1. A Challenge for All Men… …and their families.

2. OVERVIVEW About prostate gland History Prostate cancer Stages of prostate cancer Screening methods Diagnosis Treatment Risk factor Organizations

3. Prostate gland The prostate is part of a man's reproductive system. An organ located in front of the rectum and under bladder. It surrounds the urethra. It secrete a fluid to nourish semen during intercourse. The prostate is about the size of a walnut but it can grow with age and is called benign prostatic hypertrophy (BPH). Male hormones(androgens) make the prostate grow.

4. HISTORY: In 1536 - First described by venetian anatomist Niccolo massa. Until 1853 -Prostate cancer was not identified. 19th century- A rare disease, probably because of shorter life expectancies and poorer detection methods. 1890s - Surgical removal of the testes to treat prostate cancer but with limited success. 1904 - Removal of the entire gland was first performed by Hugh H. Young. 1983 - Radical retropubic prostatectomy was developed by Patrick Walsh for removal of the prostate and lymph nodes with maintenance of penile function. 20th century -Radical perineal prostatectomy was replaced by transurethral resection of the prostate (TURP) for symptomatic relief.

5. PROSTATE CANCER Prostate cancer is a malignant (cancerous) tumor growth. In prostate cancer, as in other types of cancer, cells grow out of control and form tumors. The tumor produces little or no symptoms or outward signs. It can spread beyond the prostate into the surrounding tissues. Moreover, the cancer also can metastasize throughout other areas of the body. Cancer is thought not to be related to benign prostatic hypertrophy (BPH). The tumor usually grows slowly and remains confined to the gland for many years.

6. Mechanism of prostate cancer  Hormones, including the male androgenic hormone, testosterone, could play an important role.  Epigenetic mechanisms may be the main driving force for critical changes in gene expression that are responsible for progression of prostate cancers. (i) Changing patterns of DNA methylation, (ii) Histone acetylations/ deacetylations, and (iii) Alterations in regulatory feedback loops for growth factors.  DNA hypermethylation is an important mechanism in prostate cancer for inactivation of key regulatory genes such as E-cadherin, tumor suppressors CDKN2 and PTEN and IGF-II.

7. Causes Signs Symptoms Advancing age Blood in urine Urinary frequency, Slow urinary flow Genetics (heredity) Pain in the abdomen Painful urination Hormonal influences Chest pain & coughImpotence Environmental factors as toxins, chemicals, and industrial products Overweighed person with above signs & symptoms Lower back or thigh pain Red meat, dairy products, vegetable oil, diet high in fats Blood in semen

8. Stages of Prostate cancer STAGE I (A1) : Cancer is found in the prostate only. It cannot be felt during a DRE and is not visible by imaging. It is usually found accidentally during surgery, BPH. The Gleason score is low in PSA test. STAGE II (A2/B1/B2) : Cancer is more advanced than in stage I, but has not spread outside the prostate. The Gleason score can range from 2-10. As prostate cancer progresses from Stage I to Stage IV (TNM System)

9. CONTINUE…… Stage III (C) : Cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles. The Gleason score can range from 2-10. Stage IV (D1 / D2) : Cancer has metastasized (spread) to lymph nodes near or far from the prostate or to other parts of the body, such as the bladder, rectum, bones, liver or lungs. Metastatic prostate cancer often spreads to the bones. The Gleason score can range from 2-10.

10. Methods to detect prostate cancer : Prostate cancer screening is an attempt to find unsuspected cancers. 1. Digital rectal exam (DRE) : An exam of the rectum. In prostate cancer prostate gland becomes hard & lumpy. 2. Prostate-specific antigen (PSA) test : A test that measures the level of PSA in the blood. Normally, only very low levels of the enzyme are able to enter the blood stream. But in prostate cancer PSA leaks into the blood stream, which increases level of PSA in blood (or serum). Screening :

11. Screening contd… 3. Transrectal ultrasound : Rectum exam through ultrasound transducer. To check prostate gland size (tumor). 4. Biopsy: The removal of cells or tissues to view under a microscope by a pathologist, who checks for cancer cells and determine the Gleason score. a. Transrectal biopsy : The removal of tissue from the prostate by inserting a thin needle through the rectum and into the prostate using transrectal ultrasound to help guide the needle.

