Prostatic

Cancer
Dr Messay Mekonnen

Prostatic Cancer

Incidence and etiology

Most common visceral malignancy
Second to lung cancer
Chance of a man acquiring pca during his lifetime is 15%.
Cause . unknown
Genetic influences.. 10% believed to be inherited.
.. 2-fold risk 1st -degree male relative
..5- to 10-fold risk 2 or 3 affected 1st -degree
relatives
Hormonal factors. androgen dependence
Chemical factors
Workers in the rubber, fertilizer, and textile
industries
Diet
A diet high in saturated fat
Insulin-like growth factor-1

Pca
Tumor histology and grading.
95% are adenocarcinomas
arising from prostatic acinar cells at the periphery of
the gland
SCC and TCC( 1% to 4%) of the prostate occur only
rarely

Prostatic Intraepithelial Neoplasia (PIN)

Consists of benign-appearing prostatic glands lined
by cytologically atypical cells.
low-grade and high-grade PIN, based on the
prominence of the nucleoli
6% of needle biopsy specimens have a finding of
high-grade PIN.
20% to 35% risk of cancer on subsequent biopsy

Pca

Adenocarcinoma.
The Gleason system
o five grades of glandular morphology
o two most prominent glandular
patterns are graded from 1 to 5.
o sum of these two grades will range
from 2 to 10
o 2 representing the most differentiated
& 10 representing the most anaplastic
tumors

Axiom for Early Detection:

If you dont look for it, you wont find it

Diagnosis

Prostate cancer was usually clinically silent until metastatic

disease

Symptom
signs

LUTS & metastatic

General
Focuesd

Digital rectal examination (DRE).

50% of suspicious lesions on DRE are proven cancerous on prostate
biopsy.

Size enlarged
Consistencyhard
Surface..Nodular
MobilityFixed

Diagnosis
PSA
a glycoprotein
specific to the prostate, but not to prostate cancer
correlates well with pathologic stage and tumor
volume.
levels are affected by androgen levels, prostate
volume, race, and age.

Transrectal US
hypoechoic regions with irregular borders.

Prostate biopsy
transrectal approach under US guidance
discrete nodules, focal induration, or a diffusely
hard prostate

pca
PSA

Prob CaP

How many How many

biopsied? cancers?

0-2

1%

Nobody

Almost none

2-4

15%

A few

A few

4-10

25%

Many

25%

>10

50%

Most

50%

prising if you dont perform a biopsy, you dont find d

Ultra sound

Prostatic Biopsy

Standard sextant biopsies sample the parasagittal

regions of the prostate at the apex, middle, and
base of the gland

PCA
Prostatic acid phosphatase
80% of pts with elevated PAP have metastatic
Bone scanning
useful in detecting metastatic disease

80% are osteoblastic lesions and 5% osteolytic

more sensitive than skeletal radiography

able to detect lesions up to 6 months before they are apparent on

x-ray films.
CT
can assess gross local extension
detect nodal metastases >2 cm

PCA

Route of spread.
Local invasion
lymphatic route
the external iliac (obturator group),
internal iliac
presacral nodes
.

Hematogenous routes
bone, lung, liver, and kidneys

PCA

Treatment
Clinical organ-confined (stages I and II)
Either EBRT, interstitial radiation, or radical prostatectomy

Locally invasive (stage III and T4, N0, M0)

Options include
Radical prostatectomy
External-beam radiation with or without interstitial
brachytherapy

Hormone therapy
watchful waiting. (aged 75 or older have a life expectancy of <10
years)

Metastatic (N1, M+ in any combination) disease

Androgen deprivation remains the primary treatment modality
response in up to 90% of patients but does not improve survival.

PCA

THANK
YOU