Cancer Of The Prostate

Question 1

What are some risk factors of cancer of the prostate

Answer 1

Age - The prevalence of prostate cancer rises with age and after age 50, both incidence and mortality rates increase at a near exponential rate
Family and genetic factors - a. Hereditary (a cluster of 3 or more affected relatives within any nuclear family), b. Familial (The occurrence of the disease in each of 3 generations in the patient’s paternal or maternal lineage), c. Sporadic (a cluster of 2 relatives affected at 55 years or less)
Race
Cell behavior and cell cycle such as decreased cell death, increased activity of growth factors, oncogenes and anti-oncogenes

Question 2

What are some probable risk factors of prostate cancer

Answer 2

Dietary fat: Prostate cancer has risen among Japanese since their diets have now been westernized
Hormones: Testosterone and its more potent metabolite DHT are necessary for normal prostate epithelium to grow and early prostate cancer is endocrine-dependent. However no correlation has been found between circulating androgens and raised 5-alpha reductase levels and higher incidence of the disease but prostate cancer seldom develops in men castrated before puberty and individuals with deficiency in 5-alpha reductase

Question 3

What are some potential risk factors of prostate cancer

Answer 3

Vasectomy under 35 years
Cadmium: Weak association to prostate cancer. Cadmium exposure occurs in cigarette smoking, alkaline batteries and electric plating
High vitamin A intake (high animal fat intake)
Sexual behavior: Sexually active men. Even herpes simplex type 2 virus has been implicated. This theory is not widely accepted

Question 4

How can you prevent prostate cancer

Answer 4

Decreased GF activity
High levels of selenium
Green tea
Vitamins D and E
Retinoic acid
Anti-androgens like flutamide, finesteride and casodex have the potential for chemoprevention

Question 5

Mention some anti-androgens

Answer 5

Finesteride
Flutamide
Casodex

Question 6

What are some types of prostate malignancy

Answer 6

Adenocarcinoma (85% of cases):
Ordinary adenocarcinoma
Mucinous adenocarcinoma
Ducts aggressive type
Neuroendocrine differentiation
Small cell carcinoma

Transitional cell carcinoma (arises from the bladder neck and prostatic urethra)
Pure primary squamous cell carcinoma
Sarcomas
Lymphomas (may be primary and secondary to lymphocytic leukemia and lymphoblastic leukemias)

Question 7

Which type of adenocarcinoma or the prostate is the most aggressive

Answer 7

Small cell carcinoma

Question 8

Which type of adenocarcinoma of the prostate has a more aggressive biological behavior of progression and metastasis but not the most aggressive

Answer 8

Mucinous adenocarcinoma

Question 9

Prostatic sarcomas include

Answer 9

Rhabdomyosarcoma
Leiomyosarcoma
Carcinosarcomas

Question 10

Rare prostate malignancy
Has a poor prognosis
Produces osteolytic metastasis
No elevated PSA or PAP levels
What condition might this be

Answer 10

Pure primary squamous cell carcinoma of the prostate

Question 11

Which zone of the prostate do about 70-80% of prostate cancers originate from

Answer 11

Peripheral zone (PZ) which is felt in the posterior part of the lateral prostate on DRE

Question 12

About 20% of prostate cancers arise in …….. and about 10% arise in the ………

Answer 12

TZ, CZ

Question 13

Adenocarcinoma of the prostate is bifocal
True or false

Answer 13

False
Multifocal with 2-3 foci in more than 85% of cases

Question 14

What are some examples of adenocarcinomas of the prostate

Answer 14

Ordinary adenocarcinoma
Mucinous adenocarcinoma
Ducts aggressive type
Neuroendocrine differentiation
Small cell carcinoma

Question 15

What is the Gleason grading system

Answer 15

Gleason grading system for prostatic adenocarcinoma: This is based on the glandular pattern of the tumor. Both the predominant and secondary (second most prevalent) architectural patterns are identified and assigned a grade I to 5 with 1 as the most differentiated and 5 the least differentiated. Because prostate cancers are heterogeneous, the numbers of the 2 most prominent grades are added to produce a combined Gleason grade and Gleason score which ranges from 2 to 10. Gleason scores (GS) higher than 4 are associated with a risk of more rapid disease and lower survival

Question 16

How is prostate cancer spread

Answer 16

Local spread
The tumour may involve the whole gland and by its constricting effect on, or growth into, the prostatic urethra cause outflow obstruction of the bladder. It may grow upwards to involve the seminal vesicles, the lower ends of one or both ureters and the base of the bladder.The anterior rectal wall and pelvic cellular tissue may all be infiltrated. There is also local spread to the neurovascular bundle, rectum, pelvic plexus and lymph nodes

Spread by the bloodstream
Cancellous bones are involved by bloodspread. The bones most continually affected are the pelvic, lumbar and cervical vertebrae, upper ends of the femur, ribs, sternum and skull. The sacrum and lumbar vertebrae are involved via the connections between the prostatic venous plexus and vertebral veins through the valveless pre-vertebral veins of Batson. Carcinoma of the prostate is the commonest site of origin of bony metastases followed by the breast, kidney, bronchus and thyroid. The bony deposits are usually osteoblastlc (85%), at times osteolytic (15%). Pathological fractures of vertebrae and long bones may occur.
The liver, lungs, brain, spinal cord, skin, and the palate may also be involved.

Lymphatic spread
It is also a common mode of spread. The internal and external iiiac lymph nodes and later the para-aortic and mediastinal nodes are all affected. Occasionally the inguinal nodes are also involved by retrograde spread. Oedema of the lower limbs, penis and scrotum may, therefore, occur.
The tumour cells invade the perineural lymphatics and cause back pain by irritation