by Hein Van Poppel

1. Hein Van Poppel, MD, PhD, FEBU
Prof. and Chair Urology KU Leuven, Belgium
Adjunct Secretary General EAU- Education., FEBU
Hein VChair Scientific Comm. EUomoroppel
Professor and Chairman UZ Leuven
Adjunct Secretary General EAU
What is and what goes wrong
with the Prostate ?
Brussels 16-09-2015

2. Normal
Anatomy

3. Prostate ducts
Ejaculatory duct
Bladder neck
Ejaculation

4. Prostate specific  tumor specific
- increased values: age related and
prostate volume related
- (role = liquefaction of the ejaculate)
PSA Prostate Specific Antigen

5. What goes wrong with the Prostate ?
• Enlarges: Benign Prostate Enlargement
• (Inflames: Prostatitis)
• Develops cancer: Prostate Carcinoma

6. ZonalAnatomyNormal Anatomy

7. Benign Prostate Enlargement
BPE
• Nearly all men  in fact no ‘disease’
• Occurs in the transition zone (TZ)
 peripheral zone is compressed
 urethra can be narrowed
• Can remain asymptomatic, even in very large glands, or
be pretty symptomatic in small ones

8. BPE

9. Digital
Rectal Examination
Transrectal
Ultrasound
Diagnosis of BPE
PSA
Flowmetry

10. Treatment of BPE
Indications
1. Patient- Indication: Complaints
2. Doctor’s-Indication: Acute or chronic retention
Infection
Bladder stones
Bleeding
First Medical treatment, is highly effective
Surgery if drugs not efficient

11. What goes wrong with the Prostate ?
• Enlarges: Benign Prostate Enlargement
• (Inflames: Prostatitis)
• Develops cancer: Prostate Carcinoma

12. Occult Carcinoma
10-19 y 20-29 y 30-39 y 40-49 y
PIN 0% 9% 20% 44%
OccultCa 0% 0% 27% 34%

13. Incidence of PCa

14. Risk Factors of PCa
• Age (> 50 y)
• Genetic (+ familial) factors
• Race and geographic factors
• Obesity and diet

15. PCa Mortality
Animal Fat

16. Prostate Cancer Mortality
0 5 10 15 20 25
Japan
Russia
Greece
Mexico
Italy
Israel
Spain
France
Canada
Germany
England
Austria
USA
Finland
Ireland
Netherlands
Australia
New Zealand
Denmark
Sweden
Switzerland
Norway
Mortality per 100,000 men

17. (Transition zone)
Peripheral Zone
Urethra
Where does one develop PCa?
85%

18. Prostate Cancer Symptoms
• Early PrCa is asymptomatic !
• Presence of symptoms suggests
– Locally advanced disease
– Metastases : bone pain, spinal cord compression

19. DRE

20. Cancer
TRUS
Transition zone?

21. MRI
Magnetic Resonance Imaging
Stage T2a Stage T3a
Today: Multiparametric MRI …..

22. Prostate Puncture Biopsy

23. Gleason Grade
Gleason Score
Gleason Score =
Sum of the 2 most common
Gleason Grades
Gl.Score 3+3= 6 = good
Gl.Score 10 = very bad

24. PSA for Early Detection?

25. PSA Screening
• More tumors detected !
- risk of overtreatment
• Stage migration !
• Mortality decrease …

26. PCa incidence and Mortality
Rate/100.000
PSA

27. 0
5
10
15
20
25
30
35
40
45
50
% Change
Bladder
Melanoma
Breast
Lymphoma
Colorectal
Lung
Pancreas
Leukemia
Ovary
Prostate
SEER Data , USA
Changes in Relative 5 y Survival Rates
W.Catalona

28. Management Options ?
• Active Surveillance : wait and eventually treat
• Rad.Prostatectomy : open, laparoscopic or robot
• Irradiation: - external ( EBRT, IMRT, IGRT…)
- interstitial ( brachy - implant…)
• Other : - Cryotherapy HIFU ?

29. Our Life on Earth
“A sexually transmitted condition
with 100% mortality”

30. in a clever way !

32. Leonardo da Vinci 1452-1519
Why no prostate?

33. Skin
Hair growth,
sebum
production
Liver
Synthesis of
serum proteins
Male sexual organs
Penile growth,
spermatogenesis,
prostate growth and
function
Brain
Libido, Mood
Muscle
Increase in strength
and volume
Kidney
Stimulation of
erythropoietin
production
Bone marrow
Stimulation of
stem cells
Bone
Accelerated
linear growth,
closure of
epiphyses
The Role of Testosterone

34. Andreas Vesalius 1514-1564
First illustration of the prostate (1538)

35. PCa Diagnosis
• Digital Rectal Examination DRE
• Transrectal Ultra-Sound TRUS
• Prostate Specific Antigen PSA
• Prostate Puncture Biopsy PPB
• Microscopic Findings = Pathology