8/9/2012 PROSTATE CANCER. DR. MATHEW Y. KYEI University of Ghana Medical School and urology unit KBTH

Transcription

1 PROSTATE CANCER DR. MATHEW Y. KYEI University of Ghana Medical School and urology unit KBTH

2 WHAT IS PROSTATE?

3 WHAT IS A CANCER?

4 OVERVIEW OF PROSTATE CANCER Prostate the leading site of internal cancer 2 nd cause of cancer death in men (17.35%) (Prof Wiredu et al) Disease incidence rise with age Expected increase incidence and death from CAP as life expectancy increases (64.83yrs- 2010)

5 OVERVIEW OF PROSTATE CANCER Life time risk of developing prostate cancer % Life time risk of death from prostate cancer -4.7% Age adjusted mortality from prostate cancer is 2.4 times higher in African Americans compared to whites

6 OVERVIEW OF PROSTATE CANCER What accounts for differences? Genetic predisposition Differences in cancer behaviour Higher serum testosterone Higher fat diets/ higher body mass index Detection/aggressive therapy barriers Disparity likely multifactorial

7 OVERVIEW OF PROSTATE CANCER prostate cancer causes considerable ill health from local cancer growth Spread to other organs (metastasis) Complications as a result of treatment

8 OVERVIEW OF PROSTATE CANCER Age at diagnosis- Rarely diagnosed in men younger than 50yrs (0.1%) Peak incidence yrs 85% diagnosed after 65yrs

9 GHANA GREATER ACCRA POPULATION STUDY Study of 1038 Ghanaians (50-74yrs) 346 considered at risk for prostate cancer 73 cases diagnosed 7% of men between 50-74yrs Incidence in Population study >200/100,000 (Prof E.D. yeboah et al)

10 GHANA- KORLE BU TEACHING HOSPITAL Hospital incidence KBTH ( cases/yr ( biopsies 380 cases a year) 2009 a total of 112 cases of CAP were diagnosed at KBTH Average age 69yrs 4 deaths a month( captured at KBTH) Age (yrs) No. % < > Total

11 NIGERIA Most common cancer in men Average age 68.3 yrs ± 9.4yrs Hospital incidence 127/100,000 Approx. 64% died within 2yrs

12 RISK FACTORS considerable evidence suggests that both genetics environment play a role in the origin and evolution of prostate cancer

13 RISK FACTORS MEN- Androgens influence the development, maturation, and maintenance of the prostate lifetime of variable exposure of the prostate to androgens plays an important role in prostate cancer development AGE

14 RISK FACTORS RACE: Incidence Black (USA)- 170/100,000 Whites- 100/100,000 Asians- 82/100,000

15 RISK FACTORS Familial and Genetic Influences Inherited/genetic 10-16% ( 43% for cancers below 55yrs) Classified Sporadic- negative family history Familial- cancer in a man with one or more affected relatives Hereditary- -three or more affected members (nuclear family) -prostate cancer in three successive generations -two affected individuals diagnosed with cancer before the age of 55 years

16 RISK FACTORS -FAMILIAL AND GENETIC INFLUENCES

17 RISK FACTORS- INFECTIONS Accumulating evidence suggests that prostate cancer may have an infectious etiology history of sexually transmitted infection (relative risk = 1.4) prostatitis (odds ratio = 1.57) positive associations of antibodies against syphilis, human papillomavirus, and human herpesvirus 8 higher plasma concentrations of acute-phase reactants and proinflammatory cytokines in men with prostate cancer

18 RISK FACTORS DIET Bad Red meat, high polyunsaturated fat, vitamin A Calcium - foods/ supplements Obesity o Good. Vegetables: Tomatoes (lycopene), cabbage Vitamin D (dairy products, fish) Fruits : red fruits, Vitamins C &E

19 RISK FACTORS SOCIAL HISTORY (LIFE STYLE) Early sexual activity?, multiple sexual partners?, Smoking- source of cadmium exposure, increases circulating androgen levels, and causes significant cellular oxidative stress Alcohol Vasectomy- a pooled risk of 1.37, with a linear trend suggesting a 10% increase for each additional 10 years since vasectomy

20 SYMPTOMS May be asymptomatic

21 SIGNS & SYMPTOMS In 2009 total admissions ward G= (13.5%)due to CAP and its related effect on health Haematuria anaemia AROU/obstructive uropathy uti/septicaemia metastatic bone pains paraparesis

22 SYMPTOMS VOIDING Hesitancy Weak urinary stream Interruption of urinary stream Straining to urinate

23 SYMPTOMS Frequency of micturation Nocturia urgency

24 SYMPTOMS Blood in urine (5.8% of all cases 0f haematuria seen in KBTH) Pain or burning on urination Acute Retention of urine (3 rd commonest cause) Renal failure

25 SYMPTOMS

26 SIGNS & SYMPTOMS SEXUAL FUNCTION Impotence Blood in semen Painful ejaculation 22% of cases of impotence seen in GU- KBTH( mean age 62yrs)

27 SIGNS & SYMPTOMS PROBLEMS WITH DEFAECATION Constipation Pain on moving bowels Bloody stools

28 SYMPTOMS ADVANCED STAGE Low back pains Bone pains Fracture of bones Paralysis

29 SIGNS & SYMPTOMS ADVANCED STAGE Chest and abdomen * Anaemia *Cough *Jaundice Cerebral metastasis: * Headache * Confusion * Coma * Death

