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
