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Flashcards in Carcinoma of the prostate Deck (18)

Carcinoma of the prostate

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


What are the prostatic Zones?

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


Incidence of prostatic cancer

  • 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.


Factors contributing to prostatic carcinomas

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

Environmental: diet


What's the issue with prostatic cancers clinical features?

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

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


How do we get a diagnosis with no symptoms?

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




Macroscopic appearance of prostate cancer

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


Whats in this picture

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

Bottom: adenocarcinoma, no basal cells


Grading of prostatic cancer.

"Gleason grading": unique to prostatic

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

"Gleasons score 7 (3 + 4)"


What are each leavel of gleason grading ?

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


Issues with gleasons grading

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)





New proposal for gleasons grading

Ensures "GI 6" is now the lowest grade

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


Progression of prostatic cancer

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


Prostatic Nerves

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


TNM staging: T2, T3, T4

T2: in prostate

T3: out of prostate

T4: into rectum or bladder


3 categories of management 

Small Low grade tumours: no treatment (active surveillance)

Significant Tumours: radical treatment

Advanced tumours: palliative treatment


What is meant by "radical treatment"

Radical prostatectomy: whole prostate + seminal vesicles removed

Radical radiotherapy: into prostatic bed


Palliation treatment includes

Anti-androgen treatment: castration or antiandrogen drugs


Palliative radiotherapy: local or metastases