Carcinoma of Prostate Issam S. Al-Azzawi, MD,FICMS,FEBU By

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Presentation transcript:

Carcinoma of Prostate Issam S. Al-Azzawi, MD,FICMS,FEBU By Head of Urology Department Al-Mustansiriya University

Incidence : Increase with age /over 65 Very common in west countries In Iraq : It is under estimated Aetiology : Genetic, Race, Diet ?

Pathology Adeno carcinoma Periphral zone Grading : Gleason system

Pathology : TNM Staging system

Pathology : Types of Prostate Ca. 1. Microscopic Latent cancer 2 Pathology : Types of Prostate Ca. 1. Microscopic Latent cancer 2.Early localized P cancer 3. Advanced localized P cancer 4. Metastatic P cancer

Metastasis of Prostate cancer Local spread : seminal vesicles, B neck, trigone, distal sphincter Lymph spread : Obturator, Int iliac, ext iliac / Mediastinal / Supraclavicular Blood spread : Bones, liver , lungs

Clinical features Asymptomatic Features of BOO / LUTS Hematuria Pelvic pain Bone pain / malaise / Anemia Renal failure Pathologic fractures / paraplegia Digital Rectal Examination ( DRE ) Irregular induration Hard nodule Fixed rectal mucosa

Investigations Lab . Tests S. PSA : For screening / Follow up Urinalysis CBC Renal function tests S. acid phosphatase S. PSA : For screening / Follow up less than 4 ng/ ml normal 4 – 10 ng / ml gray zone more than 10 ng/ml suggestive of Ca.

Transrectal Ultrasound ( TRUS ) + Biopsy

MRI and CT Scan

X-Ray of bones + Isotope Bone scan

Other Investigations for Prostate Ca Other Investigations for Prostate Ca. Abdominal U/S IVU CXR Laparoscopic pelvic lymphadenectomy

Treatment of prostate cancer 1. conservative ( watchful waiting ) 2. Radical prostatectomy ( open, Laparoscopic, Robotic ) 3. Radical Radiotherapy 4. Brachytherapy / Cryotherapy / HIFU 5. TURP 6. Androgen ablation 7. Molecular targeted therapy 8. Supportive therapy : Bisphosphonates , analgesics, Tx of anemia, Tx of uraemia, Orthopedic intervention

Treatment of prostate cancer Minimal invasive Tx : 1. Brachytherapy 2. Cryotherapy 3. High intensity focused U/S ( HIFU )

Androgen ablation 1. Antiandrogens ( Flutamide, Bicalutamide) 2. LHRH agonists ( Zoladex ) 3. Estrogens 4. Bilateral Orchiectomy Complete androgen blockade