B92 tumors of the prostate

Question 1

Prostate tumors

Answer 1

just Adenocarcinoma!

Question 2

PRostate adenocarcinoa epedemiology and general

Answer 2

The most common male cancer, 1/4 of all male cancers. 2nd highest cause of cancer death in males.

Occurs usually in men over 50 years.

It is currently not possible to distinguish benign vs. malignant prostate tumors with certainty.

Question 3

Prostate adenocarcinoma, morphology, histology

Answer 3

Gross morphology:

• gray/white, firm
• irrigular indistinct margin, no capsul
• Is more firm and solid looking than the surrounding spongy looking prostate tissue.
• not cystic or hemorrhagic, or lobulated.

Histology:

Low grade adenocarcinoma:

• Produces well differentiated, defined glands
• They are smaller than normal/benign glands
• There is no branching or papillary infolding into the glands, while this is often seen in the larger, normal prostate glands
• Nuclei are enlarged and have more prominent nucleoli, but there is minimal pleomorphism
• Mitotic figures are rare
• Atypical epethelium is key, there is just a single layer of epithelium around the glands, with no basal cells.
• The neoplastic cells may, but are not alwasy, be darker staining and more basophilic than normal glands.

High grade prostate adenocarcinoma

• Glands are more irregular, or incomplete
• Sheets or isolate clusters of non-gland forming cells are seen.
• Infiltrating strings or bands of very poorly differentiated cells are seen moving through normal tissue or are surrounded by acellular stroma.

Question 4

Prostate cancer grading system

Answer 4

The Gleason system. 5 grades based on degree of differentiation and the types of glandular patterns.

Are assigned two numbers since they usually express more than one pattern. First grade is for the dominant patter, second grade is for the next most frequent pattern. Only one pattern, the grade is just doubled.

Grade 1: well differentiated, forming clear, mostly normal looking glands (without the basal layer)

Grade 5: very undifferentiated with no glands.

The total grade is the sum of the two numbers. minimum 2, max 10.

Question 5

Where do prostate tumors most frequently arise?

Answer 5

80% arise in the outer, peripheral gland. This location is palpable, and may be felt if the tumor is large enough.

Most nodular hyperplasia arises in the central zone and is more likely to obstruct urine flow.

Question 6

Porstate cancer presentation, symptoms, prognosis

Answer 6

Symptoms

• Asymptomatic, or can obstruct urine flow.
• May be felt on digital rectal exam, or may be too small
• Elevates PSA, a serine protease which normally cleaves seminal fluid coagulation. 4ng/mL normal cutoff for elevation.
• Not very specific, but after cancer is diagnosed, tracking PSA is a good marker for measuring cancer growth/shrinkage.

Metastases:

• First infiltrates to: seminal vesicles, adjacent soft tissue, wall of the urinary bladder, and less often to the rectum .
• Later, metastases to: Bone of axial skeleton.

Treatment:

• In low grade cases, of elderly or young men with low PSA, “watchful waiting” can be recommended, since they can be indolent for many years and surgery may cause more problems.
• Prostatectomy
• Radiotherapy
• Metastacized prostate cancer: Adrogen deprivation - orchiectomy, or LHRH blockers.

Prognosis:

• based on gleason grade, and stage (metastases), and also PSA values

Staging:

1. T1 ‐ Clinically inapparent lesion (palpation/imaging).
2. T2 ‐ Palpable or visible carcinoma confined to the prostate.
3. T3 ‐ Local extraprostatic extension.
4. T4 ‐ Invasion of contiguous organs and/or supporting structures (bladder neck,
   rectum etc).

Question 7

Precursor lesion to prostate cancer

Answer 7

Prostatic intraepithelial neoplasia

dense, piled up epithelial cells around abnormally small glands.

If PIN is found there is adenocarcinoma present elsewhere ~50% of the time.