PROSTATE CANCER. a type of cancer that affects the prostate gland

Prostate cancer is a type of cancer that affects the prostate gland in men

1. .
prostate CANCER
CANCER OF THE PROSTATE
26-Sep-24
PRESENTED
BY
MUTEGEKI ADOLF

2. Anatomy Of Prostate
•The prostate is a walnut-sized gland located in front of the rectum
and below the bladder.
•It surrounds the urethra, the tube-like channel that carries urine and
semen through the penis.
•The primary function of the prostate is to produce seminal fluid, the
liquid in semen that protects, supports, and helps transport sperm.

3. Base of the Prostate
The base is directed
upward near the
inferior surface of the
bladder. The greater
part of this surface is
directly continuous
with the bladder wall.
Apex of the Prostate
The apex is directed downward
and is in contact with the superior
fascia of the urogenital diaphragm.
Anatomy Of Prostate

4. Anatomy Of Prostate
•Blood supply
•Inferior vesicalartery
•Derived from the internal iliac artery
•Supplies blood to the base of the bladder and prostate
•Capsular branches of the inferior vesicalartery
•Help identify the pelvic plexus
•Nerve supply
•Neurovascular bundle
•Lies on either side of the prostate on the rectum
•Derived from the pelvic plexus , arising from the S2-4 and T10-12
nerve roots
•Important for erectile function.

5. Prostatic ZonalAnatomy
•There are four zones of the
prostate :
the peripheral zone (PZ) ,
transition zone (TZ) ,
Central zone, and
anterior fibromuscularstroma
zone.

6. •Peripheral zone (PZ)
•70% of cancers
•Transitional zone (TZ)
•20%
•TZ prostate cancers are relatively
nonaggressive
•PZ cancers are more aggressive
•Tend to invade the peri-
prostatic tissues.

7. Lymphatic Drainage

8. Regional Lymph Nodes
•Pelvic
•Hypogastric
•Obturator
•Iliac (internal, external)
•Sacral (lateral, presacral, promontory [Gerota's])

9. Metastatic Lymph Nodes
•Distant lymph nodes lie outside the confines of the true pelvis.
•The distant lymph nodes include the following:
•Aortic (paraaorticlumbar)
•Common iliac
•Inguinal, deep
•Superficial inguinal (femoral)
•Supraclavicular
•Cervical
•Scalene
•Retroperitoneal

10. DEFINITION:
•Prostate cancer is a malignant tumor that
originates in the prostate gland, a small
walnut-shaped organ in men that produces
seminal fluid.
•It is one of the most common cancers in men,
often growing slowly, but some forms can be
aggressive and spread quickly.

11. AETIOLOGY (CAUSES):
•The exact cause of prostate cancer is not well understood,
but several risk factors are associated with its
development:
•Age: The risk increases with age, especially after age 50.
•Family history: A family history of prostate cancer
increases the risk, especially if a close relative (father,
brother) has had the disease.
•Genetic mutations: Mutations in BRCA1 or BRCA2 genes
or Lynch syndrome are linked to a higher risk of prostate
cancer.

12. •Race/Ethnicity: African American men have a
higher risk of developing prostate cancer and tend
to develop it at a younger age.
•Hormonal factors: Higher levels of androgens
(male hormones) may stimulate prostate cancer
growth.
•Dietary factors: High-fat diets, particularly from
animal sources, may increase risk, while diets rich
in fruits, vegetables, and omega-3 fatty acids might
reduce the risk.

13. •Diet: one of the most important modifiable risk factors --
high fat intake increases risk whereas diets rich in
carotenoids (tomato based products containing lycopene)
and vitamin-E are protective.
•No association with cigarette smoking, alcohol use,
height and weight and blood group.
•No data regarding viral origin.
•No convincing evidence that Vasectomy increases risk of
prostate cancer

14. PATHOPHYSIOLOGY:
•Prostate cancer typically starts as a small collection of
abnormal cells in the prostate gland, which can gradually
grow into a malignant tumor. There are several key
stages:
•Cellular mutation: Prostate cancer begins when healthy
cells in the prostate mutate and grow uncontrollably.
•Tumor development: The cancerous cells form a tumor.
Initially, the cancer is confined to the prostate (localized
prostate cancer).

15. •Spread (Metastasis): In advanced stages, the
cancer may spread (metastasize) to nearby
tissues, lymph nodes, and distant organs,
commonly affecting bones and lymph nodes.
•The cancer is classified based on Gleason score
(grading of prostate cancer based on cell
differentiation) and TNM staging(Tumor, Nodes,
Metastasis system).

16. CLINICAL PRESENTATIONS:
•In its early stages, prostate cancer may not cause any
symptoms.
•As the tumor grows or metastasizes, the following
symptoms may develop:
•Urinary symptoms:
•Difficulty starting or maintaining a steady urine stream.
•Increased frequency of urination, especially at night
(nocturia).
•Weak urine flow or interrupted flow.
•Pain or burning during urination.
•Hematuria (blood in urine).

