PLWC Slide Deck Series: Understanding Prostate Cancer Presents PLWC Slide Deck Series: Understanding Prostate Cancer 2006

What is Cancer? A group of 100 different diseases The uncontrolled, abnormal growth of cells Cancer may spread to other parts of the body

What is Prostate Cancer? The most common type of cancer in men and second most frequent cause of cancer-related death in men A malignant (cancerous) tumor that begins in the prostate gland Some prostate cancers grow very slowly and may not cause problems for years Prostate cancer is somewhat unusual in that many men with advanced cancer respond to treatment

What is the Function of the Prostate? The prostate is a walnut-sized gland located behind the base of the penis, in front of the rectum and below the bladder It surrounds the urethra, the tube-like channel that carries urine and semen through the penis The primary function of the prostate is to produce seminal fluid, the liquid in semen that protects, supports, and helps transport sperm

What Are the Risk Factors for Prostate Cancer? Age Race/ethnicity Family history Diet Hormones

Prostate Cancer and Early Detection Prostate-specific antigen (PSA) test Digital rectal examination (DRE) Discuss screening with your doctor

What Are the Symptoms of Prostate Cancer? Frequent urination, or weak or interrupted urine flow Pain or burning during urination or blood in the urine The urge to urinate frequently during the night Different symptoms if the cancer has spread: pain in the back, weight loss, fatigue Sometimes, people with prostate cancer do not show any of these symptoms, or these symptoms may be similar to symptoms of other medical conditions

How is Prostate Cancer Evaluated? PSA test DRE Diagnosis is confirmed with a biopsy Transrectal ultrasound (TRUS) Imaging tests can determine if the cancer has spread

Prostate Cancer Staging Staging is a way of describing a cancer, such as the depth of the tumor and where it has spread Staging is the most important tool doctors have to determine a patient’s prognosis Staging is described by the TNM system: the size of the Tumor, whether cancer has spread to nearby lymph Nodes, and whether the cancer has Metastasized (spread to organs such as the liver or lungs) Another staging system assigns letters (A,B,C,D) to describe the cancer The type of treatment a person receives depends on the stage of the cancer

Prostate Cancer Grading Grade describes how much cancer cells look like normal cells (for example, do the cells look almost normal or very abnormal?) The grade of the cancer can help the doctor predict how quickly the cancer will spread The Gleason System is the most common grading system and describes the cell patterns seen under the microscope

Stage I or Stage A Prostate Cancer Stage I cancer is found only in the prostate and usually grows slowly

Stage II or Stage B Prostate Cancer Stage II cancer has not spread beyond the prostate gland, but involves more than one part of the prostate, and may tend to grow more quickly

Stage III or Stage C Prostate Cancer Stage III cancer has spread beyond the outer layer of the prostate into nearby tissues or to the seminal vesicles, the glands that help produce semen

Stage IV or Stage D Prostate Cancer Stage IV cancer has spread to other areas of the body such as the bladder, rectum, bone, liver, lungs, or lymph nodes

How is Prostate Cancer Treated? Treatment depends on stage of cancer More than one treatment may be used Surveillance (watchful waiting) for some early stage cancers Surgery Radiation therapy Hormone therapy Chemotherapy

Cancer Treatment: Watchful Waiting A way to monitor early stage, slow-growing, prostate cancer Appropriate when treating cancer would cause more discomfort than the disease itself Mostly used in older men or men who are unwell from other illnesses Treatment begins when the tumor shows signs of growing or spreading

Cancer Treatment: Surgery Used to try to cure cancer before it spreads outside the prostate Usually the prostate and nearby lymph nodes are removed Urinary incontinence and sexual side effects may result from surgery. These side effects are treatable Cryosurgery (destroying cancer cells by freezing) is still experimental

Cancer Treatment: Radiation Therapy The use of high-energy x-rays or other particles to destroy cancer cells Used to try to cure disease or control symptoms External-beam: outside the body Brachytherapy: the insertion of radioactive pellets into the prostate Intensity-modulated radiation therapy (IMRT): small beams of radiation are aimed at a tumor from many angles Side effects may include rash and dry, reddened, or discolored skin

Cancer Treatment: Hormone Therapy Reduces level of male sex hormones to slow growth of cancer Used to treat prostate cancer that has grown after surgery and radiation therapy or to shrink large tumors before surgery and radiation therapy Can be done surgically or through medication Hormone therapy may cause a variety of side effects More information can be found in the ASCO Patient Guide: Hormone Therapy for Advanced Prostate Cancer

Cancer Treatment: Chemotherapy Drugs used to kill cancer cells No standard chemotherapy for prostate cancer Mitoxantrone (Novantrone) and docetaxel (Taxotere) are both used in men with prostate cancer that is resistant to hormone therapy Paclitaxel (Taxol), estramustine (Estracyte), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan, Neosar) have shown promise in treating advanced prostate cancer

The Role of Clinical Trials for the Treatment of Prostate Cancer Clinical trials are research studies involving people They test new treatment and prevention methods to determine whether they are safe, effective, and better than the best known treatment The purpose of a clinical trial is to answer a specific medical question in a highly structured, controlled process Clinical trials can evaluate methods of cancer prevention, screening, diagnosis, treatment, and/or quality of life

Clinical Trials: Patient Safety Informed consent: Participants should understand why they are being offered entry into a clinical trial and the potential benefits and risks Informed consent is an ongoing process; participants are constantly updated as new information becomes available Participation is always voluntary, and patients can leave the trial at any time

Clinical Trials: Phases Phase I trials determine safety and dose of a new treatment in a small group of people Phase II trials provide more detail about the safety of the new treatment and determine how well it works for treating a given form of cancer Phase III trials take a new treatment that has shown promising results when used to treat a small number of patients with cancer and compare it with the current, standard treatment for that disease; phase III trials involve a large number of patients

Clinical Trials Resources Coalition of Cancer Cooperative Groups (www.CancerTrialsHelp.org) CenterWatch (www.centerwatch.com) National Cancer Institute (www.cancer.gov/clinical_trials)

Coping With the Side Effects of Cancer and its Treatment Side effects are treatable; talk with the doctor or nurse Fatigue is a common, treatable side effect Pain is treatable; non-narcotic pain relievers are available Medication can treat many sexual side effects For more information, visit www.plwc.org/sideeffects

Where to Find More Information: PLWC Guide to Prostate Cancer (www Where to Find More Information: PLWC Guide to Prostate Cancer (www.plwc.org/prostate) Overview Medical Illustrations Risk Factors and Prevention Symptoms Diagnosis Staging With Illustrations Treatment Side Effects of Cancer and Cancer Treatment After Treatment Questions to Ask the Doctor Current Research Patient Information Resources Clinical Trials Resources

People Living With Cancer (www.plwc.org) PLWC is the cornerstone of ASCO’s patient resources program Visitors to PLWC will find: PLWC Guides to more than 90 types of cancer Coping resources Ask the ASCO Expert Series, including chats, Q&A forums, and event transcripts Cancer information in Spanish The latest cancer news For patient information resources, please call 888-651-3038