Tuesday, February 4, 2014

Carcinoma of Prostate

 Epidemiology
  •  Most common cancer in men
  •  Second most common cause of cancer death in men
  •  Incidence increases with age
  •  Highest rate in African Americans
Gross
  • ill-defined, firm, yellow mass
  • Commonly arises in the posterior aspect of the peripheral zone

Micro
  • Adenocarcinoma
  • Gleason grading system
Spread

1.Local spread
  • Tends to grow upwards to involve seminal vesicles, bladder neck, trigone, lower end of ureter.
2. Hematogenous
  • Bone esp, pelvic bone and lower lumber vertebrae.( osteoblastic)
  • Femoral head, rib cage and skull are other common sites.
3. Lymphatic
  • Commonly goes to the obturator and pelvic lymph nodes
TNM Staging

1. T1a, T1b, T1c: incidentally found tumor.
T1a : tumor involving less than 5% of the resected specimen
T1b: Tm involving greater than 5% of the resected specimen
        T1c: impalpable tumor found following a raised PSA.

2. T2a: suspicious nodule on rectal examination confined within prostate capsule involving one lobe.
T2b: involves both lobes

3. T3: extends beyond the capsule
T3a: U/L or B/L extension
T3b: seminal vesicle extension

4. T4: tm which is fixed or invading adjacent structures other than seminal vesicles- rectum or pelvic side wall


Clinical Presentation


  • Often clinically silent
  • May present with lower back pain secondary to metastasis
  • Advanced localized disease may present with urinary tract obstruction or UTIs
Investigations

  • Digital rectal exam (induration)
  • Serum PSA levels
  • Transrectal U/S and biopsy
  • Alkaline phosphatase elevated with metastasis
  • Bone scan
Treatment

Local disease (T1 and T2):
 prostatectomy and/or external beam radiation
  • Metastatic disease (T3 and T4): B/L Orchidectomy
  • Estrogens or androgen receptor blockade (flutamide or leuprolide)
  • Monitor with PSA levels

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