Carcinoma of Prostate

 Epidemiology

•  Most common cancer in men
•  Second most common cause of cancer death in men
•  Incidence increases with age
•  Highest rate in African Americans

Gross

• ill-defined, firm, yellow mass
• Commonly arises in the posterior aspect of the peripheral zone

Micro

• Adenocarcinoma
• Gleason grading system

Spread

1.Local spread

• Tends to grow upwards to involve seminal vesicles, bladder neck, trigone, lower end of ureter.

2. Hematogenous

• Bone esp, pelvic bone and lower lumber vertebrae.( osteoblastic)
• Femoral head, rib cage and skull are other common sites.

3. Lymphatic

• Commonly goes to the obturator and pelvic lymph nodes

TNM Staging

1. T1a, T1b, T1c: incidentally found tumor.

T1a : tumor involving less than 5% of the resected specimen

T1b: Tm involving greater than 5% of the resected specimen

        T1c: impalpable tumor found following a raised PSA.

2. T2a: suspicious nodule on rectal examination confined within prostate capsule involving one lobe.

T2b: involves both lobes

3. T3: extends beyond the capsule

T3a: U/L or B/L extension

T3b: seminal vesicle extension

4. T4: tm which is fixed or invading adjacent structures other than seminal vesicles- rectum or pelvic side wall

Clinical Presentation

• Often clinically silent
• May present with lower back pain secondary to metastasis
• Advanced localized disease may present with urinary tract obstruction or UTIs

Investigations

• Digital rectal exam (induration)
• Serum PSA levels
• Transrectal U/S and biopsy
• Alkaline phosphatase elevated with metastasis
• Bone scan

Treatment

Local disease (T1 and T2):
 prostatectomy and/or external beam radiation

• Metastatic disease (T3 and T4): B/L Orchidectomy

• Estrogens or androgen receptor blockade (flutamide or leuprolide)
• Monitor with PSA levels