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Prostate cancer in new zealand

Prostate cancer in new zealand. LADUCA Group CPD. Who Develops Prostate Cancer ?. Michael Miliken (junk bond wizard) Arnold Palmer (golf master) Francois Mitterand (French president) Charles de Gaulle (vive le Quebec libre) Ayatollah Komeini (Ayatollah) Robert Dole (senior politician)

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Prostate cancer in new zealand

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  1. Prostate cancer in new zealand LADUCA Group CPD

  2. Who Develops Prostate Cancer? • Michael Miliken (junk bond wizard) • Arnold Palmer (golf master) • Francois Mitterand (French president) • Charles de Gaulle (vive le Quebec libre) • Ayatollah Komeini (Ayatollah) • Robert Dole (senior politician) • Rudolph Giuliani (mayor NYC) • Rupert Murdoch (media mogul) • Sir Alec Guinness (Obi-Wan Kenobi) • Sidney Poitier (actor) • Sean Connery (007) • Roger Moore (007) • Pierre Elliott Trudeau (Prime Minister) • Andy Grove (Intel corp) • Marv Levy (Buffalo Bills Head Coach) • Preston Manning (politician) • Linus Pauling (Nobel x 2) • Eddie Shack (‘clear the track’) • Charleton Heston (Moses) • Frank Zappa (musician)

  3. Prostate Cancer: New Zealand Statistics

  4. Prostate Cancer: Not The Only Cause Of Death In Men

  5. Prostate Cancer • What/where is the prostate? • Who is at risk? • Diagnosis • How aggressive is the cancer (grading) • How advanced is the cancer (staging) • What are the treatment options for localised and advanced prostate cancer • What is the outlook after treatment

  6. Prostate function • Majority of seminal fluid is prostatic in origin: average ejaculate volume= 2-5 mls; only 0.1-0.2 mls = sperm • “Nourishment and support” of sperm in the ejaculate • Provision of income for Urologists!

  7. Prostate Cancer Risk Factors • Beyond Your control: • Age • Testosterone • Race • Family history • Lifestyle • Geography • Diet

  8. Race and Nationality Mortality Rates Per 100,000

  9. Holistic Approaches to Prevention • Low-fat diet • Soy products • tomatoes • Nutritional supplements • Selenium, vitamin E • Lifestyle - exercise, BMI • Herbal preparations

  10. Early Diagnosis of Prostate Cancer Digital Rectal Examination (DRE) Diagnostic Triad Prostate Specific Antigen (PSA) Transrectal Ultrasound (TRUS) • symptoms not helpful

  11. Prostate Cancer: Diagnosis • Majority diagnosed on PSA (Prostate Specific Antigen) testing with nil symptoms and normal rectal examination • Presentation with urinary symptoms • Abnormal findings on rectal examination • Presentation with symptoms of advanced disease eg bone pain or fracture due to cancer spread to bone • Incidental diagnosis following prostate surgery

  12. Prostate Cancer: Urinary symptoms • “Blockage of the bladder”- poor flow, hesitancy, intermittency of flow, urgency retention of urine • “Irritation” of the bladder- frequency day/night, urgency, urge leakage • Kidney obstruction and kidney failure

  13. PSA (Prostate Specific Antigen) • Produced by both benign and malignant prostate disease – benign enlargement, prostate infection and prostate cancer • Not elevated by other cancers • ↑ levels with ↑ age: -age scale 40-50 2-2.5 50-60 2.5-3.5 60-70 3.5-5.0 70-80 5.0-7.0

  14. Prostate Cancer Screening Controversy The case for screening • The lengthy preclinical detectable phase of prostate cancer allows for early detection • Devastating effects of metastatic prostate cancer • Availability of convenient and inexpensive screening tests (DRE and PSA) • Treatments for early disease

  15. Prostate Cancer Screening Controversy The case against screening • Inconsistency in disease progression • High prevalence of asymptomatic disease • Does screening do more harm than good? • No evidence on benefits available from randomized clinical trials • Excess cost, morbidity and mortality from treatments

  16. PSA – Current Recommendations • American, Canadian Cancer Society - annual PSA&DRE men >50 (discuss) • AUA, CUA - annual PSA&DRE men >50 (discuss) • CTFPH (GPs), USPSTF - recommend against screening (grade D evidence) • This will not be resolved until results of PLCO and ER-SPC studies (?2009-10)

  17. Conclusions – PSA screening • Does PSA screening predict risk of Prostate Cancer? • Yes • Does PSA screening predict clinically significant prostate cancer? • Probably • Does PSA screening improve survival? • Only future studies can prove

  18. Prostate Cancer: Prostate Biopsy • Sample of prostate must be taken to confirm diagnosis: prostate biopsy • Day stay local anaesthetic/sedation procedure • Generally 12 cores taken from throughout the prostate • Risks bleeding infection pain retention

  19. Prostate Cancer • Diagnosed on prostate biopsy • Factors determining treatment: Cancer Grade- how aggressive is it? Cancer Stage- has it spread beyond the prostate PSA level General health issues Patient views

  20. Prostate Cancer Grade • Gleason Score: Pathologist determines from recognised patterns the aggressiveness of the disease • Gleason score: 6-10 • Gleason 6: favourable • Gleason 10: highly aggresive

  21. Prostate Cancer: Stage • Has the cancer extended outside of the prostate? Rectal examination findings X rays MRI pelvis bone scan chest xray

  22. Prostate Cancer: Treatment options Localised prostate cancer Prostate removal (radical prostatectomy) Radiation Treatment -external beam radiation -brachytherapy (radioactive seed implantation) Advanced prostate cancer Androgen deprivation treatment Chemotherapy Radiation/palliative measures

  23. Prostate Cancer: Radical Prostatectomy • Open surgery, Laparoscopic surgery, Robotic surgery • Works well if cancer confined within the prostate • Long term adverse effects incontinence impotence

  24. Prostate Cancer: External Beam Radiation Treatment • Long duration of treatment: 6-8 weeks after planning • Limited resource available • Long term adverse effects overactive bladder/bowel symptoms

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