Male reproductive cumulative

What is the most common malignancy in males in the United States?

Prostate cancer

Incidence of prostate cancer in men

1 in 8

Prostate cancer is ___ leading cause of cancer death in men

2nd

Incidence of prostate cancer ________ with age

Increases

Prostate cancer is 70% higher in ________ than in other races

Black men

Having a ________ with prostate cancer more than doubles a man’s risk of developing this disease

Father or brother

What genetic syndromes and mutations associated with prostate cancer?

BRCA1 and 2 mutations and Lynch syndrome

________ increase the risk of developing fatal prostate cancer

Obesity and smoking

Prognostic indicators for prostate cancer

Tumor stage and histologic differentiation

PSA (normal =1-4, abnormal >4)

Lymph node status

When to begin to discuss PSA screening with a health care provider

Age 50 — relatively healthy men at average risk

Age 45 — black men or if you have a close relative diagnosed before age 65

Age 40 — several close relatives diagnosed at early age and have BRCA mutation

Prostate cancer common clinical presentations

Early stage = asymptomatic

Weak/ interrupted/ difficult urine flow

Frequent urination/ nocturia

Hematuria

Pain or burning with urination

Advanced prostate cancer commonly spreads to ________

Bone

Detection and diagnosis of prostate cancer

H&P, DRE

CBC, Serum PSA

CT, MRI, Chest XR, Bone Scan, US

Needly Bx

Prostate cancer can invade which routes?

Perineural spaces, lymphatics, and blood vessels

Gleason scoring system

Based on how it looks under a microscope. Scores range from 2-10

Lower score = less chance of spread

Most common pathology prostate cancer

Adenocarcinoma

Since prostate cancer is slow-growing, ________ is acceptable in early-stage diagnosis

Watchful waiting

Which patients receive radiacal prostatectomy?

Cancer confined to the gland (T1, T2)

Life expectancy of at least 10 years

Post-op radiation for prostate cancer is used when?

1. PSA does not decrease to the undetectable immediately after prostatectomy

2. PSA is undetectable after surgery, but tumor margins contain tumor or seminal vesicles are involved

3. PSA is undetectable immediately after surgery but after a period begins to rise

Prostate doses (non-SBRT)

64-66 Gy - when undetectable PSA

70 Gy - when rising PSA levels

Prostate cancer treatment

*Mainstay: MAB (maximum androgen blockage)

EBRT/ Brachytherapy/ Proton

Hormonal therapy

Surgery

Chemo: Doxorubicin and cyclophosphamide

SBRT doses

GTV to 45Gy and PTV to 40Gy

Proton prostate treatment

Right and left lateral fields, 76-82 Gy

Brachytherapy doses prostate

Implant alone: 160 Gy

HDR: 45.5 Gy

Patients with significant risk of tumor extension outside the prostate capsule receive ________

Brachytherapy boost

Prostate 5-year survival rate

98%