Prostate Cancer Flashcards
What and where is the prostate gland?
Cone shaped solid organ in retroperioneum
Just below bladder
Anterior to rectum
No capsule
How much does the prostate gland weight?
20g
What does the prostate gland look like histologically?
Branched tubulo acinar glands with fibromuscular stroma
How much of seminal fluid does it secrete?
50%
How many zones can it be divided into?
4
What are 4 of the zones of the prostate?
Transition zone - 5% of tissue - BPH occurs here
- 20% of Pr. Ca
- Surround urethra
Central zone - 25% of tissue -
- Surrounds ejaculatory ducts at base of gland
Peripheral zone - 70% of tissue
- 75% of PC - Pulpable - Surrounds central zone
Anterior fibro muscular stroma
What is the verumontanum?
Where the ejaculatory ducts from seminal vesicles enter into prostatic urethra
Where is benign prostatic hyperplasia most common?
In the transition zone
Where is prostate cancer most common?
In the peripheral zone
What is the normal architecture of the prostate?
Lobular architecture
Large, irregularly shaped glands
2 cell layers - Epithelial cells + basal cells
Epithelium has folded/papillary appearance
Tall columnar cells with basaly located nuclei
Androgens control growth
What are the three main diseases of the prostate?
1) Inflammation (prostatitis)
2) Benign nodular enlargement (BPH) - most common
3) Tumours
How common is BPH?
Seen in all men over 50 yrs
Why does BPH generally result in lower urinary tract symptoms?
Obstruction and irritation of bladder due to occuring in transitional zone of prostate
What are some symptoms of BPH?
Increased pee frequency Dribbling Hard to initiate Decreased size + strength of stream Cannot post pone Pushing to get it out
Where does prostate cancer deaths rate?
3rd most common
Most diagnosed in men
What is chance at age 85?
1 in 5
What are some risk factors for prostate cancer?
Old age Family history Race High levels of testosterone Diets high in fat
What are symptoms of prostate?
Similar to BPH
Mostly asymptomatic
How is PC tested?
Palpation on digital rectal examination Symptoms Rectal ultrasound Tran rectal ultrasound guided biopsy (trusBX) Serum PSA
What is PSA?
Prostate specific antigen
What can raise PSA levels?
1) Age
2) BPH
3) Subclinical prostatitis
4) Prostate carcinoma
What is disease median age of prostate cancer diagnossi?
67
median age of 80 at death
How long is pre-clinical phase of prostate cancer?
10 or 15 years
What is the commonest epithelial malignancy of the prostate gland?
Acinar adenocarcinoma (>95%)
What are some other types of Epithelial neoplasms associated with PC?
Ductal adenocarcinoma
Adenosquamous Carcinoma
Small cell carcinoma
Sacromatoid carcinoma
What are the 4 characteristic histological features of prostate carcinoma?
1) Infiltrative glands - Too small, corwded and clear
2) Absence of basal cell layer
3) Large nuclei
4) Prominent nucleoli
What immunohistochemical stain cocktail can demonstrate absent basal cell layer in prostate Ca?
PIN4
What is the second most common form of prostate cancer?
Ductal adenocarcinoma
Why was ductal adenocarcinoma known as endometrioid adenocarcinoma?
Because it looks look similar to endometrioid adenocarcinoma
What is the current internationally accepted grading system for prostate cancer?
The Gleason score
What is the Gleason score based upon?
The architectual patterns of the tumour
- The more irregularly structured the worse
4x or 10x magnification
Not influenced by anything else
What are the most common sites of metastasis of prostate cancer?
Bone Lung Lymph nodes Liver Brain
Metastases often sclerotic on imaging
What are the 4 T stages of TNM staging key?
T1 = not palpable, incidentally discovered
T2= Organ confined
T3=Extends through capsule including seminal vesicles
T4= Invades adjacent structures
N1 = regional LN metastases
M1 = Distant metastases
What are the AJCC key components of prostate cancer staging?
TNM
Pre op serum PSA
Gleason score
What are some radical treatments for locally or advanced prostate cancer?
1) External Beam Radiotherapy
2) Radical radiotherapy and androgen deprivation therapy
3) Brachytherapy
4) Radical prostatectomy
How is advnaced/metastatic ca treated?
Endocrine therapy - Orchidectomy or administration of LHRH
What does the androgen receptor play a role in?
Normal development of prostate
Prostate carcinogenesis
Progression to metastasis
Have AR mutations been linked to PC?
Yes, especially in african american population
