Prostate Cancer

PROSTATE CANCER

Mr.Abdulaziz R. Alanzi

Medical Student, Al-Imam University

Riyadh – Saudi Arabia

Objectives

1. Anatomy & Histology of Prostate Gland

2. Causes of Hematuria

3. Benign Prostatic Hyperplasia (In General Overview)

4. Prostatic Adenocarcinoma: Definition Etiology & Risk Factors Pathophysiology Clinical Presentation (Common metastasis) S&S of Spinal Cord : Grading and Stages Investigation Management

Anatomy & Histology of

Prostate Gland

http://www.furunmedical.com/img/img17.gif

Figure 88-2 Zones of the prostate. The peripheral zone, accounting for 70% of the prostate gland, is the site of origin of ≤70% of prostate cancers; the central zone, approximately 25% of the prostate gland, gives rise to only 1% to 5% of prostate cancers; and the transition zone, 5% to 10% of the prostate gland, gives rise to 20% ∼of prostate cancers and is the site of origin of benign prostatic hyperplasia (BPH).  (From Green DR, Shabsign R, Scardino PT: Urological ultrasonography. In: Walsh PC, Rettic AB, Stamey CA, Vaughan ED Jr [eds]: Campbells's Textbook of Urology, 6th ed. Philadelphia, WB Saunders, 1992.)

Anatomy of Prostate Gland • Arterial supply a. Internal pudendal artery b. Inferior vesical arteryc. Middle rectal artery

• Veinous Drainage a. Form venous plexusb. Drain into internal iliac veinsc. Communicate with vesical & vertebral venous plexuses

• Lymphatics Drainagea. Most terminate in internal iliac & sacral nodes b. From posterior: to external iliac nodes

Histology Of Prostate Gland• Peripheral zone:• Upto 70% of prostate • Surrounds distal urethra• Accounts for 70-80% of prostatic cancer

• Central zone:• Upto 25% of prostate• Surrounds ejaculatory duct• Accounts for 2.5% of prostate.cancers

• Transition zone:• Upto 5% of prostate area• Surrounds proximal urethra• Accounts for 10-20% of prostatic cancers

Causes of Hematuria

Reference : Access Medicine Medical Database

Cystitis Urinary calculiBenign

prostatic hyperplasia

Renal cell carcinoma

Transitional cell carcinoma

Glomerulonephritis

Polycystic kidney disease

Anticoagulant use

Prostate cancer

Papillary necrosis

Renal infarction

Interstitial nephritis

Medullary sponge kidney

Radiation or chemical cystitis

Atrophic vaginitis

Schistosomiasis

Menses

Benign Prostatic Hyperplasia

(In General Overview)

Definition

• Benign prostatic hyperplasia (BPH) is defined histologically by hyperplasia of both epithelial and stromal cells, beginning in the periurethral area. With aging, multiple small hyperplastic nodules grow, coalesce, and compress normal tissue outward against the true prostatic capsule, creating a surgical capsule that bounds the expanding adenoma.

Figure 91–2 Testosterone (T) diffuses into the prostate epithelial and stromal cell. T can interact directly with the androgen (steroid) receptors bound to the promoter region of androgen-regulated genes. In the stromal cell a majority of T is converted into dihydrotestosterone (DHT)—a much more potent androgen—which can act in an autocrine fashion in the stromal cell or in a paracrine fashion by diffusing into epithelial cells in close proximity. DHT produced peripherally, primarily in the skin and liver, can diffuse into the prostate from the circulation and act in a true endocrine fashion. In some cases the basal cell in the prostate may serve as a DHT production site, similar to the stromal cell. Autocrine and paracrine growth factors may also be involved in androgen-dependent processes within the prostate. (From Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res 2008;20[Suppl. 3]:S11–8.)

FIGURE 131-2 International Prostate Symptom Score (IPSS). The seven symptom questions constitute a scale initially developed by the American Urological Association. The eighth question about quality of life is scored separately. (From Barry MJ, Fowler FJ Jr, O’Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia: the Measurement Committee of the American Urological Association. J Urol. 1992;148:1549.)

Prostatic Adenocarcinoma:

Definition

Overview• Prostate cancer is the most common

noncutaneous malignant neoplasm in men in the United States, where it results in about 32,000 deaths each year, making it the second most common cause of cancer death in men. Prostate cancer is a single histologic disease with marked clinical heterogeneity ranging from indolent, clinically irrelevant disease to a virulent, rapidly lethal phenotype.

Reference: www.uptodate.com

Prostatic Adenocarcinoma:Etiology & RF

RF

• Age• Race (polymorphism of the X-linked AR gene )• Hormone levels (High Androgens) • Environmental variables• Familial prostate cancers (germline mutations of BRCA2) • Animal fat — A diet high in animal fat may be an

important factor in the development of prostate cancer• Vegetables — A diet low in vegetables may be another

risk factor for prostate cancer

Reference: www.uptodate.com

Pathophysiology

Pathophysiology

Figure 88-5 The molecular pathogenesis of prostate cancer.

Reference: Abeloff: Abeloff's Clinical Oncology, 4th ed.

Prostatic Adenocarcinoma:

Clinical Presentation+

Metastasis

Clinical Presentation• Most men with early stage prostate cancer have no symptoms

attributable to the cancer.• Urinary frequency, urgency, nocturia, and hesitancy are seen

commonly but are usually related to a concomitant benign prostate enlargement.

• Hematuria and hematospermia are uncommon presentations of prostate cancer but their presence in older men should prompt consideration of prostate cancer in the differential diagnosis. These symptoms are also present in men with benign prostatic hyperplasia (BPH) and are more likely to be caused by BPH than cancer.

• Bone pain may be the presenting symptom in men with metastatic disease but an initial diagnosis when bone metastases are present has become unusual

Reference: www.uptodate.com

Metastasis

Metastases first spread via lymphatics:• initially to the obturator nodes • eventually to the para-aortic nodes

Hematogenous spread occurs mainly to the bones.

Reference: Dr Mamlook Lecture

S & S of Spinal cord compression

Vertebral metastases are a particularly common site of metastatic disease in men with advanced prostate cancer. Pain is usually the first symptom of spinal cord compression, and this generally precedes the development of other symptoms by weeks or even months. Symptoms occurring later can include motor weakness, sensory findings, bowel and bladder dysfunction, and ataxia

Grading & Staging

Investigations

Investigations of Prostate CancerSerum Tumor MarkersMiscellaneous laboratory testing (BUN,

Creatinine, AP)Prostate biopsyIMAGING TESTS- Transrectal ultrasonography - MRI- Radionuclide bone scan (Bony Metastasis)

Reference: CURRENT Medical Dx & Tx > Chapter 39. Cancer

Management

Treatment of Prostate Cancer

Radical Prostatectomy (seminal vesicles, prostate, and ampullae of the vas deferens are removed).

Radiation Therapy Surveillance CryosurgeryCombination therapy (androgen deprivation

combined with surgery or irradiation)

Reference: CURRENT Medical Dx & Tx > Chapter 39. Cancer

Thank [email protected]@AbdulazizEnazi

http://imamu.academia.edu/AbdulazizAlanzi