Transcript Prostate cancer

Prostate cancer
Tim Bracey
Histopathology
What are we going to talk
about?






Anatomy of prostate
Very basic histology!
How prostate cancer starts and spreads
Epidemiology and risk factors
Presenting symptoms and signs
Investigations and Management
Prostate cancer
Anatomy

Name 5 main anatomical relations of the prostate
1.
2.
3.
4.
5.
Prostate cancer
Bladder base
(base)
Pelvic floor (apex)
Seminal vesicles
Rectum
Urethra
Histology


From which cells do prostate cancers arise?
What types of cancers arise in the prostate?
Dysplasia (PIN)
Genetic changes
Normal glands and stroma
Prostate cancer
Prostatic adenocarcinoma
Where does prostate cancer
start?
Prostate cancer
How does prostate cancer
spread?



Direct
Lymphatic
Blood

Prostate cancer
Commonly to bone
Epidemiology 1

What percentage of 80 yr old men have prostate ca?

From 50-80% in autopsy studies!
Prevalence from autopsy studies
Prostate cancer
Clinical Prevalence
Epidemiology 2


Why did incidence rise in 1990’s?
Probably secondary to PSA testing!
Prostate cancer
Aetiology


Name 2 endogenous and 2 exogenous
aetiological factors for prostate ca
Endogenous


Age, race, genetics, hormone levels
Exogenous
Diet: high fat (inc risk), omega 3, selenium,
vitA, soya (dec risk)
 Vasectomy (+1.56 RR)

Prostate cancer
Clinical Features

Name 2 general and 2 specific presenting features for
prostate ca

LUTS





Prostate cancer
Poor stream
Hesitancy
Nocturia
Term dribbling
Spread to other
organs
Investigations





Name 5 clinical tests or investigations for a
patient with suspected prostate ca
Bedside: DRE
Bloods: FBC, U+E, Ca, G+S, PSA
Imaging: CXR, USS, CT, MRI, bone scan
Invasive: TRUS biopsy

Note 10% are incidental on TURP for BPH
Prostate cancer
Prostate cancer
Management


What are the principles of management of a
patient with prostate cancer?
Conservative


“Die with not from”, Watchful waiting, palliation
Medical


Hormonal treatment, Radiotherapy
Medical therapy is targeted at all parts of the
endocrine axis


LHRH, anti-androgens or complete blockade, oestrogens,
some men opt for orchidectomy (eunochs don’t get prostate
cancer!)
Surgical

Radical prostatectomy
(open
Prostate
cancer or lap), TURP for LUTS
What have we talked about?






Anatomy
Histology
Epidemiology, Aetiology and Risk Factors
Clinical Presentation and investigations
Basics of Management
Any Questions?
Prostate cancer