Lecture 23: Carcinoma prostate Flashcards
What makes the prostate difficult to target? and what factors can be used as a potential target?
- Prostate responds to androgens (treatment and pathogenesis)
- Variable biological behaviour makes it hard to target
What is the spectrum of prostate cancer?
- Incidental tumours (Benign, found post mortem)
- Clinically important tumours (Environment plays imp. role, migration has changed incidence in populations)
Describe the aetiology and pathogenesis of prostate cancer:
Genetic factors
- Familial (BRACA)
- Higher in black americans
Environmental
- Diet (obesity increases incidence)
What are the prostatic zones of importance when it comes to cancer?
(VIP to know)
Transition zone (occupies most of prostate with age)
- Around urethra
- Site of BHP
- Some carcinomas
Peripheral zone
- Atrophies
- Most carcinomas
What are the clinical features of prostate cancer?
- No specific symptoms, can cause obstruction or uinary flow… (Not till advanced)
- Examination = firm area/nodule, but doesnt always cause this to happen
What are some methods of prostate cancer diagnosis?
- PSA (Prostate specific antigen)
- DRE (Digital rectal examination)
- Transrectal US / MRI / PET + radio-opaque specific dye
- Biopsy
What are some notes on prostate biopsy?
Done transrectal or transperineal, transperineal is better for posterior prostate access
What does macroscopic examination of the prostate teach us?
Very hard to see where the cancer is because it has a diffuse nature and not well defined boundaries
When staining sections of prostate, what is evident with cancerous structures?
Prostate = glandular nature
Carcincoma = No basal cells, disorganised nature
What is prostate specific antigen testing?
- PSA liquifies semen coagulum
- Some is reabsorbed into blood (prostectomy = low levels)
- PSA increases in the blood with:
- > increasing prostate size, injury/inflam , age, post ejaculation and CARCINOMA
Does PSA always increase with carcinoma?
Carcinoma can cause PSA to become very high, but some carcinomas produce very little PSA
Therefore PSA is very unspecific and insensitive, they are developing a new test.
What is gleason grading?
Using grading metrics to define the primary and secondary patterns of prostate and combining the scores to define whether carcinoma or not.
Briefly definte the gleason grading system:
1-3: Circumscribed (ish) boundary + glandular tissue somewhat still well formed
4: Glands fuse together to form chain
5: Single cells in stroma, no glands OR tumour fills existing ducts.
What was the issues with the gleason grading?
Scores 1-5 no longer used. Lowest is a 6 now but can be confusing as seems middle of range.
Earlier combinations of scores can have same total but completely different prognosis
How is prostate progression defined?
Local Spread
Lymph nodes
Distant metastatis
Define the local spread of prostate cancer:
Cancer spreads into:
- Extraprostatic fat
- Seminal vesicles
- Other pelvic structures (Rectum bladder)
Describe the likely lymph node spread of prostatic cancer:
- Pelvic, aortic nodes - can block off ureters
Where does prostate cancer common metastasise to?
Vertebral bodies is common
What are the three categories of management of prostate cancer?
- Small low grade tumours = No treatment, just active surveillance (Incidental tumours)
- Significant tumours - Radical treatment
- Advanced tumours - Palliative treatment
What is the radical treatment?
- Radical prostectomy
- Radical radiotherapy
What is the palliative care for prostate cancer?
Anti-androgen treatment
- Castration
- Anti-androgen drugs
NB: Cancer can come back indp. of androgens
Palliative radiotherapy
- Local
- Metastases
What are potential pathologies of the bladder? whats most important?
- Congenital
- Diverticula
- Stones
- Inflammation
Most imp. Bladder carcinoma
Whats the incidence, aetiology and pathogenesis of bladder cancer?
Incidence: 3:1 males, older
Aetiology: Smoking, industrial chemicals (esp. dyes)
Pathogenesis: Arises from urothelial cell CIS
What are the clinical features of carcinoma of the bladder?
- Present with haematuria
- Often recurrent or new tumours
- Follow by urine cytology, cytoscopy
Whats the morphology of carcinoma of the bladder?
Macro: Most are papillary, may become invasive
Micro: Most are urothelial (transitional) epithelium, some squamous or adenocarcinoma
What is the treatment for bladder carcinoma?
Superficial: Local therapy, BCG (like TB) into the bladder
Once cancer is into detrusor muscle then cystectomy
What is the aetiology of renal cell carcinoma?
Smoking
Genetic -> von Hippel-Lindau disease
What is the macroscopic features of renal cell carcinoma?
- Well circumscribed mass
- Mottled red, yellow, brown
- Part cystic
- May invade renal vein (metastasise time)
What is the microscopic detail of adenocarcinoma?
Adenocarcinoma
- Clear cell variation most common
- Grade depends on nuclear features
What is the clinical features of renal cell carcinoma?
- Symptoms occur late
- Haematuria
- Flank pain
- Palpable abdominal mass
- Ectopic hormone production
= Polycythemia
= Hypertension
= Hypercalcemia
= Cushings syndrome
= Feminisation or masculisation
Where does renal cell carcinoma spread to?
- Local spread uncommon
Mainly blood borne: - Lungs, bones, liver, adrenals, brain
- Regional lymph nodes
Overal survivial: Around 40% @ 5 years
