Pro sta te 10/ 5/ 2017 COLLECTING CANCER DATA: PROSTATE 2017‐2018 NAACCR WEBINAR SERIES Q&A • Please submit all questions concerning webinar content through the Q&A panel. • Reminder: • If you have participants watching this webinar at your site, please collect their names and emails. • We will be distributing a Q&A document in about one week. This document will fully answer questions asked during the webinar and will contain any corrections that we may discover after the webinar. 2 NAACCR 2017-2018 We b ina r Se rie s 1
Pro sta te 10/ 5/ 2017 Fabulous Prizes 3 AGENDA • Anatomy • Multiple Primary and Histology Rules • Epi Moment • Staging • Treatment 4 NAACCR 2017-2018 We b ina r Se rie s 2
Pro sta te 10/ 5/ 2017 ANATOMY PROSTATE 5 ANATOMY By Created by US government agency National Cancer Institute ‐ http://www.cancer.gov/cancertopics/wyntk/prostate/allpages#ab3d 4f20‐6ab9‐4428‐9717‐067035d2e691, Public Domain, https://commons.wikimedia.org/w/index.php?curid=837427 6 NAACCR 2017-2018 We b ina r Se rie s 3
Pro sta te 10/ 5/ 2017 ZONES OF THE PROSTATE • Peripheral Zone • BPH • 10‐15% of prostate cancers • Surrounds the distal urethra • Anterior Zone • 80‐85% of prostate cancers • Central Zone • Composed of muscle and fibrous tissue • Surrounds ejaculatory ducts • Most of the prostate • 5‐10% of prostate cancers • Transitional Zone • Surrounds proximal urethra • Grows throughout life 7 LOBES OF THE PROSTATE Lateral Lobes Prostatic Capsule Anterior Lobe Urethra Median Lobe Ejaculatory Ducts Posterior Lobe 8 Image Source: SEER Training Modules NAACCR 2017-2018 We b ina r Se rie s 4
Pro sta te 10/ 5/ 2017 LOBES AND ZONES OF PROSTATE Lobes of Prostate Zones of Prostate Anterior Lobe Part of the transitional zone Posterior Peripheral zone Right and Left Lateral Lobes Spans all zones Median lobe Part of Central Zone 9 REGIONAL LYMPH NODES • Pelvic, NOS • Hypogastric • Obturator • Iliac (internal, external or NOS) • Sacral (lateral, presacral, promontory gerota’s, or NOS) 10 NAACCR 2017-2018 We b ina r Se rie s 5
Pro sta te 10/ 5/ 2017 METASTATIC SITES • Distant Lymph Nodes • Bone • Aortic (paraortic lumbar) • Lung • Common iliac • Liver • Inguinal, deep • Superficial inguinal (femoral) • Brain • Supraclavicular • Cervical • Scalene • Retroperitoneal Duke University Medical Center. "Where prostate cancer spreads in the body affects survival time." ScienceDaily. ScienceDaily, 7 March 2016. <www.sciencedaily.com/releases/2016/03/160307184040.htm> 11 2018 TEASERS MULTIPLE PRIMARY AND HISTOLOGY RULES AND GRADE 12 NAACCR 2017-2018 We b ina r Se rie s 6
Pro sta te 10/ 5/ 2017 CHANGES TO HISTOLOGIES IN PROSTATE • Acinar Adenocarinoma, sarcomatoid • New term • Histology code 8572 13 GRADE Gleason Grade Score Code • Instructions for Coding Grade for 2014+ 2 1 • https://seer.cancer.gov 3 1 • Use the highest Gleason score from the 4 1 biopsy/TURP or prostatectomy/autopsy. 5 1 6 1 • Use a known value over an unknown 7 2 value. 8 3 • Exclude results from tests performed 9 3 after neoadjuvant therapy began 14 10 3 NAACCR 2017-2018 We b ina r Se rie s 7
Pro sta te 10/ 5/ 2017 POP QUIZ 1 • Pathology from needle core biopsies Data Item Value of the prostate Grade 3 • Gleason pattern/score 3+4=7 • Pathology from prostatectomy • Gleason pattern/score 4+4=8 15 Code Description GRADE CLINICAL 1 Grade Group 1: Gleason score less than or equal to 6 GRADE PATHOLOGICAL 2 Grade Group 2: Gleason score 7 GRADE POST‐NEOADJUVANT Gleason pattern 3+4 3 Grade Group 3: Gleason score 7 • For cases diagnosed 2018+ Gleason pattern 4+3 • Two data items 4 Grade Group 4: Gleason score 8 5 Grade Group 5: Gleason score 9 or 10 • Grade Clinical is pre‐treatment A Well differentiated B Moderately differentiated • Grade Pathological is grade from the C Poorly differentiated resected specimen (pT) or clinical D Undifferentiated, anaplastic grade. Whichever is higher. E Stated as “Gleason score 7” with no patterns • Grade Post‐neoadjuvant is grade post documented or treatment Any Gleason patterns combination equal to 7 not specified in 2 or 3 • Linked to site/histology 16 9 Grade cannot be assessed; Unknown • Codes 1‐5 take precedence over A‐D Not applicable NAACCR 2017-2018 We b ina r Se rie s 8
