Beruflich Dokumente
Kultur Dokumente
Department of Surgery
University Teaching Hospital
5th year lecture
24th April 2015
Layout of Presentation
Introduction
Risk factors
Diagnosis
Grading
TNM classification
Imaging
Treatment
Questions
Introduction
Prostate cancer
Disease
Hormonal management
Most common malignancy in
elderly men
Second most common cause of
death in elderly men
Decreased risk
Race
Asian
Diet high in:
Plant Vitamin A
Isoflavonoids
Lycopenes
Selenium
Vitamin E
Prostate Cancer:
Diagnosis
Method of Detection
DRE
Localized 50% -
diagnosis1,2
60% at time of
PSA
of time
Diagnostic triad
TNM Classification
System (T)
TNM Classification
System
(N)
N+ Involvement
of regional lymph nodes
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastases
N1 Metastasis in a single regional lymph
node, <2
cm in greatest dimension
N2 Metastasis in a single regional lymph
node, >2
cm but not >5 in greatest
dimension, or multiple
regional lymph
nodes, none >5 cm in greatest
dimension
N3 Metastasis in regional lymph node >5 cm
in greatest dimension
TNM Classification
System
(M)
M+ Distant metastatic spread
MX Presence of distant metastases cannot
be assessed
M0 No distant metastasis
M1 Distant metastasis
M1a Involvement of nonregional lymph
nodes
M1b Involvement of bone(s)
M1c Involvement of other distant sites
Imaging Tests
Bone Scan
Low detection rate.
Provides additional information in patients
with skeletal symptoms.
Computed Tomography (CT)
Useful for staging in T4 disease.
Recommended in patients with Gleason score
of 8 to 10, clinical stage T3 or T4.
Radiography
Bone scan
Treatment Options
Watchful waiting
Therapies of curative intent
Radical prostatectomy
Retropubic
Perineal
Laparoscopic
Radiotherapy
Cryotherapy
Therapies of Curative
Intent
Radical prostatectomy
Retropubic
Perineal
Laparoscopic
Radiotherapy
External beam radiation
Brachytherapy
Cryotherapy
Radical Prostatectomy
Advantages
Primary treatment
Stage-
dependent
Disadvantages
Major operation
Erectile dysfunction
Incontinence
Bowel complications
Disadvantages
Erectile dysfunction
Chronic bowel
complications
Incontinence
Brachytherapy
Advantages
As effective as EBRT
or surgery
Disadvantages
Urinary voiding
symptoms
Erectile dysfunction
Rectal discomfort
Edema
Cryotherapy
Advantages
Short hospital stay
Relatively
noninvasive
Disadvantages
Erectile dysfunction
Urinary problems
(short-term)
Unknown long-term
effectiveness
Hormonal Therapy:
Current Treatment Options
Bilateral orchidectomy
LHRH-A
LHRH-A + antiandrogen (CAB)
Bilateral orchidectomy +
antiandrogen (CAB)
LHRH-A
Advantages
As effective as
bilateral
orchidectomy in
decreasing
testosterone levels
Administered every
1, 3, 4, or 12 months
Potentially reversible
Disadvantages
Hot flashes
Decreased libido
Erectile dysfunction
Management of Advanced
Prostate Cancer
Inhibit testosterone production
Surgical castration
Medical castration with an
LHRH-A
Block androgen receptor binding
Antiandrogen
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