How does family history affect your likelihood of getting prostate cancer?
Men with a father or brother with prostate cancer are twice as likely to develop prostate cancer
What race has the highest incidence of prostate cancer?
AFRICAN AMERICANS
What hormonal factors contribute to prostate cancer?
Men with high plasma testosterone levels are at increased risk
What age has the highest incident of prostate cancer?
65-74 age range
What items may increase your risk for prostate cancer?
- synthetic folate supplements
- Diary and Ca+
- Dioxin in agent orange!
What in the diet may be protective from prostate cancer?
Folate in the DIET (green leafy veggies)
What medications can reduce the incidence of prostate cancer?
Finasteride
Dutasteride
(5alpha reductase inhibitors)
What are some symptoms of prostate cancer?
Difficulty urinating Less force to stream Dribbling Hematuring Pain/burining BACK PAIN NOT RESOLVING
If there is a male patient with hip or back pain not resolving… what should you be suspicious of?
prostate cancer
What is for sure an elevated PSA at any age?
> 10 ng/mL
Borderline PSA?
4-10
Normal PSA?
What is the best way to measure PSA if patient wants to do screening?
PSA Velocity = measures how quickly PSA level rises over time
A change of > .75 ng/mL in one year is significant
Should you do a PSA screen in a healthy asymptomatic man?
NO!!!! not at any age, family history or ethnicity!
What age group is a candidate for a radical prostatectomy?
age 50-60
When would you do a TURP (transurethral resection prostate)
If they couldn’t void
Treatment for someone who is older, may have comorbid conditions, but has a positive prostate biopsy?
Radiation therapy
What treatment strategy would you recommend for a 74 year old male with oxygen dependent COPD, PSA 8 and an enlarged prostate?
Active Surveillance
What are indications for a prostate biopsy?
- Abnormality on DRE
- PSA elevation for age
- PSA velocity > .75
- Previous negative biopsy but continually increasing PSA