What is the Prostate Cancer?

                                                               Prostate Cancer 

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes and protects sperm.

Most common malignant tumour in men >65  years. 25% of men 50-65 years. 70% of men >80years.

What are the 4 stages of prostate cancer ?

Prostate cancer stages range from I through IV.

• Stage I means the cancer is on one side of the prostate. 
• Stage II means the cancer remains confined to the prostate gland.
• Stage III means the cancer is locally advanced. 
• Stage IV means the cancer has spread to lymph nodes or to other parts of the body.

Aetiology / cause of prostate cancer- unclear

 Familial and genetic- 10-15% of younger men who develop prostate cancer have positive family history

 High cholesterol diet

 Geography

 Smoking

 Heavy alcohol consumption

Usually (70%) of prostate cancer originates in the peripheral

zone. So prostatectomy for BPH does not

prevent development of cancer. 25-30% arises

from transition zone.

PSA(prostate Specific Antigen Test) and DRE (Digital Rectal examination) are used for screening

 Men > 50yrs- annually

 High risk patients >45 yrs

20% of men with clinically significant prostate cancer will have normal PSA.

Histology

 Adenocarcinoma (98%)

 Gleason’s score will give the differentiation

1- Most differentiated

2- Least differentiated

Spread of prostate cancer

a. Local

 Seminal vesicles

 Trigone

 Anal sphincter

 Ureters

 Sciatic nerve

 Perineural invasion

b. Lymphatic

 Internal iliac

 External iliac

 Retroperitoneal

c. Haematogenous

 Bone

 Common

 Osteosclerotic lesion

 Sites- Pelvic bone,

Lower lumber vertebra and femoral head

 Liver

 Lung

Prostatic Cancer Symptoms

Asymptomatic

 Screening

 Following TURP (incidental)

 Nodule in DRE

Symptomatic

a. Locally advanced disease

 LUTS(Lower Urinary Tract symptoms)

 Urinary retention - acute and chronic

 Haematuria

 Perineal pain, loin pain

 Impotence

 Haematospermia

b. Metastatic disease

 Bone pain

 Renal failure

 Anaemia

 Leg swelling

 Paraplegia

 Pathological fracture

 Proptosis

 Malaise

 Pancytopaenia

Digital rectal examination Findings

 Enlarged prostate

 Hard

 Irregular

 Obliteration of median sulcus

 Fixed overlying mucosa

Prostate cancer diagnosis and Investigations

Blood tests

 PSA

 Liver function tests

Alkaline Phosphatase elevated in liver and bone

secondary

 Acid phosphatase

 Radiological

 Plain X-Ray (L/S spine)- for osteosclerotic mets.

 CXR- Lung metastasis

 USS abdomen

 TRUS

 Excretion urography

 CT

 MRI

 Prostate biopsy

 Bone scan- If bone pain or PSA>20ng/ml

Treatments of Prostatic Cancer

Depends on

 Stage of the disease

 Life expectancy

 Patient preference

a. Early disease

 Conservative Mx- Active

monitoring or watchful waiting

 Radical prostatectomy

 Radical radiotherapy- EBRT or

Brachytherapy

 Cryoablation

 Adjuvant Radiotherapy or

Chemotherapy

b. Locally advanced

 Radical prostatectomy

 External beam radiotherapy

c. Advanced disease

 Androgen deprivation therapy or Hormone therapy (80% are 

androgen dependent)

 General radiotherapy

 Channel TURP

The 5-year survival rate for people with prostate cancer is 98%. The 10-year survival rate is also 98%. Most prostate cancers (89%) are found when the disease is in only the prostate and nearby organs. This is referred to as the local or regional stage.

ANDROGEN DEPRIVATION THERAPY

1. Inhibition of LHRH or LH

 Diethyl stilbestrol

 Leuprolide

 Triptorelin

2. Ablation of androgen sources

 Orchidectomy

3. Inhibition of androgen synthesis

 Aminoglutethimide

 Ketoconazole

4. Antiandrogens

 Cyproterone acetate

 Flutamide

 Bicalutamide

 Nilutamide

Orchidectomy is done in,

1. Prostate cancer

2. Male breast cancer

COMPLICATIONS OF ANDROGEN ABLATION

 Osteoporosis

 Hot flashes

 Sexual dysfunction‐ erectile

dysfunction and loss of libido

 Changes in body habitus

 Gynaecomastia

 Anaemia