INTRODUCTION TO UROLOGIC ONCOLOGY Prof Dr Faruk Yencilek

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INTRODUCTION TO UROLOGIC ONCOLOGY Prof. Dr. Faruk Yencilek

INTRODUCTION TO UROLOGIC ONCOLOGY Prof. Dr. Faruk Yencilek

PROSTATE CANCER Most frequently diagnosed cancer (USA) Number 1 in cancer related male mortality

PROSTATE CANCER Most frequently diagnosed cancer (USA) Number 1 in cancer related male mortality Incidence increases with age: ◦ <40 ◦ 40 -59 ◦ 60 -79 1/10, 000 1/100 1/8 Life-time P Ca. Risk of a 50 - yo male: ◦ Latent (autopsy): 40% ◦ Clinic: 9. 5% ◦ Death: 2. 9%

 Many cancers can remain latent and do not threaten the patient’s life. However,

Many cancers can remain latent and do not threaten the patient’s life. However, becomes symptomatic in some patients, and kills the patient if left untreated Wide spectrum in the biological behaviour of the disease makes it difficult to make a decision on patient basis.

Risk factors: Presence of P Ca. in family is a risk factor! ◦ 1.

Risk factors: Presence of P Ca. in family is a risk factor! ◦ 1. Degree 1 relative 2 -fold 2 relatives 5 -fold 3 relatives 11 -fold ◦ Annual PSA follow-up must start at age of 40.

 Diet Geography - life style Race P Ca. incidence same in autopsies Clinic

Diet Geography - life style Race P Ca. incidence same in autopsies Clinic P Ca incidence different – Low in Asian race ◦ Diet may not start cancer, but may affect the progress of cancer.

Fat: May affect androgen level Causes the formation of free radicals Fatty acid metabolites

Fat: May affect androgen level Causes the formation of free radicals Fatty acid metabolites can be carcinogenic Polyunsaturated linoleic acid in red meat

Diet Soy – isoflavon ◦ Genistein – EGFR inhibition; P Ca cell inhibition. Lycopene

Diet Soy – isoflavon ◦ Genistein – EGFR inhibition; P Ca cell inhibition. Lycopene ◦ Carotenoid, tomatoes, antioxidant Selenium ◦ In antioxidant glutathion peroksidase Vitamin E (alpha-tocopherol) ◦ Antioxidant Green tea (polyphenols)

Pathology Gleason scoring system ◦ Glandular pattern; not cytologic features ◦ Example: Gleason 3+4:

Pathology Gleason scoring system ◦ Glandular pattern; not cytologic features ◦ Example: Gleason 3+4: 7

Clinical suspicion Abnormal serum PSA value Suspicious digital rectal examination To diagnose TRUS guided

Clinical suspicion Abnormal serum PSA value Suspicious digital rectal examination To diagnose TRUS guided biopsy Standard 12 cores Bx (-) and still suspicious re-biopsy

Prostate Specific Antigen (PSA) Enzyme (serine protease) Secreted from prostatic epithelial cells Liquidification of

Prostate Specific Antigen (PSA) Enzyme (serine protease) Secreted from prostatic epithelial cells Liquidification of semen Prostate specific, not prostate cancer !! What is abnormal? ◦ 4, 0 2, 5 ng/ml.

Staging TNM staging is based on DRE findings. To obtain more detailed information, inform

Staging TNM staging is based on DRE findings. To obtain more detailed information, inform the patient and plan the treatment: ◦ Biopsy findings ◦ Nomograms ◦ Radiologic imaging methods

TREATMENT Classic treatment altenatives stage by stage Individualied treatment

TREATMENT Classic treatment altenatives stage by stage Individualied treatment

Localized P Ca. Surveillance Radical prostatectomy ◦ Open surgery ◦ Laparoscopic prostatectomy ◦ Robotic

Localized P Ca. Surveillance Radical prostatectomy ◦ Open surgery ◦ Laparoscopic prostatectomy ◦ Robotic surgery Radiation therapy ◦ External beam Rx ◦ Brachytherapy

Locally Advanced Disease Neoadjuvant hormonal treatment + Radiation therapy

Locally Advanced Disease Neoadjuvant hormonal treatment + Radiation therapy

Metastatic Disease Hormonal Treatment

Metastatic Disease Hormonal Treatment