This presentation was my assignment to the school of ntaural sciences. It gives a presentational kind of approach to the topic of prostate cancer. Prostate cancer happens to be one of the most common types of cancer in men. Note: This presentation is not designed to be exhaustive but it will give an insight into prostate cancer.

1. Cancer Biology and
Molecular Oncology
BIOC: 262

2. PRESENTATION BY:
MUUNDA MUDEDA
15/BSB/BU/R/0004
LECTURER: MR. S. BAMUTEZE
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3. TOPIC
Discuss Prostate cancer.
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4. WHAT IS PROSTATE
CANCER?
• Normal prostate cell that has begun to grow in a fast and
uncontrolled way
• Requires dozens of changes to a normal prostate cell
• Cancer cells will grow into normal tissue
• After more changes can get into lymph and blood system to
grow colonies at a distance (metastasis)
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6. RISK FACTORS
• It is not known exactly what causes prostate cancer,
although a number of things can increase your risk of
developing the condition.
• These include:
• Age – risk rises as you get older and most cases are diagnosed
in men over 50 years of age.
• Ethnic group – prostate cancer is more common among men
of African-Caribbean and African descent than in men of
Asian descent.
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7. • Family history – having a brother or father who
developed prostate cancer under the age of 60 seems
to increase the risk of you developing it. Research
also shows that having a close female relative who
developed breast cancer may also increase your risk
of developing prostate cancer.
• Obesity – recent research suggests that there may be
a link between obesity and prostate cancer.
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8. Continued…
• Exercise – men who regularly exercise have also been
found to be at lower risk of developing prostate
cancer.
• Diet – research is ongoing into the links between diet
and prostate cancer. There is evidence that a diet high
in calcium is linked to an increased risk of developing
prostate cance
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9. HOW A TUMOUR
GROWS
• A tumour is a collection of cancer cells
• A tumour starts as one cancer cell
• 1 cell then 2 then 4 then 8 …..
• Tumour growth if more cells are made
than die
• Tumour doubles in size over 1-3 years
or longer
• Tumour - 1 cm in size has a billion
cells
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10. HOW PROSTATE CANCERS
CAUSE PROBLEMS
• Problem in the prostate
o Narrow the tubing – urinate more often and
o Slowing of stream
• Spread to lymph nodes – uncommon
• Spread to other parts of body especially bones
• Affect whole body - fatigue
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11. Factors determining
Treatment Options
• How advanced is the cancer (staging)
o Curable or not
• Factors in curable prostate cancer
o PSA – blood test
o Rectal exam (T stage)
o How aggressive is the cancer (Gleason Score)
o How much cancer was seen on biopsy (# cores, %
cancer in each core)
• Fitness of the man
• What does the man want?
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12. Prostate Specific Antigen -
PSA
• A chemical produced by both normal
prostate cells and prostate cancer cells
• Inflammation / infection of the normal
prostate cells causes the PSA to increase
– Whether or not prostate cancer cells are present
– Explains why the PSA can bounce up and down
• Excellent marker of cancer after diagnosis
– PSA should be undetectable after surgery
– PSA should be low after radiotherapy
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13. PSA does not localize
cancer cells
• Prostate cancer cells
produce PSA no matter
where they are in the body
• A rapidly rising PSA and a
very high PSA likely means
there are cancer cells
beyond the prostate area
– Eg. PSA doubling time < 3 months or
PSA >50
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14. MAKING THE DIAGNOSIS
• Biopsy - take a piece of
tumor and look under
microscope
• 8-12 cores of tissue – each
measuring 1cm by 0.1cm
• This is a tiny sampling of the
prostate gland
• May miss cancer completely
• May miss more aggressive
cancer
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19. Gleason Score:
How aggressive is the cancer?
• Score is out of 10
• Made up of two grades or patterns, each out of 5
• First grade is the most common cancer seen
• Second grade is the second most common cancer
• Gleason score 6 or less is slow growing
– Example 3/5 plus 3/5
• Gleason score 8 or more is fast growing
• Gleason 7 is neither fast nor slow
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20. TREATMENT OPTIONS FOR
PROSTATE CANCER
At Diagnosis
Curable
Watch +/-
hormones
Watch +/-
treat for cure
later
TREAT NOW
for cureNon-
Curable
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21. Active Surveillance
• Watch, and if need be treat for cure later
• Means watching PSA and re-biopsy of
prostate every 1-2 years
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22. Low-risk prostate cancer
• Cancer is VERY LIKELY restricted to the
prostate gland
• Must have T2 (or less) and PSA <10 and
Gleason Score 6 (or less)
• Expect 80-95% chance of cure with
treatment
• Active surveillance is good option for
many 22

23. Low-risk prostate cancer
T1/T2 and PSA<10 and GS<7
Low risk
Therapy
Surgery
Seed
implant
External
Radiotherapy
Surveillance
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24. operation
• Radical prostatectomy – removes the
prostate and seminal vesicles
• Has a specific side effects
oRelated to major operation
oUrinary incontinence 5-10%
oErectile dysfunction 30-70%
oBladder neck stricture 10%
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25. Continued…
• Is an excellent option in a situation where prostate
cancer cells are likely restricted to the prostate gland
• Removing the prostate gland provides much more
information about the aggressiveness and extent of
cancer
• Radiotherapy can be used after surgery if it looks like
cancer is likely left behind in the surgical bed or if PSA
begins to rise in follow up
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27. Treatment of cure:
Radioactive seeds in prostate
• Also called Low Dose Rate or Seed Brachytherapy
• Best for men with early disease when cancer cells
likely in prostate gland of just beyond capsule
• Very high cure rates similar to operation when
done by an experienced specialist
• “Simple” outpatient procedure
o General anaesthetic
o Rapid return to normal activity
o Men appear happy with this treatment
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31. Measuring needle penetration
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32. Needle tip at C4
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36. Side Effects of Seed
Brachy
• Urinary
o Irritative and obstructive symptoms for 3-6 months
• Worse than with EBRT
o 1 in 10 needs catheter, temporarily
o ~85% will normalize within 1 year
o Incontinence rare
• Usually “urgency” incontinence
• Rectal
o Even mild toxicities are rare
o 1 in 1000 risk of breakdown
• Erectile function
o 80-85% will maintain erectile function afterwards
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37. Treatment of Side Effects
of Seed Brachytherapy
• Pill for urinary flow (alpha blockers) prolonged
• Anti-inflammatories
• Watch out for urinary tract infections
• 15-20% incontinence if TURP (ream out) after implant
• Erectile dysfunction (15-20%) can be treated with pills
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38. Treatment for cure:
External radiotherapy
• Technology has advanced in last few years to allow very
high dose of radiotherapy to gland while minimizing dose
to surrounding tissue
• Especially good for situations in which prostate cancer
cells beyond capsule of the prostate but not spread
elsewhere
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39. CT SIMULATION
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42. The Issue of Target Margin
around prostate
• The target is the prostate gland PLUS areas where cancer cells
may have spread
• Also have to account for set up error and motion of the prostate
gland
o Men need to have same degree of filling in bladder
o Bowel movement prior to simulation and treatment daily
• Gold seeds can be inserted in prostate to localize prostate
during treatment
• The front rectum, bottom of bladder and urethra will always be
in the field
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44. DOSIMETRY
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46. Prostate + Pelvic Lymph Nodes
Simultaneous
Integrated
Boost
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47. TREATMENT
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48. THE END
Thank you!
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