2. • It is the most common malignant tumour in men over
65 years
• It occurs in peripheral zone in prostate gland proper
i.e., commonly in posterior lobe
• Incidence of prostate cancer in men over 80 years is
70%
3. • Microscopically latent
• Tumours incidentally found either by TURP or PSA
estimation
• Early localized carcinoma
• Advanced local prostatic carcinoma
• Metastatic carcinoma in to bone or other organs
4. • It is an adeno carcinoma where in, there is loss of
myoepithelial cell layer which normally surrounds the
prostatic gland
5. • Occult – diagnosed after investigation due to suspicion
• Stage I – tumour confined to prostate
• Stage II – tumour involving capsule or diffuse type
• Stage III – tumour involving seminal vesicle
• Stage IV – extension in to adjacent tissue
6.
7. 1) Local spread
• Upward in to seminal vesicles, bladder neck, trigone, later in to both ureters causing
anuria
• Downward in to distal sphincter
2) Blood spread
• In to bones commonly pelvic bones, lumbar vertebrae, femoral head, ribs, skull
• Pathological fractures can occur in long bones and vertebrae
• Paraplegia may occur if spine is involved
3) Lymphatic spread
• In to obturator lymph nodes and then internal iliac lymph nodes
• Through seminal vesicles in to external iliac and retroperitoneal lymph
nodes
8. • Commonly asymptomatic
• Bladder outlet obstruction, so retention of urine
• Hematuria
• Pelvic pain, back pain, arthritic pain in sacroiliac joint
• P/R examination , prostate feels hard, nodular,
irregular
• Features of renal failure
• Anemia secondary to extensive bone marrow invasion
and also due to renal failure
9. Are other causes of retention of urine and other
causes of back pain
10. • Hb%, peripheral smear
• Prostatic specific antigen(PSA) – more than 10ng/ml is suggestive
• Prostatic fraction of acid phosphatase – is increased
• Blood urea, serum creatinine, liver function tests
• Transrectal ultrasound (TRUS)
• Transrectal prostatic biopsy
• Plain X-ray, KUB – show dense coarse sclerotic secondaries
• Ultrasound abdomen to see tumour extension
• MRI/CT for staging of the disease
11.
12. • Radical prostatectomy is done in early growth with removal of
prostate, seminal vesicles, distal sphincter along with reconstruction
of urethra
• Radical radiotherapy for early carcinoma prostate can be given using
both interstitial and external radiation
• Pelvic lymph node dissection with IODINE 125 radiation seeds
implantation
• Bilateral subcapsular orchidectomy to reduce the testosterone levels
• TURP + bilateral orchidectomy + external radiotherapy for bone
secondaries + flutamide – commonly advocated method
