Transcript Prostate Cancer in Men of African Decent

Prostate
Cancer
James B. Benton,M.D.
Prostate Cancer
• Significant of the clinical problem
• Early detection/screening
• Prevention/Management
Prostate Cancer
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220,000 new case per year in US
380,000 cases projected in 2025
40,000 death per year
Second largest cancer killer after lung
cancer.
• Probably #1 in non-smokers.
• Lifetime risk of diagnosis of prostate
cancer is 17%
• Lifetime risk of death from prostate cancer
is 3.4%
• Autopsy series (22 -55% incidence of
prostate cancer)
Epidemiology
• The incidence and mortality of prostate
cancer is quite varied among different
populations
• The incidence rate among African
Americans is 224/100,000 and American
Indians..46/100,000
Epidemiology Cont’d
• African-American men have the highest
mortality in the world (54/100,000)
• A high mortality rate has also been noted
in African heritage in Brazil , Jamaica, and
in sub-Saharan Africans.
Epidemiology Cont’d
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In 1990, 172,596 cases….33011 deaths
149,631 whites….25,281 deaths
17,417 blacks….5,181 deaths
4,291 Hispanics….727 deaths
<400 Orientals….<70 deaths
• African American (AA) men historically
presented with more advanced disease,
and an increased death rate.
• Because of early detection and more
aggressive treatments, survival may be
equilibrating.
Age Specific PSA
Age
PSA
Age
PSA
40
2.0
45
2.4
41
2.1
46
2.5
42
2.2
47
2.6
43
2.3
48
2.6
44
2.3
49
2.7
Age Specific PSA..cont’d
Age
PSA
Age
PSA
50
2.8
55
3.3
51
2.9
56
3.4
52
3.0
57
3.5
53
3.1
58
3.6
54
3.2
59
3.7
Age Specific PSA..cont’d
Age
PSA
Age
PSA
60
3.8
65
4.5
61
4.0
66
4.6
62
4.1
67
4.8
63
4.2
68
4.9
64
4.4
69
5.1
Age Specific PSA..cont’d
Age
PSA
Age
PSA
70
5.3
75
6.2
71
5.4
76
6.4
72
5.6
77
6.6
73
5.8
78
6.8
74
6.0
79
7.0
Prevention
• Restrict excessive fat and/or
carbohydrates
• ?Vitamins/Minerals: Selenium and Vitamin
E, and Lycopene
• Annual exam: DRE and PSA at age 40-50
• ? Hormonal…ie. Proscar
Prostate Cancer Prevention Trial
• 18,882 men: 55y/o or older: Finasteride(Proscar) or
placebo; nl DRE and PSA <3.0: 7 year study
(Thompson NEJM…2003)
• CAP developed in 24% of placebo and 18% proscar
(25% reduction)
• High grade cancers in 22% of placebo and 37% of
proscar
• Side effects: impotence with proscar
Prostate Cancer Screening
• Since introduction of the PSA in the 1980’s, there is
evidence that prostate cancer mortality has decreased.
• In countries not using PSA testing, prostate cancer
mortality continues to rise (Denmark, Mexico, and
Sweden)
American Cancer Society Prostate Cancer
Screening Guidelines
• Beginning at age 50, all men with a ten year life
expectancy should be offered both PSA and DRE
annually
• Men in high risk groups, such as African- Americans or
those with a family history should start at age 45
ACS Guidelines Cont’d
• Men at an appreciably higher risk due to multiple firstdegree relatives who were dx at an early age could
begin at age 40
• If PSA < 1.0, no more until age 45
• If PSA 1.0 – 2.4, annual testing
• If PSA > 2.4, consider biopsy
American Urological Association
Guidelines
• All men 50 or older with a ten year life
expectancy
• Men 40 – 50 with first degree relative with
prostate cancer or of African-American heritage
background
• Exams: DRE and PSA
PSA Density and Free PSA
• PSA density(PSAD): PSA value divided by the
volume of the prostate gland: >0.15 considered
abnormal.
• Free PSA: unbound PSA divided by bounded
PSA: < 25% is considered abnormal
• Used as factors to determined the need for a
biopsy when PSA is 4.0 – 10.0 range
Treatment Options
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Surgery
Simultaneous Radiotherapy
External Beam Radiotherapy alone
Seed Implants alone
Cryotherapy
Observation
Hormonal Ablation
? Vaccines
Treatment cont’d
• Combined Radiation and Tumor-specific
vaccine regimen.
• Chemotherapy: Doxil +/- hormonal therapy
Surgery
• Traditional Radical Prostatectomy
• Laparoscopic Prostatectomy
• Robotic Prostatectomy
Radiotherapy
• Simultaneous: Seeds/XRT
• Sequentially: XRT/Seeds
• Seeds alone
• XRT alone: IMRT- Proton/Neutron/Photons
Cryotherapy
• Freezing the prostate
• Limited experience
Hormonal Therapy
• Chemical
• Orchiectomy
Experienmental
• Vaccines
• High energy microwaves therapy
Learning How to Count
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