Prostate Cancer


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Abdulaziz Rajeh Alanzi

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  • AR = Androgen Receptor Gene
  • T1
  • T2
  • T3
  • T4
  • G3
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  • G5
  • Prostate Cancer

    1. 1. PROSTATE CANCERMr.Abdulaziz R. AlanziMedical Student, Al-Imam UniversityRiyadh – Saudi Arabia
    2. 2. Objectives1. Anatomy & Histology of Prostate Gland2. Causes of Hematuria3. 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
    3. 3. Anatomy &Histology ofProstate Gland
    4. 4.
    5. 5. Figure - Zones of the prostate. The peripheral zone, accounting for of the prostate gland, is the site of origin of ≤ of prostate cancers; the central zone,approximately of the prostate gland, gives rise to only to of prostate cancers; and the transition zone, ∼ to of the prostate gland, gives rise to ofprostate 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]: Campbellss Textbook of Urology,th ed. Philadelphia, WB Saunders,
    6. 6. Anatomy of Prostate Gland• Arterial supplya. Internal pudendal arteryb. Inferior vesical arteryc. Middle rectal artery• Veinous Drainagea. Form venous plexusb. Drain into internal iliac veinsc. Communicate with vesical & vertebral venous plexuses• Lymphatics Drainagea. Most terminate in internal iliac & sacral nodesb. From posterior: to external iliac nodes
    7. 7. 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
    8. 8. Causes of Hematuria
    9. 9. Reference : Access Medicine Medical Database
    10. 10. Benign ProstaticHyperplasia(In General Overview)
    11. 11. Definition• Benign prostatic hyperplasia (BPH) is definedhistologically by hyperplasia of both epithelialand stromal cells, beginning in theperiurethral area. With aging, multiple smallhyperplastic nodules grow, coalesce, andcompress normal tissue outward against thetrue prostatic capsule, creating a surgicalcapsule that bounds the expanding adenoma.
    12. 12. 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 promoterregion 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 inan 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 skinand 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 DHTproduction 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.)
    13. 13. FIGURE 131-2 International Prostate Symptom Score (IPSS). The seven symptom questions constitute a scale initially developed by the American UrologicalAssociation. 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 MeasurementCommittee of the American Urological Association. J Urol. 1992;148:1549.)
    14. 14. ProstaticAdenocarcinoma:Definition
    15. 15. Overview• Prostate cancer is the most commonnoncutaneous malignant neoplasm in men inthe United States, where it results in about32,000 deaths each year, making it the secondmost common cause of cancer death in men.Prostate cancer is a single histologic diseasewith marked clinical heterogeneity rangingfrom indolent, clinically irrelevant disease to avirulent, rapidly lethal phenotype.Reference:
    16. 16. ProstaticAdenocarcinoma:Etiology & RF
    17. 17. RF• Age• Race (polymorphism of the X-linked AR gene )• Hormone levels (High Androgens)• Environmental variables• Familial prostate cancers (germline mutations ofBRCA2)• Animal fat — A diet high in animal fat may be animportant factor in the development of prostate cancer• Vegetables — A diet low in vegetables may be anotherrisk factor for prostate cancerReference:
    18. 18. Pathophysiology
    19. 19. PathophysiologyFigure 88-5 The molecular pathogenesis of prostate cancer.Reference: Abeloff: Abeloffs Clinical Oncology, 4th ed.
    20. 20. ProstaticAdenocarcinoma:Clinical Presentation+Metastasis
    21. 21. Clinical Presentation• Most men with early stage prostate cancer have no symptomsattributable to the cancer.• Urinary frequency, urgency, nocturia, and hesitancy are seencommonly but are usually related to a concomitant benign prostateenlargement.• Hematuria and hematospermia are uncommon presentations ofprostate cancer but their presence in older men should promptconsideration of prostate cancer in the differential diagnosis. Thesesymptoms are also present in men with benign prostatichyperplasia (BPH) and are more likely to be caused by BPH thancancer.• Bone pain may be the presenting symptom in men with metastaticdisease but an initial diagnosis when bone metastases are presenthas become unusualReference:
    22. 22. MetastasisMetastases first spread via lymphatics:• initially to the obturator nodes• eventually to the para-aortic nodesHematogenous spread occurs mainly to thebones.Reference: Dr Mamlook Lecture
    23. 23. S & S of Spinal cordcompression
    24. 24. Vertebral metastases are a particularly commonsite of metastatic disease in men with advancedprostate cancer.Pain is usually the first symptom of spinal cordcompression, and this generally precedes thedevelopment of other symptoms by weeks or evenmonths.Symptoms occurring later can include motorweakness, sensory findings, bowel and bladderdysfunction, and ataxia
    25. 25. Grading & Staging
    26. 26. Investigations
    27. 27. Investigations of Prostate Cancer Serum Tumor Markers Miscellaneous laboratory testing (BUN,Creatinine, AP) Prostate biopsy IMAGING TESTS- Transrectal ultrasonography- MRI- Radionuclide bone scan (Bony Metastasis)Reference: CURRENT Medical Dx & Tx > Chapter 39. Cancer
    28. 28. Management
    29. 29. Treatment of Prostate Cancer Radical Prostatectomy (seminal vesicles,prostate, and ampullae of the vas deferens areremoved). Radiation Therapy Surveillance Cryosurgery Combination therapy (androgen deprivationcombined with surgery or irradiation)Reference: CURRENT Medical Dx & Tx > Chapter 39. Cancer
    30. 30. Thank