B/ 92 Tumors of the prostate

Question 1

Etiology

Answer 1

Most common visceral cancer in males. Second most common cause of cancer-related death after carcinoma of the lung. Disease of older males - latent cancers are very common.

Question 2

Pathogenesis

Answer 2

Androgens are thought to have a role on the development, but the exact mechanism is not known.
There is an increased risk amongst 1 degree relatives of patients who present with prostate cancer. There seems to be several susceptibility loci on chromosome 1.
In sporadic cases - hypermethylation of gluthatione S-transferase p1 is a common alteration. Also indicated in an over expression of ETS transcription factors.
Environmental factors are: diet rich in animal fat, and industrial work

Question 3

Morphology

Answer 3

70-80% arise in the outer glands (peripheral), thus these can be palpated during a rectal examination. Due to this location, urinary obstruction may occur only in ADVANCED stages.
Gross: Firm, gray-white to yellow lesions which infiltrate adjacent glands. Can give metastasis to pelvic lymph nodes. Advanced stages can lead to infiltration of the seminal vesicles and the periurethral zone of the prostate. Invasion of the rectum is very uncommon.
Microscopically: Most of the prostate cancers are adenocarcinomas with a varying degree of differentiation. It can range from well differentiated to anaplasia. In the case of adenocarcinoma, the glands are line by a single layer of epithelial cells - the basal cells are absent !

Question 4

PIN - Prostate intraepithelial neoplasia

Answer 4

A precursor lesion to carcinoma of the prostate. Found in glands adjacent to invasive carcinoma. Subdivided into high and low grade. High grade shares morphology with the invasive carcinoma.

Question 5

Grading system of prostate cancer

Answer 5

Gleason system

Question 6

PSA - Prostate specific antigen

Answer 6

Proteolytic enzyme produces in both normal, hyper plastic and neoplastic parenchyma of the prostate. It is secreted into the seminal fluid. It may be elevated in any condition which disrupts the normal architecture of the gland.

Question 7

Uses for PSA

Answer 7

Not specific for cancer - but can rather be used together with other screening methods or for use in follow-up in a patient receiving treatment for prostate cancer.

Question 8

Clinical features

Answer 8

Usually silent and are discovered incidentally. May produce discomfort and urinary tract obstruction . Bone metastasis is common, can be both osteoblastic and osteolytic.

Question 9

Staging system and treatment

Answer 9

TNM. Surgery, radiation and hormonal manipulation.