SH Prostate Cancer

Describe epidemiology of prostate cancer:

• commonly has indolent course

• can have aggressive course

• 2nd leading cause cancer-related deaths in biologic males

• Incidence declined 2007-2014 due to recommendation against routine screening

• deaths declined since 1993

The decrease in prostate cancer mortalities in the US from 2013-2016 is most likely related to:

• decrease in PSA screening

• increase in PSA screening

• increase in advanced-stage diagnoses

• decrease in advanced-stage diagnoses

Risk factors include:

• Age > 65 YO

• genetic: familial prostate cancer inherited in autosomal dominant

• germline mutations (ATM, ATR, BRCA1, BRCA2, CHEK2

• environmental and occupational

Which of the following are probable risk factors?

• mediterranean diet

• high fat diet

• high meat diet

• increased intake of 25-dihydroxyvitamin D, lycopene, and beta-carotine

Answer explanation

decreased intake of 25-dihydroxyvitamin D, lycopene, and beta-carotine increases risk

T/F: Finasteride and dutasteride are recommended for prevention of prostate cancer.

• True

• False

Answer explanation

not recommended:

development of more aggressive tumors

lack of survival benefit

increased risk of adverse effects

Which of the following is true about prostate cancer prevention?

• screening is not routinely recommended for all individuals at risk

• lycopene, green tea, NSAIDs, isoflavones, statins are recommended

• there is enough evidence to show that prostate cancer screening can reliably detect cancer at early disease and intervention would decrease mortality

• selenium and vitamin E together can prevent prostate cancer

Prostate cancer graded based on histology on scale 1-5

• 2 specimens examined

• gland architecture examined & rated (1=well differentiated, 5= poorly differentiated)

• score for each specimen is added

• 2 most common scores are added to give Gleason pattern

Pathophysiology of early-stage prostate cancer:

• aberrant tumor cell proliferation promoted by presence of androgens

• blockage od androgens induces tumor regression

• hormonal manipulations to ablate or reduce circulating androgens can occur through several mechanisms

• organs responsible for androgen production can be removed surgically: oorchiectomy, hypophysectomy, adrenalectomy

androgen synthesis inhibitors:

• abiraterone acetate

• ketoconazole

• tamoxifen

• fulvestrant

Hormonal Manipulation:

• Androgen synthesis inhibitors: abiraterone acetate, ketoconazole

• LHRH agonists: goserelin, leuprolide, triptorelin

• LHRH/GnRH: degarelix, relugolix

• First generation antiandrogens: bicalutamide, flutamide, nilutamide

• second generation antiandrogens: apalutamide, darolutamide, enzalutamide