17. •Other symptoms:
•Erectile dysfunction.
•Painful ejaculation.
•Blood in semen.
•Persistent pain in the lower back, hips, or pelvis
(due to metastasis).
•Unexplained weight loss, fatigue, or weakness
(in advanced cases).

18. STAGING OF PROSTATE
CANCER

21. INVESTIGATIONS:
1.Digital Rectal Examination (DRE): A physical exam
where a doctor feels the prostate through the rectum
to detect lumps or abnormalities.
2.Prostate-Specific Antigen (PSA) Test: A blood test to
measure the levels of PSA, which may be elevated in
men with prostate cancer. However, PSA can also rise
due to BPH or infections.
3.TransrectalUltrasound (TRUS): An ultrasound probe
is inserted into the rectum to produce images of the
prostate and guide biopsy.

22. 4.Prostate Biopsy: If prostate cancer is
suspected, a biopsy may be performed where
tissue samples are taken from the prostate for
microscopic examination.
5.MRI or CT Scans: Used to determine the
extent of the cancer or if it has spread.
6.Bone Scan: To detect if the cancer has
metastasized to bones, particularly in
advanced stages.

23. LABORATORY INVESTIGATIONS
•PROSTATE SPECIFIC ANTIGEN
•Serine protease glycoprotein secreted by prostatic epithelium
•Carcinoma specific
•Normal : 0.4 -4 ng/ml (upper limit 2.6 ng/ml)
•t
1/2: 2.2― 3.2 ±0.1 days
•Mild elevation 4 ― 10 ng/ml
•Significant elevation >10 ng/ml
•Sensitivity ― 85%
•Specificity –65-70%
•Estimated rate of cancer detection by PSA screening ― 1.8-3.3%
•Carcinoma with normal PSA ― 25%

24. Digital Rectal Examination
•Cornerstone of the physical examination/ instrumental in
staging
•Sim’slateral position.
•Organ palpation:
•Craniocaudaland transverse dimension
•Consistency / Mobility
•Any firm/ elevated area and its size.
•Typical finding ca prostate-Hard, nodular, asymmetrical, may or
may not be raised above the surface of gland and is surrounded by
compressible prostatic tissue.
•Prostatic induration-BHP nodule/ calculi/
infection/ granulomatousprostatitis/ infarction
•Specificity-50% and Sensitivity-70%
•Only 25-50% of men with an abnormal DRE have cancer.
•DRE + PSA specificity 87%

25. Prostate Anatomy on DRE

26. MANAGEMENT:
•1. Active Surveillance:
•In cases of slow-growing, localized prostate cancer,
active surveillance may be recommended. This
involves regular monitoring with PSA tests, DREs, and
biopsies to track the progression of cancer.
•2. Surgery:
•Radical Prostatectomy: Surgical removal of the entire
prostate gland, often along with nearby tissues and
lymph nodes. This is often used for localized cancer.

27. •3. Radiation Therapy:
•External Beam Radiation Therapy
(EBRT): Radiation is directed at the
prostate gland from outside the body.
•Brachytherapy: Involves placing
radioactive seeds directly inside the
prostate gland to deliver localized
radiation.

28. •4. Hormonal Therapy(Androgen Deprivation
Therapy, ADT):
•Since prostate cancer cells rely on androgens
(e.g., testosterone) to grow, lowering androgen
levels or blocking their action can help control
cancer growth. Medications include:
•LHRH agonists/antagonists: To reduce testosterone
production. EG Degarex, Ganirex
•Anti-androgens: To block the action of androgens.

29. 5. Chemotherapy:
•Used for more advanced or aggressive prostate
cancer that has spread beyond the prostate.
Common drugs include docetaxeland cabazitaxel.
6. Immunotherapy:
•Sipuleucel-T (Provenge): A vaccine that stimulates
the immune system to attack prostate cancer
cells, used in advanced prostate cancer.

30. 7. Targeted Therapy:
•Drugs that target specific genetic
mutations (e.g., PARP inhibitors for BRCA-
mutated prostate cancer) may be used in
certain cases of metastatic prostate cancer

31. SURGERY

32. PREVENTION:
•While no sure way exists to prevent prostate cancer, some
measures may lower the risk:
•Healthy diet: A diet rich in fruits, vegetables, and whole grains
while limiting red meat, dairy fats, and processed foods.
•Regular exercise: Maintaining physical activity can help control
weight and improve overall health.
•Weight management: Obesity has been linked to a higher risk of
developing aggressive prostate cancer.
•Screening: Regular screening with PSA tests and DRE,
particularly in men with a family history of prostate cancer or
those at higher risk, can help in early detection.

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