1 VI Podkarpackie Warsztaty Endoskopowe 25.11.2016r. KrosnoNowoczesna diagnostyka raka prostaty. Biopsja fuzyjna vs. standardowa biopsja VI Podkarpackie Warsztaty Endoskopowe r. Krosno

2 RAK STERCZA DANE EPIDEMIOLOGICZNELek. Wojciech Tomkalski Wojewódzki Szpital Podkarpacki im. Jana Pawła II w Krośnie Oddział Urologii i Urologii Onkologicznej Kierownik Oddziału: Dr n. med. Dariusz Sobieraj

3 Among men alive today, it is estimated that 1 in 7 (15Among men alive today, it is estimated that 1 in 7 (15.3%) will be diagnosed with prostate cancer and 1 in 38 (2.6%) will die from this Disease Brawley et al, 2012a

4 Świat

5 Świat - zachorowalnośćThe incidence rate rose by approximately 2% per year from 1975 to the late 1980s, related in part to the incidental detectionof prostate cancer associated with the use of transurethral resectionof the prostate for benign prostatic hyperplasia Potosky AL, Kessler L, Gridley G, et al. Rise in prostatic cancer incidence associated with increased use of transurethral resection. J Natl Cancer Inst 1990;82:1624–8. The incidence of prostate cancer rose dramatically from 1989 to 1992 after the introduction of a prostate-specific antigen (PSA) screening test Siegel R, Ma J, Zou Z, et al. Cancer statistics, CA Cancer J Clin 2014; 64:9–29.

6 Świat – wiek postawienia diagnozyProstate cancer is rarely diagnosed in men less than 50 years of age, accounting for only 2% of all cases. Jani AB, Johnstone PA, Liauw SL, et al. Age and grade trends in prostatecancer ( ): a Surveillance, Epidemiology, and End Results Registry analysis. Am J Clin Oncol 2008;31:375–8. Prior to the PSA era, median age at diagnosis was 70 years, falling to 67 years over the past decade, with 63% diagnosed after age 65 Ries LAG, Melbert D, Krapcho M, et al, editors. SEER Cancer Statistics Review, Bethesda (MD): National Cancer Institute; 2008.

7 Świat – stopień zaawansowania w momencie diagnozySince the introduction of PSA testing, 81% of newly diagnosed men have localized disease, whereas the incidence of metastatic disease has decreased by 75% Newcomer LM, Stanford JL, Blumenstein BA, et al. Temporal trends in rates of prostate cancer: declining incidence of advanced stage disease, 1974 to J Urol 1997;158:1427–30. Nonpalpable cancers (AJCC clinical stage T1c) now account for 60% to 75% of newly diagnosed disease Gallina A, Chun FK, Suardi N, et al. Comparison of stage migration patterns between Europe and the USA: an analysis of men treated with radical prostatectomy for prostate cancer. BJU Int 2008;101:1513–8.

8 Świat - umieralność The observed decline in mortality since 1991 may be due to: (1) early detection and stage migration from PSA screening, (2) increased utilization and effectiveness of curative treatments, (3) changes in the attribution of cause of death, (4) improvementsin therapy for advanced disease, or ( (5) increased risk ofdeath from secondary causes among men receiving prostatecancer therapy Brawley et al, 2012b (6)The result of the more aggressive treatmentof prostate cancer that began in the 1980s Walsh PC. 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 Urol 2000;163:364–5. (7)the vast majority of men diagnosed with prostate cancersince 1986 have received curative-intent therapy at a rate doublethat observed before 1986 Etzioni R, Tsodikov A, Mariotto A, et al. Quantifying the role of PSA screening n the US prostate cancer mortality decline. Cancer Causes Control 2008;19:175–81.

9 Różnice rasowe Differences in treatment patterns by race have consistently shown that African-Americans at every stage get less aggressive therapy regardless of age, marital status, tumor risk, and Comorbidities status compared to Caucasians, even within equal-access health care systems Klabunde et al, 1998; Hoffman et al, 2003; Shavers et al, 2004; Gross et al, 2008; Nambudiri et al, 2012; Presley et al, 2013 Even among those treated with “watchful waiting,” African-Americans receive less intensive follow-up Shavers VL, Brown ML, Potosky AL, et al. Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer. J Gen Intern Med 2004;19:146–55. Japanese immigrants have an incidence more comparable to men of similar ancestry born in the United States than to those living in Japan Shimizu H, Ross RK, Bernstein L, et al. Cancers of the prostate and breastamong Japanese and white immigrants in Los Angeles county. Br J Cancer 1991;63:963–6.

10 Różnice geograficzne Age-standardized incidence rates per 100,000 men are highest in the highest income regions of the world, including North America (85.6), the Caribbean (71.1), Australia and NewZealand (104.2), Western Europe (93.1), and Scandinavia (73.1),and lowest in Asia (7.2) and Northern Africa (8.1). In 32 of40 countries analyzed, increasing incidence rates over the last one to two decades were observed, and they had stabilized in 8 countries, including the United States, Canada, and Australia, where there was early adoption of PSA screening. Hsing AW, Tsao L, Devesa SS. International trends and patterns of prostate cancer incidence and mortality. Int J Cancer 2000;85:60–7.

11 Polska Didkowska Joanna, Wojciechowska Urszula. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie.

12 Polska - zachorowalnośćDidkowska Joanna, Wojciechowska Urszula. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie.

13 Polska na tle Europy - Zachorowalność69,5 32,3 Zachorowalność  na nowotwory gruczołu krokowego w Polsce jest niższa o około 45% niż przeciętna dla krajów Unii Europejskiej - w 2010 roku współczynnik umieralności wynosił 32,3/105, natomiast średnia dla krajów Unii Europejskiej (dane z 2009 roku) – 69,5/105 (rys. 6).  Didkowska Joanna, Wojciechowska Urszula. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie.

14 Polska na tle Europy - Umieralność12,1 Umieralność z powodu nowotworów gruczołu krokowego w Polsce jest nieco wyższa niż przeciętna dla krajów Unii Europejskiej - w 2010 roku współczynnik umieralności wynosił 12,4.105, natomiast średnia dla krajów Unii Europejskiej (dane z 2009 roku) – 12,1/105. (rys. 5).  Didkowska Joanna, Wojciechowska Urszula. Zachorowania i zgony na nowotwory złośliwe w Polsce. Krajowy Rejestr Nowotworów, Centrum Onkologii - Instytut im. Marii Skłodowskiej - Curie.

15 Województwo PodkarpackieZakład Epidemiologii i Podkarpacki Rejestr Nowotworów . Podkarpackie Centrum Onkologii 

16 GRUCZOŁ KROKOWY C61 (zachorowania i zgony dla województwa podkarpackiego za lata 2000-2010)– wskaźnik surowy na 100 000 Zakład Epidemiologii i Podkarpacki Rejestr Nowotworów . Podkarpackie Centrum Onkologii 

17 woj. Podkarpackiego w latach 1999- 2011Zachorowalność i umieralność na nowotwór gruczołu krokowego w powiatach woj. Podkarpackiego w latach Zakład Epidemiologii i Podkarpacki Rejestr Nowotworów . Podkarpackie Centrum Onkologii 

18 VI Podkarpackie Warsztaty Endoskopowe 25.16 2016r. KrosnoNowoczesna diagnostyka raka prostaty. Biopsja fuzyjna vs. standardowa biopsja VI Podkarpackie Warsztaty Endoskopowe r. Krosno