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
