It is not for practicing, only general description of prostate cancer.......of my presentation . for explanation study authentic books also .....and webs.

1. PROSTATE CANCER
PRESENTED
BY
AHAMD ALI
CLINICAL PHARMACY

2. CONTENTS OF PRESENTATION:
• WHAT IS PROSTATE ?
• Structure of prostate.
• PATHOPHYSIOLOGY OF PC.
• RISK FACTORS FOR PC.
• CLINICAL PRESENTATION.
• DAIGNOSIS .
• TREATMENT.

3. WHAT IS PROSTATE ?
• It is small gland located just below the UB . Its weight is
about 40gm. The growth of prostate is under the control of
testosterone.
• Its size is about the size of walnut that surrounds the first
part of the male urethra at the base of the bladder . It is
present only in male. Prostate secretes prostatic fluid, which
is emptied into prostatic urethra through prostatic sinuses .

5. Structure of prostate:
• The whole prostate is surrounded by capsule of connective tissues
and smooth muscle.
Prostate is divided into three zones.
1. Peripheral zone
2. Central zone
3. Transitional zone

6. • Peripheral zone is the largest zone and is outer most layer. Most of
cancer arise in this part . Adenocarcinoma is the most common
carcinoma. This carcinoma is because of genetic mutation in luminal
and basal cells.

8. PATHOPHYSIOLOGY:
• Prostate functions and growth are controlled by androgens i-e
testosterone, dihydrotestosterone. In the prostate, free testosterone
diffuses into the epithelial cells where it is converted to DHT by alpha
reductase enzymes. This DHT then complexes with their receptor
(androgen receptor) and bind to DNA and result in stimulation of
prostate growth. This growth continues from puberty to age 30 to 35,
and onward no more growth of prostate occurs, after 45 to 60 age
only hypertrophy occurs. Sometimes this control growth is invaded
by genetic mutation and result in uncontrolled growth of cells. This
Genetic mutation mostly occurs in luminal cell and basal cell of tiny
glands in prostate. And this glandular carcinoma of prostate is called
adenocarcinoma.

9. PC RISK FACTORS:
• AGE: PC occurs mainly in older age, about six cases in ten are diagnosed in
men aged 65 or older, and it is rare before age 40.
The average age at thee time of diagnosis is about 66.
• ETHNICITY: Higher in African American men, lower in Asian men.
• FAMILY HISTOR: Having a father or brother with PC more than a doubles a
risk of developing this disease.
• DIET: High in red meat, low in vegetable.
• GENES: Genes which are common for mutation are
1. BRCA 1
2. BRCA 2
3. HOXB13
4. MSH2

10. CLINICAL PRESENTATION:
• Clinical symptoms of PC are similar to those for BPH, and there are no
symptoms which correlate specifically to early PC.
• Localized Disease
Asymptomatic
• Locally Invasive Disease
Ureteral dysfunction,
frequency,
hesitancy, and dribbling Impotence

11. • Advanced Disease
Back pain
Cord compression
Lower extremity edema
Pathologic fractures
Anemia
Weight loss

12. DIAGNOSES:
• Diagnostic tests and Staging Workup for Prostate Cancer :
Initial tests :
1. Digital rectal examination (DRE): A DRE is an important diagnostic
tool for PC with an estimated sensitivity of more than 60%.
2. Prostate-specific antigen (PSA) : Measurement of PSA is an accurate
and clinically useful biochemical marker because it is specific to
prostate tissue and produced by the columnar epithelial cells in the
prostate gland.

13. 1. Trasnsrectal ultrasonography (TRUS) if either DRE is positive or PSA is
elevated Biopsy: TRUS of the prostate is commonly used to aid the
diagnosis of PC. Sensitivity ranges from 48% to 100%.
2. Prostate biopsy : This is a definitive method to detect PC. TRUS guided
biopsy will help obtain samples from the peripheral and transitional
zones of the prostate and other suspicious areas.
Staging tests
1. Gleason score on biopsy specimen: The most widely accepted histological grading
system, which corresponds to biological malignancy, is based on the Gleason scale
. A score of 1 corresponds to well-differentiated cells, while a score of 5
corresponds to poorly differentiated cells. The higher the score, the more
aggressive the cancer.

15. 2. Bone scan
3. Complete blood count
4. Liver function tests Serum phosphatases (acid/alkaline)
5. Excretory urogram
6, Chest x-ray
Additional staging tests:
1. Skeletal films
2. Lymph node evaluation

16. TREATMENT:
• Treatment plans are applied according to condition of disease. Disease
condition may be,
1. Localized PC
2. Locally advanced PC
3. Metastatic PC
• Localized PC:
1. Active surveillance: In this patient is generally observed for
symptoms and treatment is not given.
2. Radical prostatectomy
3. Radical external beam radiotherapy
4. Cryosurgical ablation of prostate : Cryosurgical ablation of
prostate (CSAP). Cryosurgical ablation involves freezing the
prostate which results in cell death by protein denaturation,
direct rupture of cellular membranes and apoptosis.

17. 5.Interstitial brachytherapy: With interstitial brachytherapy radioactive
isotope seeds are placed in the prostate. These implants can emit
radiation of low energy over several weeks and can be temporary or
permanent. This treatment has the potential advantage of less erectile
dysfunction than other treatment.

19. • Locally advanced PC:
when surrounding areas with prostate are involve, they are considered locally
advanced. Different treatment plans are used to treat locally advanced PC.
1. Hormonal therapy OR androgen deprivation therapy:
Androgens are produced by testes(95%)
under stimulation of luteinizing hormone(LH) and LHRH from pituitary gland and 5% by adrenal
gland. Deprivation of androgens can be achieved by two methods. (1) surgical castration (2) medical
castration. Medical castration can be achieved by medicines.
1. LHRH AGONISTS : It includes the
gosereline, leuprorelin, triptorelin, histrelin.
2. Antiandrogens :
cyproterone acetate, megasterol acetate, nilutamide, flutamide, bicalutamide.

20. • Metastatic PC:
1) LHRH agonists
2) surgical castration
3) LHRH antagonists
Abarelix
Degarelix
4) chemotherapy
docetaxel
Cabazitaxel

21. References :
• Clinical pharmacy and therapeutics by Roger Walker and Cate
Whittlesea 5th edition.
• Pharmacotherapy Handbook Ninth Edition by Barbara G. Wells,
Joseph T. DiPiro, Terry L. Schwinghammer, Cecily V. DiPiro.
• Pharmacotherapy A Pathophysiological approach 8th ed by by Barbara
G. Wells, Joseph T. DiPiro, Terry L. Schwinghammer, Cecily V. DiPiro.
• Topics of www.courser.com lecture of PC.