A brief review on prostate and prostate cancer

Get to know about the walnut sized gland and the second most commonly diagnosed cancer in the world.

1. 24.04.24
Prostate cancer
Deepak Krishna Muthukrishnan

2. Overview
An overview of prostate ?
•Prostate is about the size of a walnut.
•Weighs about 1 ounce (30 grams).
•The prostate and seminal vesicles are part of the male reproductive system.
•The prostate sits below the bladder, in front of the rectum. It surrounds the urethra, a
small tube that carries urine from the bladder out through the penis.
•Function of the prostate and seminal vesicles is to make fluid for semen. (During ejaculation,
sperm moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the
urethra. This mixture— semen—goes through the urethra and out of the penis as ejaculates.)
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3. Anatomy
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6. Zonal Anatomy
1.Transition zone — surrounds the prostatic urethra.

This zone enlarges in aging men resulting in benign prostatic hyperplasia.
2.Central zone — lies in the base of the prostate behind the transition zone and surrounds
the left and the right ejaculatory duct.
3.Anterior fibromuscular stroma — is a small area of tissue that is situated on the
anterior side of the prostate.
4.Peripheral zone — is situated on the posterior and lateral side of the prostate.


70-75% of all prostate cancers originate in the peripheral zone (PZ).

25% of prostate cancers originate in the transition zone (TZ).

7. 1.Due to cause / risk groups
2.Mutation & abnormal cell division
3.Prostate enlargement
4.Urethral obstruction
5.Proliferation to surrounding tissue
6.Metastasis to lymph nodes
7.Prostate cancer
Pathophysiology
The exact
pathophysiology is not
yet clearly understood.

8. The uncontrolled cell growth in the prostate gland.
What is prostate cancer ?
▪Benign growths (example; BPH), are not life
threatening. They do not spread to nearby tissue or
other parts of the body. These growths can be
removed and may grow back slowly (but often do not
grow back).
▪Cancerous growths, (example; prostate cancer), can
spread to nearby organs and tissues such as the
bladder / rectum, or to other parts of the body. If the
abnormal growth is removed, it can still grow back.
Prostate cancer can be life threatening if it spreads far
beyond the prostate (metastatic disease).
Classification : 2
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9. Epidemiology
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10. •Prostate cancer is the second most commonly diagnosed cancer
•Fifth leading cause of cancer death among men worldwide, with an estimated 1,414,000
new cancer cases and 375,304 deaths in 2020.
•Almost 300,000 new cases are expected this year.

11. Who are at risk ?
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12. All men are at risk for prostate cancer.
1.African-American men
•Are more likely to get prostate cancer than other men.
•Are more than twice as likely to die from prostate cancer than other men.
•Get prostate cancer at a younger age and tend to have more advanced disease when it is found.
2.Age
3.Family history
4.Overweight
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AUA (American urological association) criteria :

13. Early detection
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14. American Cancer Society Recommendations
•Age 50 for men who are at average risk
of prostate cancer and are expected to live at least 10 more years
•Age 45 for men at high risk
of developing prostate cancer. This includes African American men and men who
have a first-degree relative (father or brother) diagnosed with prostate cancer at an
early age (younger than age 65).
•Age 40 for men at even higher risk
(those with more than one first-degree relative who had prostate cancer at an early
age)

15. Are there any
stages ?
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16. They are grouped into “4” stages :
▪Stages I & II (Early-stage): The tumor has not spread beyond the prostate.
▪Stage III (Locally Advanced): Cancer has spread outside the prostate, but only to
nearby tissues.
▪Stage IV (Advanced): Cancer has spread outside the prostate to other parts such as
the lymph nodes, bones, liver or lungs.
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17. Symptoms
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18. In early stages; no symptoms.
When symptoms do occur; it could be that of enlarged prostate or BPH.
1.Dull pain in the lower pelvic area
2.Nocturia
3.Trouble emptying bladder, pain, burning, or weak urine flow
4.Hematuria 
5.Painful ejaculation
6.Pain in the lower back, hips or upper thighs & bones
7.Loss of appetite & weight

19. How do you screen
them ?
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20. Biopsy
Gold standard :
12-core transrectal
ultrasound-guided prostate
biopsy (TRUS-B).

21. Bard magnum gun with needle

22. PSA
•Measures a protein in your blood called the prostate-specific antigen (PSA). Results for
this test are usually shared as nanograms of PSA per milliliter (ng/mL) of blood.
•It is used to stage cancer, plan treatment and track how well treatment is going. A rapid
rise in PSA may be a sign something is wrong.
•The PSA test is not used alone to make a diagnosis.

