uses a radioactive substance sealed in needles, seeds, wires, or
catheters that are placed directly into or near the cancer. The needles are removed after
the radioactive seeds are placed in the prostate.
 Alpha emitter radiation therapy : uses a radioactive substance to treat prostate cancer
that has spread to the bone
 The way the radiation therapy is given depends on the type and
stage of the cancer being treated.
 Men treated with radiation therapy for prostate cancer have an
increased risk of having Urinary Bladder and/or Gastrointestinal cancer.
 Radiation therapy can cause impotence and urinary problems.

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  Uses drugs to kill rapidly growing cells, including cancer cells
 Can be administered through a vein in of the arm, in pill form or both
 Indications -- Treatment option for men with prostate cancer that has spread to distant areas of
their bodies
-- Chemotherapy may also be an option for cancers that don't respond to hormone
therapy

 To treat advanced, recurrent prostate cancer

 This treatment takes some of the body’s own immune cells, genetically engineers them to fight
Prostate cancer, then injects the cells back into the body through a vein
 Very expensive and requires multiple visits for the treatment

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Thank you