12. Screening cont… b.Transperineal biopsy : The removal of tissue from the prostate by inserting a thin needle through the skin between the scrotum and rectum and into the prostate.

13. Diagnosis methods 1. Radionuclide bone scan : To check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner. 2. Pelvic lymphadenectomy : A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.

14. Diagnosis contd…. 3. MRI (magnetic resonance imaging) 4. CT scan (CAT scan)

15. Treatment Surgical treatment:- Referred to as a radical or total prostatectomy, which is the removal of the entire prostate gland. Radiation therapy:- To damage the cancer cells and stop their growth or kill them. It is used for patients with organ-confined (localized) prostate cancer. It can be given either as external beam radiation or as an implant of radioactive seeds (brachytherapy) directly into the prostate.

16. Hormonal treatment :- It is to decrease the stimulation by testosterone of the cancerous prostatic cells. Androgenic deprivation can be accomplished surgically or medically. Cryotherapy:- Is one of the newer treatments use in the early stage of prostate cancer. This treatment kills the cancer cells by freezing them by inserting a freezing liquid (liquid nitrogen or argon) through needles directly into the prostate gland.

17. Chemotherapy It is used only for advanced metastatic prostate cancers that have failed to respond to other treatments. It is used as a palliative treatment. Estramustin (Emcyt), Mitoxantrone (Novantrone) is effective in combination with Prednisone for palliating androgen- independent prostate cancer. Herbal or other alternative medicine treatments It includes non-traditional treatments as herbs, dietary supplements, and acupuncture. Wedelia chinensis

18. Risk factors RACE DIET AGE FAMILY HISTORY

19. DIET DO’S  A balanced diet rich in fruits and vegetables.  Eat more plant-based food like soy protein.  Eat foods with lycopene (tomatoes, watermelon and red grapefruit) which may be associated with a decreased risk of prostate cancer.  Intake of vitamin E. DON’T’S  Eating red meat.  Processed and fried foods.  Vegetable oil is rich in a fatty acid.  Eating a diet high in fats.

20. Drugs under clinical trial Drugs/TherapyPhase Status Treatment Neoadjuvant therapy Phase II Completed Prostate cancer Selenium Phase III RecruitingProstate cancer Dutasteride Phase III CompletedProstate cancer Purified isoflavones & Methyl cellulose blend Phase II Recruiting Prostate cancer Degarelix Phase III RecruitingProstate cancer

21. Statistics:-  Man is 33% more likely to get prostate cancer than a woman is to get breast cancer.  One in every six men will get prostate cancer.  Over 2.8 million cases of prostate disease reported in 2010.  35% will be under the age of 65. Race/Ethnicity Male All Races159.3 per 100,000 men White153.0 per 100,000 men Black239.8 per 100,000 men Asian/Pacific Islander 91.1 per 100,000 men American Indian/Alaska Native 76.1 per 100,000 men Incidence Rates by Race

22. Articles Cancer researchers announce breakthroughs in natural prostate cancer prevention and treatment. 15/12/2009 - (Natural News). German scientists presented research showing that hops could play a role in preventing prostate cancer. Hops, the flowering clusters of the plant known to botanists as Humulus lupulus. Valera Seeks FDA Approval for Prostate Cancer Implant. Valera Pharmaceuticals has submitted a New Drug Application (NDA) to the Food and Drug Administration (FDA) for Vantas(TM), designed for the continuous 12-month administration of Histrelin, a luteinizing hormone releasing hormone (LHRH) for the palliative treatment of metastatic prostate cancer.

23. Organizations:- 1) Prostate Cancer Foundation (PCF) :- Founded in 1993 to find better treatments and a cure for prostate cancer. 2) Prostate Cancer Support Association (PSA) :- Providing support and information for all those affected by prostate cancer. 3) Give India:- Give India is a donation platform that allows you to support a cause of your choice from about 200 NGOs that have been scrutinized for transparency & credibility.

24. PROSTATE CANCER AWARENESS MONTH September 2010

25. References:-  http://www.medicinenet.com/script/main/hp.asp  http://www.medicinenet.com/diseases_and_conditions/articl e.htm  Recent advances in prostate cancer & BPH. -by F.H.Schrder  How to prevent & reverse prostate cancer. - by MIKE ADAMS

26. Thank you

27. Together we will beat prostate cancer