23. DRE
•A physical exam used to help your doctor feel for changes in your prostate.
•During this test, the doctor feels for an abnormal shape, consistency, nodularity or
thickness to the gland.
•For this exam, the doctor puts a lubricated gloved finger into the rectum.
•The DRE is safe and easy, but cannot spot early cancer by itself.
•It is often done with a PSA test. Together, the PSA and DRE can help to find prostate
cancer early, before it spreads.
•Early prostate cancer treatment may stop or slow the spread of cancer.

25. If no prostate
cancer on screening
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26. Depends on the results of the PSA blood test
•Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need
to be retested every 2 years.
•Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

27. How do you
diagnose ?
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28. Gleason Score
•A measure of how quickly the cancer cells can grow and affect other tissue.
•Lower grades are given to samples with small, closely packed cells.
•Higher grades are given to samples with more spread out cells.
•The Gleason score is set by adding together the two most common grades found in a
biopsy sample.

30. TNM
A system used for tumor staging & measuring how far the prostate cancer has spread in the body.
1.The T score rates the size and extent of the original tumor.
2.The N score rates whether the cancer has spread into nearby lymph nodes.
3.The M score rates whether the cancer has spread to distant sites.
•Tumors found only in the prostate are more successfully treated than those that have metastasized
outside the prostate and cured sometimes cured with therapies.
•The "T" stage is found by DRE and other imaging tests such as an ultrasound, CT scan, MRI or
bone scan to check if the cancer has spread, to lymph nodes or bone, etcetera.
•These staging imaging tests are generally done for men with a Gleason grade of 7
or higher and a PSA higher than 10.

32. What are the
survival rates ?
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33. Men will not die from PC; they will die from other causes.
•99% of men with prostate cancer will live for at least 5 years after diagnosis.
•Most prostate cancer is slow-growing and takes many years to progress.
•One out of three men will survive after five years, even if the cancer has spread to other
parts of the body.

34. How do you treat ?
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Prostatectomy Therapies Observations

35. Observation
Active surveillance
Watchful waiting
Exercises
Lifestyle changes
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36. Therapies
•Radiation therapy - external & internal (brachytherapy) type
•Cryotherapy. Placing a special probe inside or near the prostate cancer to freeze and kill the cancer
cells. This is a less common treatment.
•Chemotherapy. Using special drugs to shrink or kill the cancer after it has spread to other parts of the
body. The drugs can be pills you take or medicines given through your veins, or, sometimes, both.
•Biological therapy. Works with your body’s immune system to help it fight cancer or to control side
effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.
•High-intensity focused ultrasound. This therapy directs high-energy sound waves (ultrasound) at
the cancer to kill cancer cells. This is a less common treatment.
•Androgen deprivation therapy, Cryoablation & Electroporation.

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38. Prostatectomy
1.Robotic Assisted Laparoscopic Radical Prostatectomy (RALP). In this surgery, five very small
incisions (cuts) are made in the lower abdomen through which instruments and a small camera are guided to allow
the surgeon access to remove the prostate. RALP surgery is one of the most common types of prostate cancer
surgery today.
2.Retropubic Open Radical Prostatectomy. Your surgeon will make a cut in your lower belly and remove
the prostate through this opening.
3.Perineal Open Radical Prostatectomy. The prostate is removed through a cut between the anus and
scrotum. Because the complex pelvic veins are avoided, bleeding is rare.
4.Laparoscopic Radical Prostatectomy. This surgery uses a video camera and small surgical tools that fit
through cuts in the belly to remove the prostate. This surgery has mostly been replaced with robotic assisted
laparoscopic surgery.
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39. Bibliography
•https://www.urologyhealth.org/urology-a-z/p/prostate-cancer
•https://www.cdc.gov/cancer/dcpc/about/
•https://www.cdc.gov/cancer/prostate/basic_info/screening.htm
•https://radiologyassistant.nl/abdomen/prostate/prostate-cancer-pi-rads-v2-1-1
•https://www.cancer.org/cancer/types/prostate-cancer/about/key-statistics.html#:~:text=About 6 in
10 prostate,in men of other races.
•https://zerocancer.org/stay-informed/prostate-cancer-news/american-cancer-society-reports-2024-
facts-figures#:~:text=Almost 300,000 new cases are,populations facing higher mortality rates.
•https://www.youtube.com/watch?v=JUIpUXSSOs0
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40. Thank you for
your attention !