Lecture 20: Carcinoma of the prostate Flashcards
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?
- Transition Zone (TZ): around urethra, site of BPH (benign prostatic hyperplasia), some carcinomas occur
- 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
MRI
Biopsy
Macroscopic appearance of prostate cancer
Replaces the normal tissue rather than growing from a ball like other tumours so is hard to distingish from normal prostate tissue at a macroscopic level.
Where is the carcinoma in this picture?
Top: normal glandular prostate (higgildy piggildy with dark basal cells)
Bottom: adenocarcinoma, no basal cells + enlarged nuclei
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)”
5 different Gleason patterns observed?
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/poorly formed glands
5: diffusely infiltrating single cells or glands, have a necrotic core
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
