Carcinoma of the prostate Flashcards

1
Q

Carcinoma of the prostate

A
  • Most common cancer in men
  • 10% cancer mortality in men
  • Increasing incidence as more men getting checked
  • Hormonal factors important
  • Extremely variable
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2
Q

What are the prostatic Zones?

A
  1. Transition Zone (TZ): around urethra, site of BPH (benign prostatic hyperplasia), some carcinomas occur
  2. Peripheral one (PZ): atrophy, most carcinomas occur here
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3
Q

Incidence of prostatic cancer

A
  • Incidental tumours: all pops have a high incidence, increases with age
  • Clinically important tumours: marked variation- 20x higher in black amaericans than japan, changes with migration.
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4
Q

Factors contributing to prostatic carcinomas

A

Genetic Factors: familial incidence (high in black-americans)

Environmental: diet

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5
Q

What’s the issue with prostatic cancers clinical features?

A

That there are none (not specific ones anyway). Obstructive symptoms too late.

Only way to find is examination: firm area/nodule (finger on prostate)

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6
Q

How do we get a diagnosis with no symptoms?

A

PSA: protein specific antigen in the serum poor sensitivity/specificity

MRI

Biopsy

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7
Q

Macroscopic appearance of prostate cancer

A

Can be really hard to spot, as it is sneaky and just infiltrates, doesn’t change mass/size

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8
Q

Whats in this picture

A

Top: normal glandular prostate (higgildy piggildy with dark basal cells)

Bottom: adenocarcinoma, no basal cells

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9
Q

Grading of prostatic cancer.

A

“Gleason grading”: unique to prostatic

Patterns 1-5, add two most common patterns to get the score eg

“Gleasons score 7 (3 + 4)”

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10
Q

What are each leavel of gleason grading ?

A

1: not even cancer, proliferating condition
2: too regular, also not cancerous
3: lowest you can use for cancers, starting to become irregular
4: glands start to fuse together, no individual glands
5: diffusely infiltrating single cells or glands, necrosis in the middle

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11
Q

Issues with gleasons grading

A

Scores of 2-5 no longer used, lowest score is 6 (which then gets percieved as middle of the range by those that don’t know better).

Group scores lumped together even though prognosis may be different eg 7 could be (4 + 3) or (3 + 4)

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12
Q

New proposal for gleasons grading

A

Ensures “GI 6” is now the lowest grade

a 7 (3 + 4) is lower then a 7 (4 + 3)

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13
Q

Progression of prostatic cancer

A

Local spread: extraprostatic fat, seminal vesicles, other pelvic V. BAD!!!

Lymph nodes(uncommon): pelvic, aortic, can block off ureters

Distant metastasis: often to vertebrae

**the further out of the prostate → the higher the stage → the worse the prognosis

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14
Q

Prostatic Nerves

A

Main nerves run between prostate and rectum. These can be the way the cancer of the prostate goes out. These supply penis and can be damaged during prostate removal → further issues

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15
Q

TNM staging: T2, T3, T4

A

T2: in prostate

T3: out of prostate

T4: into rectum or bladder

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16
Q

3 categories of management

A

Small Low grade tumours: no treatment (active surveillance)

Significant Tumours: radical treatment

Advanced tumours: palliative treatment

17
Q

What is meant by “radical treatment”

A

Radical prostatectomy: whole prostate + seminal vesicles removed

Radical radiotherapy: into prostatic bed

18
Q

Palliation treatment includes

A

Anti-androgen treatment: castration or antiandrogen drugs

Palliative radiotherapy: local or metastases