Pro sta te 10/ 5/ 2017 POP QUIZ 2 A patient had biopsies of the prostate followed by a prostatectomy. Below are the path reports. Data Item Value • Pathology from needle core biopsies of the prostate Clin Grade 2 • Gleason pattern/score 3+4=7 Path Grade 4 • Gleason Grade Group 4 2 Post Therapy blank • Pathology from prostatectomy Grade • Gleason pattern/score 4+4=8 • Gleason Grade Group 3 4 17 QUESTIONS? 18 NAACCR 2017-2018 We b ina r Se rie s 9
Pro sta te 10/ 5/ 2017 EPI MOMENT 19 “official” theme song Superman https://www.youtube.com/watch?v=c8AF6gx8CY0 COLLECTING CANCER DATA: PROSTATE EPI MOMENT: RECINDA SHERMAN, OCT 5 TH , 2017 NAACCR 2017-2018 We b ina r Se rie s 10
Pro sta te 10/ 5/ 2017 BURDEN OF PROSTATE CANCER 21 ETIOLOGY OF PROSTATE CANCER • Inheritable gene mutations (BRCA1 & BRCA2) • Age (65+), race/ethnicity, geography • Life style factors – diet unclear • High testosterone levels (TRT‐‐stimulates growth of prostate) • Environmental • Fire fighting chemicals, Agent Orange (possible) • Unclear relationship • STI, diet, inflammation, vasectomy • Unlikely causal • Obesity, smoking • Possibly protective • “clear the pipes” 22 NAACCR 2017-2018 We b ina r Se rie s 11
Pro sta te 10/ 5/ 2017 PROSTATE CANCER PROGNOSIS Prostate Cancer Survival (5‐year RSR) 100 90 80 70 60 50 40 30 20 10 0 White Black Local Reginoal DistantUnknown 15‐44 45‐54 55‐64 65‐74 75+ 23 PROSTATE CANCER SCREENING 24 NAACCR 2017-2018 We b ina r Se rie s 12
Pro sta te 10/ 5/ 2017 25 PSA SCREENING & PROSTATE INCIDENCE 26 NAACCR 2017-2018 We b ina r Se rie s 13
Pro sta te 10/ 5/ 2017 RECENT TRENDS, 2011‐2015 Male Delay‐Adjusted Incidence Rates Current Trend Site 5 Year AAPC Cases per 100,000 Mortality Prostate -7.6* (-10.5 - -4.7) 118.2 118.2 Lung and bronchus -2.4* (-2.8 - -2.0) 73.2 73.2 Colon and rectum -1.9* (-3.2 - -0.6) 46.5 46.5 Declines 4% Urinary bladder -0.8* (-1.0 - -0.7) 36.8 36.8 Melanoma of the skin +2.3* (2.0 - 2.6) 27.4 27.4 Non-Hodgkin lymphoma -0.2 (-0.5 - 0.1) 23.7 23.7 Kidney and renal pelvis +1.1* (0.5 - 1.8) 22.3 22.3 Leukemia +1.6* (1.1 - 2.1) 19.0 19.0 Oral cavity and pharynx +1.3* (1.0 - 1.6) 17.7 17.7 Pancreas +1.0* (1.0 - 1.1) 14.5 14.5 Liver and intrahepatic bile duct +2.8* (2.0 - 3.6) 12.5 12.5 Stomach -0.3 (-0.7 - 0.1) 9.4 9.4 Myeloma +2.5* (2.0 - 3.0) 8.7 8.7 Esophagus -1.6* (-2.3 - -1.0) 8.1 8.1 Brain and other nervous system -0.2* (-0.3 - -0.1) 7.9 7.9 Thyroid +2.4* (1.3 - 3.5) 7.3 7.3 Larynx -2.3* (-2.4 - -2.1) 6.1 6.1 * AAPC is statistically significantly different from zero (two-sided P < .05). 27 QUIZ 1 28 NAACCR 2017-2018 We b ina r Se rie s 14
Pro sta te 10/ 5/ 2017 SUMMARY STAGE 2000 SUMMARY STAGE 2018 1‐LOCALIZED • Confined to the prostate • Invasion into, but not through prostatic capsule Source: National Cancer Institute (NCI) Creator: NIH Medical Arts NAACCR 2017-2018 We b ina r Se rie s 15
Pro sta te 10/ 5/ 2017 2‐REGIONAL BY DIRECT EXTENSION ONLY • Direct extension beyond the prostate • Extracapsular extension • Bladder • Seminal vesicle(s) • Skeletal muscle, NOS • Ureter(s) • Direct extension to bone is By Created by US government agency National Cancer Institute ‐ 7‐distant mets http://www.cancer.gov/cancertopics/wyntk/prostate/allpages#ab3d 4f20‐6ab9‐4428‐9717‐067035d2e691, Public Domain, https://commons.wikimedia.org/w/index.php?curid=837427 31 3 REGIONAL TO LYMPH NODES • Iliac, NOS • 3‐Regional lymph node(s) • External involved only • Internal (hypogastric) • Obturator • Pelvic, NOS • Periprostatic • Sacral, NOS: • Lateral (laterosacral) • Middle (promontorial) • Presacral 32 • Regional lymph node(s), NOS http://training.seer.cancer.gov/lymphoma/anatomy/chains/pariental‐pelvis.html NAACCR 2017-2018 We b ina r Se rie s 16
Pro sta te 10/ 5/ 2017 7‐DISTANT SITE(S)/LYMPH NODE(S) INVOLVED • Distant Lymph Nodes • Direct extension or fixation to: • Pelvic wall or pelvic bone • Penis • Sigmoid colon • Other direct extension • Discontinuous metastasis 33 AJCC STAGING 7 TH EDITION WITH AN 8 TH EDITION TEASER 34 NAACCR 2017-2018 We b ina r Se rie s 17
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