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

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

3. Pathology
Adeno carcinoma
Periphral zone
Grading : Gleason system

4. Pathology : TNM Staging system

5. 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

6. 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

7. 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

8. 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.

9. Transrectal Ultrasound ( TRUS ) + Biopsy

10. MRI and CT Scan

11. X-Ray of bones + Isotope Bone scan

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

13. 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

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

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