prostate cancer defention ,diagnosis,treatment

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1. Osama Aldweik
Al-Quds university
Dr. Mahmoud Allan
Prostate Cancer

2. prostate anatomy
The prostate is a dense fibromuscular gland. Iwalnut-shaped gland that produces the seminal
fluid that nourishes and transports sperm. surrounding the neck of the urinary bladder, apex
below situated on the external urethral sphincter
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3. Prostate Cancer
Prostate cancer is one of the most common types of cancer in men. Prostate cancer usually
grows slowly and initially remains confined to the prostate gland, where it may not cause
serious harm.
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4. Pathophysiology
•Mutation is majorly in p53 gene, BCL2 and ERK5 which contribute toward the development of
prostate cancer.
•prostate glands require hormones, known as androgens that are involved in cell survival and
apoptosis. Androgens include testosterone and dihydrotestosterone.
•Initially, small clumps of cancer cells remain confined to prostate glands, a condition known
as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Over
time, these cancer cells begin to multiply and spread to the surrounding prostate tissue
forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such
as the nearby lymph nodes or the rectum, or metastasize to bone, lymphatic system and
bladder.
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5. Epidemiology
Incidence: most common cancer in men.
Mortality: in 2020, second leading cause of cancer deaths in men in the US.
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8. Risk factors
•- Advanced age (> 50 years)
•- Family history
•- African-American descent
•- Genetic disposition (e.g., BRCA2, Lynch syndrome)
•- Dietary factors: high intake of saturated fat, well-done meats, and calcium
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9. Symptoms
• Typically asymptomatic
- Early prostate cancers detected during screening tests.
•Patients may present with features of complicated lower urinary tract symptoms (LUTS), including:
• - Urinary retention
◦- Hematuria
◦- Incontinence
◦- Flank pain (due to hydronephrosis)
Advanced prostate cancer can manifest with:
◦ Constitutional symptoms: fatigue, loss of appetite, unintentional weight loss
◦Features of metastatic disease; examples include:
▪Bone pain (due to bone metastasis, especially in the lumbosacral spine)
▪Neurological deficits (e.g., due to vertebral fracture causing spinal cord compression)
▪Lymphedema (caused by obstructing metastases in the lymph nodes)
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10. Diagnostic Parameters
•Prostate-Specific Antigen: is a protein produced by the prostate gland. is an organ-specific marker. It is not cancer-specific All men have a small amount of PSA in
their blood, and it increases with age.
•Prostate cancer can increase the production of PSA, also benign conditions
•PSA level should usually be below 2.5 ng/mL Mostly PSA levels up to 4.0 ng/mL
Total PSA levels
▪PSA < 2.5 ng/mL: Prostate cancer is unlikely.
▪PSA 2.5–4 ng/mL: Prostate cancer is possible in symptomatic patients.
▪PSA > 4 ng/mL: Prostate cancer is likely.
▪PSA 4–10 ng/mL (moderately elevated PSA): ∼ 25% chance of prostate cancer
▪PSA > 10 ng/mL: > 50% chance of prostate cancer
▪!!A PSA level ≤ 4 ng/mL does not exclude prostate cancer!
1- PSA (Prostate-Specific Antigen)

11. 2- Digital rectal examination (DRE)
A DRE should be performed in individuals with elevated serum PSA
DRE has a low positive predictive value
not be performed as the sole screening modality.
•features suggestive of prostate cancer include:
◦- Localized indurated nodules on an otherwise smooth surface
◦- Prostatomegaly, lobar asymmetry
◦- Hard nontender nodules
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12. 3- MRI and CT Scan:
•To access the extension into the bladder and lymph nodes for staging the cancer and to
evaluate bone metastasis.

13. 4- Transrectal ultrasound of the prostate
predominantly used to guide prostate biopsy if there is clinical suspicion of prostate cancer

14. 4- Biopsy:
•This aid in the diagnosis and help to determine the Gleason score.
•The samples of tissue from the biopsy are studied in a laboratory. If cancerous cells are found,
they can be studied further to see how quickly the cancer will spread.
lower the score, the less likely the cancer will spread:
A Gleason score of <7 means the cancer is unlikely to spread.

A Gleason score of =7 means there is a moderate chance of the cancer spreading.
A Gleason score of >7 means there is a significant chance the cancer will spread

16. Staging
TNM
▪ T: Tumor.
- T1 : Tumor not felt by PR exam. & not seen by imaging .
- T2 : Tumor localized to the prostate felt by PR exam. or seen by imaging.
- T3: Tumor spread out side the capsule of the prostate .
- T4 : Tumor spread to the surrounding structures .
▪ N: Node metastases.
- N0: no node metastases .
- N1 : Affection of one or more node in the pelvis .
▪ M: Distal metastases.
- M0 : No evidence of distal metastases.
- M1: evidence of distal metastases.
▪Most common site: bone especially the vertebrae
▪Less common sites: lungs, liver, and adrenal glands

17. Treatment
•The treatment of prostate cancer can vary based on the stage and aggressiveness of the
cancer. Common treatment options include:
•1. Active Surveillance: For low-risk cases, monitoring the cancer's progression with scheduled
DRE, PSA, prostate biopsies, and mpMRI

18. •This can help suppress the growth of cancer cells by reducing the levels of male hormones (androgens).
- Androgen deprivation therapy (ADT)
◦*Medical castration: decreases pituitary stimulation of androgen production by the testes
▪- Gonadotropin-releasing hormone (GnRH) agonists (e.g., leuprolide)
▪- Gonadotropin-releasing antagonist (e.g., degarelix)
▪- GnRH receptor antagonist (e.g., relugolix)
◦*Surgical castration: bilateral orchiectomy
•Adverse effects
◦ - Increased risk of osteoporosis and fractures
◦ - Sexual dysfunction: loss of libido, erectile dysfunction
◦ - Change in body image: gynecomastia, weight gain, decreased penile and testicular size
◦ -Change in body composition: increased body fat, decreased muscle mass
◦ - Increased cardiovascular and metabolic risk Anemia
2. Hormonal Therapy

19. Androgen synthesis inhibitors and androgen receptor antagonists
•Indication: Addition to ADT in locally advanced and metastatic prostate cancer
•*Androgen synthesis inhibitors
◦- Mechanism of action: inhibition of CYP17 gene products (including 17α-hydroxylase and 17,20-lyase) → inhibits androgen synthesis in the
adrenal glands, testis, and tumor tissue
◦- Commonly used agent: abiraterone
◦Specific adverse effects:
▪- Increased production of mineralocorticoids: hypertension, hypokalemia, cardiac arrhythmias
▪- Inhibition of glucocorticoid production: adrenal insufficiency so (Glucocorticoids should be co-administered to avoid adrenal
insufficiency.)
•*Androgen receptor antagonists (antiandrogen therapy)
◦Mechanism of action: displaces androgens from androgen receptors
◦Commonly used agents: apalutamide and enzalutamide (second-generation antiandrogens)
2. Hormonal Therapy

20. Treatment
•3. Radiation Therapy: External beam radiation or brachytherapy (internal radiation) can be used to
target and destroy cancer cells After prostatectomy
•4. Surgery: Prostatectomy is the surgical removal of the prostate gland. This can be done
through open surgery or minimally invasive procedures like laparoscopy or robotic-assisted
surgery.
•5. Chemotherapy: Sometimes used for advanced cases that don't respond to other
treatments.
•6. Management of bone health

21. Thank you