Carcinoma Of Prostate

CARCINOMA OF PROSTATE


CARCINOMA OF PROSTATE

  • Carcinoma of prostate is the MC malignant tumour in men over 65 years.
  • MC cause of bone secondaries
  • Carcinoma of prostate occurs in peripheral zone in prostatic gland proper (commonly in posterior lobe)

RISK FACTORS-

  • Advancing age + increase fat intake
  • Genetic alterations is hypermethylation of glutathione transferase (GSTP-1) located on chromosome 11

PATHOLOGY-

  • Adenocarcinoma of prostate is the MC form of cancer in males
  • They are multifocal and heterogenous

SPREAD-

1. Local spread-

  • Upward- seminal vesicles, bladder neck, trigone
  • Downward- distal sphincter

2. Blood spread-

  • Bones- pelvic bones, lumbar vertebrae, femoral head, ribs and skull
  • MC site of origin- for skeletal metastases

3. Lymphatic spread-

  • Obturator lymph nodes

CLINICAL FEATURES-

  • Bladder outlet obstruction
  • Haematuria
  • Commonly asymptomatic
  • Pelvic pain, back pain, arthritic pain
  • Renal failure
  • Perineural invasion
  • Rectal examination- prostate feels hard, nodular, irregular and obliteration of medial sulcus

STAGING-  

INVESTIGATIONS-

1. Hb%

  • Anemia
  • Thrombocytopenia
  • DIC

2. Plain X-ray, KUB-

  • Shows sclerotic metastases in lumbar vertebrae and pelvic bones

3. Serum acid phosphatase-

  • Responsible for acidic pH in the prostatic urethra and normally drained in urine
  • Increase acid phosphatase

4. Serum alkaline phosphatase-

  • Increase in extensive liver metastasis or bone metastasis

5. Prostate specific antigen(PSA)

  • It is a glycoprotein, serine protease elaborated by columnar prostatic acinar epithelial cells.
  • Free- 10- 40%, complexed to antiprotease- 60 to 90%
  • Formed in prostate and secreted in seminal fluid
  • Causes liquefaction of seminal coagulum
  • More than 4nmol/ml- carcinoma detected
  • 10 nmol/ml- prostatic carcinoma
  • 35 nmol/ ml- disseminated carcinoma
  • Prostate specific, but not prostate cancer specific
  • Most efficient test and for staging and assessing

6. Abdominal and transrectal USG- staging of the disease

7. CT scan or MRI scan

  • Staging of the disease
  • MRI is ideal for most accurate for local staging

8. Bone scan-

  • Increased ALP
  • Increased PSA (>20nmol/ml)
  • For diagnosing metastasis

TREATMENT-

I) Early malignancy

a) T1 a-

  • Well differentiated associated with very slow growth rate
  • Regular follow up with DRE and PSA

b) T1b T1c, T2

  • Radical prostactectomy or radiotherapy
  • External beam radiotherapy- T1 or low T2 disease
  • Branchytherapy- low T1 disease

II) Late malignancy (T3, T4 or any metastasis)

  • Androgen ablation is the first line of treatment followed by antiandrogenic measure
  • Orchiectomy + flutamide or LHRH + flutamide
  • Palliative radiotherapy

Exam Important

  • Carcinoma of prostate is the MC malignant tumour in men over 65 years.
  • MC cause of bone secondaries
  • Carcinoma of prostate occurs in peripheral zone in prostatic gland proper (commonly in posterior lobe)

CLINICAL FEATURES-

  • Bladder outlet obstruction
  • Haematuria
  • Commonly asymptomatic
  • Pelvic pain, back pain, arthritic pain
  • Renal failure
  • Perineural invasion
  • Rectal examination- prostate feels hard, nodular, irregular and obliteration of medial sulcus

INVESTIGATIONS-

1. Hb%

  • Anemia
  • Thrombocytopenia
  • DIC

2. Plain X-ray, KUB-

  • Shows sclerotic metastases in lumbar vertebrae and pelvic bones

3. Serum acid phosphatase-

  • Responsible for acidic pH in the prostatic urethra and normally drained in urine
  • Increase acid phosphatase

4. Serum alkaline phosphatase-

  • Increase in extensive liver metastasis or bone metastasis

5. Prostate specific antigen(PSA)

  • It is a glycoprotein, serine protease elaborated by columnar prostatic acinar epithelial cells.
  • Free- 10- 40%, complexed to antiprotease- 60 to 90%
  • Formed in prostate and secreted in seminal fluid
  • Causes liquefaction of seminal coagulum
  • More than 4nmol/ml- carcinoma detected
  • 10 nmol/ml- prostatic carcinoma
  • 35 nmol/ ml- disseminated carcinoma
  • Prostate specific, but not prostate cancer specific
  • Most efficient test and for staging and assessing

6. Abdominal and transrectal USG- staging of the disease

7. CT scan or MRI scan

  • Staging of the disease
  • MRI is ideal for most accurate for local staging

8. Bone scan-

  • Increased ALP
  • Increased PSA (>20nmol/ml)
  • For diagnosing metastasis

TREATMENT-

I) Early malignancy

a) T1 a-

  • Well differentiated associated with very slow growth rate
  • Regular follow up with DRE and PSA

b) T1b T1c, T2

  • Radical prostactectomy or radiotherapy
  • External beam radiotherapy- T1 or low T2 disease
  • Branchytherapy- low T1 disease

II) Late malignancy (T3, T4 or any metastasis)

  • Androgen ablation is the first line of treatment followed by antiandrogenic measure
  • Orchiectomy + flutamide or LHRH + flutamide
  • Palliative radiotherapy
Don’t Forget to Solve all the previous Year Question asked on CARCINOMA OF PROSTATE

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