1. Prostate cancer Produced by Dr. Magdy M. Awny 2018

2. WHAT IS PROSTATE CANCER?
It is a malignant growth of prostate gland (in the male reproductive system )
Most prostate cancers are slow growing but may
metastasize (spread) to bones and lymph nodes. In
the size
Of a small
kiwifruit
or a large walnut.
normal wt gm, while a diseased prostate can weigh up to 100 grams.
secretes a milky fluid that makes up around % of semen (contain Zn, enzymes, citric acid) this fluid nourish sperm and protect them from vaginal acidity as semen from seminal vesicle is alkaline
cells lining the ducts of the prostate gland secrete PSA an enzyme that keep semen in its liquid form as it undoes the effect of clotting enzyme of seminal vesicle fluid which makes the ejaculate gel. This thinning action allows sperm to swim more freely

4. Risk factors Age (>65 years) Race: Africans more than whites
Family history (father, brother)
Obesity
Diet rich in saturated fats
Hormonal disturbance and increased androgen
smoking
Infection and inflammation of the prostate gland (prostatitis)
Inherited genes or Genetic mutation especially PRCA1

5. Pathophysiology of BPH
With age loss of testosterone →↑ release of prolactin, estradiol, LH and FSH.
elevated estrogens inhibit the body’s metabolism of testosterone and DHT.
These hormonal changes →↑concentration of DHT within prostate tissue.
prostate tissue receptors have a 5 fold greater affinity for DHT > testosterone.
BPH tissue has 3-4 fold greater net ability to increase tissue levels of DHT.
DHT, in concert with estrogens, activates growth factors in prostate tissue that stimulate cell proliferation. This is how BPH arises with aging.

7. Symptoms of prostate cancer
Early No symptom.
Frequent burning urination or incomplete bladder emptying
Weak or interrupted urine flow
Difficulty in having erection & painful ejaculation
Lower back pain & stiffness due to metastasis to hips and upper thighs

8. A 61-year-old man had a history of benign prostate hyperplasia for 10 years. He came to the hospital due to symptoms of abdominal fullness and urine retention of 1 month’s duration. He had no history of dysuria or body weight loss. Laboratory workup demonstrated microscopic hematuria by urinary analysis and a high level of prostate-specific antigen (PSA) up to 35 ng/mL (normal < 4.0 ng/mL). Abdominal computed tomography (CT) detected enlargement of the prostate gland to about 5.3 cm in diameter with low attenuation nodules. Transurethral resection of the prostate was performed, and biopsy reported adenocarcinoma without perineural invasion. Bone scan study found No definite evidence of bone metastasis.
The patient was later discharged from the hospital and received radiotherapy of the prostate gland for 2 months, which was followed by continuous hormone therapy. PSA level ranged from 2 ng/mL to 4 ng/mL.

9. Prostate cancer diagnosis
1.Digital rectal examination (DRE): 2.Prostate specific antigen (PSA) test: 3.Biopsy 4.Trans-rectal ultrasound (TRUS) 5. MRI scan 6.CT scan

10. Prostate cancer diagnosis
Digital rectal examination
(DRE)
The doctor feels the prostate gland with his index finger in the rectum to detect shape, size and abnormalities of the gland.

11. PSA Screening test for prostate cancer.
Is a protein made by the prostate that normally is present in the blood.
This protein increases in men who have prostate cancer.
A PSA level of
0 -4 ng/ml is considered normal
ng/ml ………. slightly elevated.
ng/ml ………moderately elevated.
> 20 ng/ml …………..highly elevated

12. cancer is felt on DRE and is limited to the prostate.
Cancer is not palpable by DRE and is localized
but is only found by ↑ PSA and biopsy
cancer is felt on DRE and is limited to the prostate.
Cancer spreads beyond the capsule of the prostate into local organs or tissues, but has not yet metastasized . This stage is determined by DRE, or CT/ MRI scans.
Cancer spreads to distant lymph nodes, bones or other sites. 
This is usually determined by bone scan.

13. Treatment If large prostate tumor or spread only locally
surgery, radiation therapy, hormonal therapy, cryotherapy, and combinations of some of these treatments
If metastatic prostate cancer
hormonal therapy and chemotherapy.

14. Treatment
Surgery
Radiation
Cryotherapy
Chemotherapy
Hormonal therapy

15. Radical prostatectomy:
Surgery
Radical prostatectomy:
Surgical removal of prostate gland +
some of surrounding tissue
Orchiectomy:
Surgical removal of testis

16. 2- Radiotherapy A) External beam radiation directed from outside
Use high energy beamed x-rays to destroy cancer cells and ↓its ability to divide & multiply.
2 types:
A) External beam radiation directed from outside
B-Brachytherapy (internal radiation or seed implantation):
By using implanted seeds (radioactive materials) placed directly into prostatic gland to destroy the malignancies, ex: I125 or palladium 103 , this is metal seeds giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues.

17. Cryosurgery or Cryotherapy
a newer treatment that is being evaluated for use in the early stage of prostate cancer.
Is a therapy by which surface skin lesions are frozen by application of extreme cold on tumors to destroy cancer cells
Liquid nitrogen used more often than Co2 snow
Cryosurgery is effective in men who have had cancer cells return after radiation treatments, or for whom radiation treatment was unsuccessful.

18. 4-Hormonal therapy Oestrogen (ethinyl estradiol and DES )
By removal of testis (Orchiectomy) or use of drugs that ↓testosterone production or block its actions
Drugs that can prevent the adrenal glands from making androgens include ketoconazole and aminoglutethimide.
Oestrogen (ethinyl estradiol and DES )
it seldomly used as it ↓male sex characters (hot
flushes, ↓libido,…..
Fosfesterol (DES diphosphate)
LHRH analogue e.g. Leuprolide & goserelin ????
Anti androgen e.g. flutamide, nilutamide

19. 2. LHRH analogue : e.g. Leuprolide, goserelin
1. Antiandrogens
are medication to block the action of testosterone.
e.g. bicalutamide (Casodex®), flutamide (Euflex®),
nilutamide (Anandron®)
. Orally adminstered every day
2. LHRH analogue : e.g. Leuprolide, goserelin
are medication to stop the testicles from making testosterone.
e.g. leuprolide (Lupron®), goserelin (Zoladex®)
buserelin (Suprefact®).
given every 1 to 4 months by an injection into skin or muscle.

20. Prevention Regular aerobic exercise
Take a multivitamin that includes vitamin D and antioxidants, especially selenium.
Eat little to no red meat and saturated fat
Eat more vegetables, especially tomatoes and tomato sauce.
Lycopene, a carotenoid found in tomatoes and watermelon, has been linked to a lower risk of prostate cancer.
Eat more fish at least once a week
Eat more fiber that helps in the elimination of hormones such as testosterone

21. Thank you