30 DETECTION/DIAGNOSIS SYMPTOMS SIGNS AND DIGITAL RECTAL EXAMINATION

31 DETECTION/DIAGNOSIS PROSTATE SPECIFIC ANTIGEN(PSA) (0-4.0ng/ml) o Screening o diagnosis Results Stage migration 75% of diagnosed cap very early and curable 5- and 10-year survival rates,now are 100% and 92%, respectively

32 PROSTATE BIOPSY Digitally directed Ultrasound guided

33 PROSTATE BIOPSY COMPLICATIONS Blood in urine Bleeding per rectum Blood in semen/ ejaculate Acute retention of urine Infections

34 DETECTION RATE Sensitivity for prostate cancer detection PSA range DRE Normal DRE abnormal > > DRE Normal DRE abnormal

35 OTHER INVESTIGATIONS Full blood count Kidney function tests Uroflowmetry Abdomen pelvic ultrasound Abdominopelvic CT scan

36 CHALLENGES IN THE DIAGNOSIS OF PROSTATE CANCER IN GHANA 1. The low numbers of Urologists 2. A Dedicated center. THE NATIONAL UROLOGICAL CENTRE

37 SUNYANI REGIONAL HOSPITAL

38 REFERENCES 1.Wiredu EK, Armah HB, Cancer mortality patterns in Ghana: a 10 year review of autopsies and hospital mortality.bmc Public health2006 Jun 20;6:159 2.Sensitivity of digital rectal examination and various PSA levels in prostate cancer detection using transrectal ultrasound guided biopsy of the prostate in 464 Ghanaians presenting at an urology clinic Urology, Volume 68, Supplement 1, November 2006, Pages E. Yeboah, M. Kyei, Y. Tettey, R. Kumoji 3.Prostate Cancer Screening In Ghana Urology, Volume 74, Issue 4, Supplement 1, October 2009, Pages S200-S201 E. Yeboah, E. Hsing, Y. Tetteh, R. Biritwum, A. Adjei, G. Klufio, S. Gepi Attee, M. Kyei, J. Mensah, B. Morton, R. Ankomah, J. Bentsi, P. Quist, R. Gyasi, A. Akosa Radical prostatectomy an under utilised cure for prostate cancer Seminar Presentation Department of Surgery University of Ghana Medical School February M. Y. Kyei

39 REFERENCES Jemal et al., Jemal A, Tiwari RC, Murray T, et al: American Cancer Society: Cancer statistics CA Cancer J Clin 2004; 54:8-29. Stephenson et al., Stephenson RA, Smart CR, Mineau GP, et al: The fall in incidence of prostate cancer: On the down side of a PSA induced peak in incidence. Cancer 1996; 77: Feuer et al., Feuer EJ, Merrill RM, Hankey BF: Cancer surveillance series: Interpreting trends in prostate cancer part II: Cause of death misclassification and the recent rise and fall in prostate cancer mortality. J Natl Cancer Inst 1999; 91: Tarone et al., Tarone RE, Chu KC, Brawley OW: Implications of stage-specific survival rates in assessing recent declines in prostate cancer mortality rates. Epidemiology 2000; 11: American Cancer Society, American Cancer Society : Cancer Facts and Figures 2005, Atlanta, American Cancer Society, Powell et al., Powell IJ, Banerjee M, Bianco FJ, et al: The effect of race/ethnicity on prostate cancer treatment outcome is conditional: A review of Wayne State University data. J Urol 2004; 171:1508. American Cancer Society, American Cancer Society : Cancer Facts and Figures for African Americans , Atlanta, American Cancer Society, Quinn and Babb, Quinn M, Babb P: Patterns and trends in prostate cancer incidence, survival, prevalence and mortality. Part I: International comparisons. Br J Urol Intl 2002; 90: Gronberg, Gronberg H: Prostate cancer epidemiology. Lancet 2003; 361: Muir et al., Muir CS, Nectoux J, Staszewski J: The epidemiology of prostatic cancer. Geographical distribution and timetrends. Acta Oncol 1991; 30: Shimizu et al., Shimizu H, Ross RK, Bernstein L, et al: Cancers of the prostate and breast among Japanese and white immigrants in Los Angeles County. Br J Cancer 1991; 63: Landis et al., Landis SH, Murray T, Bolden S, Wingo PA: Cancer statistics, CA Cancer J Clin 1999; 49:8-31. Ries et al., In: Ries LAG, Eisner MP, Kosary CL, et al ed. SEER Cancer Statistics Review, , Bethesda, Md: National Cancer Institute; 2004 Sakr et al., Sakr WA, Haas GP, Cassin BF, et al: The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol 1993; 150: Hankey et al., Hankey BF, Feuer EJ, Clegg LX, et al: Cancer surveillance series: Interpreting trends in prostate cancer part I: Evidence of the effects of screening in recent prostate cancer incidence, mortality, and survival rates. J Natl Cancer Inst 1999; 91: Mettlin et al., Mettlin C, Murphy GP, Lee F, et al: Characteristics of prostate cancers detected in a multimodality early detection program. The Investigators of the American Cancer Society National Prostate Cancer Detection Project. Cancer 1993; 72: Newcomer et al., Newcomer LM, Stanford JL, Blumenstein BA, Brawer MK: Temporal trends in rates of prostate cancer:

40 THANK YOU