Prostate Cancer 3

Question 1

What is the most common histologic type of prostate cancer?

Answer 1

Adenocarcinoma arising from the prostatic acini

Question 2

How is the potential aggressiveness of prostate cancer evaluated?

Answer 2

• Gleason grading system that has 5 different patterns
  
  • nearly normal looking glandular tissue (Gleason pattern 1)
  • cords and sheets of anaplastic cancer cells (Gleason pattern 5)

Question 3

How does the Gleason system score prostate cancer?

Answer 3

• The score of the primary (majority) pattern is added to the score of the secondary (minority) pattern to yield a Gleason sum, ranging from 2 to 10
• In recent years, the Gleason system has evolved into a limited number of sums, ranging from 3+3 = 6 (mildly aggressive) to 3+4=7 (low end of moderately aggressive) to 4+3 = 7 (high end of moderately aggressive) to 4+4 = 8, 4+5 = 9 or 5+4 =9 (highly aggressive)

Question 4

How is staging done in higher-risk patients with prostate cancer?

Answer 4

• Radionucleotide bone scan and a CT or MRI scan of the abdomen and pelvis, looking for local extension of the cancer into the periprostatic tissues, lymph node involvement or bone metastases
  
  • stage T1
    
    • microscopic tumor confined to the prostate gland that is palpably normal on DRE
    • most common stage is T1c in which tumor is discovered through a biopsy performed because of an elevated PSA
  • stage T2 denotes palpable tumor confined to the gland
  • stage T3 denotes tumor that has begun to extend beyond the prostate
  • stage T4 denotes a tumor that is fixed and has invaded adjacent organs
  • N1 denotes lymph node metastases and M1 distant metastases, usually to bone
    
    • however prostate cancer can metastasize to any organ.