Prostate cancer – What you need to know! Miss Hazel Warburton FRCS (Urol), MD Consultant Urological Surgeon The prostate What is Prostate cancer? Incidence • ~37 000 cases diagnosed in the UK • ~215 000 men living in the UK with prostate cancer Mortality • ~10 100 deaths per year (12%) • 70% 5 year survival (95-98% 5 year survival for treated localised disease) Risk Factors • Age • Race • Family history Family History Relative Risk Absolute risk (%) None 1 8 Father or brother 2 15 Father or brother <60 years 3 20 Father and brother 4 30 Hereditary prostate cancer 5 35-45 Prevention • Little evidence • ??Lycopene, green tea, soya sauce, selenium and vitamin E, low saturated fats, finasteride Symptoms • Early disease – none or those of benign disease • Late disease – systemic symptoms, bone pain Diagnosis - DRE Diagnosis - PSA • • • • What is PSA? What is a normal PSA? What does an abnormal PSA mean? Does a normal PSA mean no cancer? PSA • What is PSA? PSA • What is a normal PSA? Age Range Normal PSA range (ng/ml) All ages <4.0 40-49 <2.5 50-59 <3.5 60-69 <4.5 >70 <6.5 PSA • What does an abnormal PSA mean? Causes of an Elevated PSA • Prostate Cancer • Age • BPH • Infection • Retention • Catheterisation/ Instrumentation • Prostate biopsy • Post Pelvic Radiotherapy • • Potential causes an Elevated PSA • Cycling • Prostate massage PSA • Does an normal PSA mean no cancer? PSA ng/ml Risk for prostate cancer 0.0 - 0.5 6.6% 0.6 – 1.0 10.1% 1.1 - 2.0 17.0% 2.1 – 3.0 23.9% 3.1 – 4.0 26.9% 50-66 year old Thompson IM et al: N Eng J Med 2004;350(22):2239-2246 Prostate Biopsy Diagnosis • Grading • Gleason grade Diagnosis • Staging • TNM Treatment – Localised Disease • Low risk • Intermediate risk • High Risk • Also an individual’s age, preference and other medical problems (life expectancy) Active surveillance • Very close monitoring and avoidance of the side effects of treatment until evidence of growth of the tumour • PSA every 3-4 months, rectal examination (ideally by a urologist) and repeat biopsy every 18 months to 2 years Surgery • Radical Prostatectomy Radiotherapy + hormones Brachytherapy Experiment procedures • HIFU • Cryotherapy Metastatic disease Metastatic disease Metastatic disease • First line GnRH analogues or orchidectomy • Second/Third line hormones (anti-androgens) • MAB • Steroids and chemotherapy • Trials • Palliative care Blue Skies 10km Run for Prostate Cancer Thank you • Any questions? PCA 3 • Urine test post prostatic massage • Prostate cancer gene 3 (66 fold greater expression in prostate cancer) • Most useful in men with a negative biopsy • Level >35 suggest cancer, available in some private clinics cost £300-£400 Abiraterone • Metastatic prostate cancer • CYP17 inhibitor, ablates androgens and oestrogen synthesis in tissue • Currently in phase III trials • Need to take in conjunction with high dose steroids The next Foundation Trust Health Seminar will take place on: Monday 11th April 2011 10.30-11.30 am in the Lecture Theatre , Education Centre, BVH The topic is: “A better tomorrow starts today – Making steps towards a healthier lifestyle.”