Pathology of Prostate - Cancer

prostatic cancer.

1. BPH4 : Urinary Tract Dis: Prostate Cancer

2. Prostatic Cancer: Introduction Many prostatic carcinomas are small and clinically insignificant . If tested, seen in many elderly dying of other causes* (incidental Ca) But some are rapidly fatal, no specific test to detect early* Population screening of PSA – controversial, now discouraged *** % of free PSA to total PSA is lower in men with prostate cancer . Adenocarcinoma, Most common male cancer , elderly (>50y), But second common cause of cancer death in males. (next to lung)

3. Adeno-Ca Prostate BPH Cancer Gross: Irregular, stony hard Peripheral / posterior

4. Prostatic Cancer: Etiopathogenesis Etiology : ?Androgens, genes (ETS, PTEN) & ? env / diet. ( Not BPH ) PSA* proteolytic enzyme, liquefies semen. Not cancer specific . Normal Serum PSA < 4.0ng/L .  in Prostate damage / malignancy . Lower in non malignant but significant overlap*. Patients (54%) lacking both PTEN & ETV had ‘good prognosis’ (85.5% alive at 11 years )* - localized cancer without killing …! * BJC PIN : Prostatic Intraepithelial Neoplasia Pathogenesis: Dysplasia  PIN  cancer. Loss of double layer in Ca

5. Prostatic Cancer: Microscopy Microscopy: Pleomorphic cells Single layer glands No secretions. Normal Cancer Gross: Hard, gritty / stoney Normal Cancer

6. Prostatic Ca: Gleason Scoring: Gleason Scoring : (note limitations*) Biopsy microscopy study. Two prominent areas. Add the values. (2  10 max) E.g. 3 + 4 = 7 1 2 5 Glands

7. Prostate Cancer: Summary Staging: Stage-1 90% 5 year surviva l to Stage-4 10% survival. Summary: Adenocarcinoma , Commonest men cancer. Two clinical types: good & bad prognosis. Many cancers are small, non palpable (DRE), asymptomatic discovered on needle biopsy following raised PSA level *** . 20 to 40% of localised prostate cancer have normal PSA value. PSA is useful but imperfect marker * Progressive increase in PSA is more useful in monitoring. Low grade , localized cancers best managed by wait & watch.