1. Prostate Cancer
Dr .Gehan Mohamed

2. Prostate Cancer
Common in men older than 50; ranks high as cause of cancer death

3. Risk Factors Environmental factors (diet, saturated fats)
Genetic factors(family history)
2.4 times increased risk ( if first degree relative had cancer prostate)
Geography/race:
More in african,american due to high level of testosterone

4. Pre cancerous lesions
High grade prostatic intraepithelial neoplasia = high grade dysplasia :
is a condition in which some of the prostate’s epithelial cells look abnormal under the microscope. Epithelial cells are the cells that line the tiny sacs in the prostate and the ducts that carry fluid in the prostate

6. High grade prostatic intraepithelial neoplasia

7. Presentations of CANCER Prostate
1- Asymptomatic , Incidental pathological finding
2- Urinary irritative and obstructive symptoms
3- abnormal DIGITAL RECTAL EXAMINATION / raised PSA level(47%) .
4- Metastatic symptoms
bone pain,Pathological fractures,anorexia ,spinal cord compression etc.

8. Prostate Cancer—Signs and Symptoms
Hard nodule in periphery of gland
Detected by rectal exam
urethral obstruction
As tumor develops, some obstruction occurs
Hesitancy, decreased stream, urinary frequency, bladder infection

9. Digital rectal examination (DRE)
YOU CAN DETECT Abnormal nodules, hard spots, enlarged prostate.

10. Prostate biopsy Performed during transrectal ultrasonography.
Random biopsy 6-10 are taken to get a representative sample of prostate.
Possibility of infection,give prophylactic antibiotic.

11. Triad of diagnosis,--(PSA_DRE_BIOPSY)

12. Prostatic adenocarcinoma showing the prostatic glands lined by one TYPE of malignant cells

13. Prostatic adenocarcinoma showing the prostatic glands lined by one TYPE of malignant cells.

14. Prostate Cancer—Diagnostic Tests
2 helpful serum markers
Prostate-specfic Antigen (PSA)
Useful screening tool for early detection
Prostatic acid phosphatase
Ultrasound and biopsy confirms.
TO DETECT ANY DISTANT METASTASIS DO :
1- Bone scan
2- CT abdomen/pelvis
3- Chest x-ray

15. Prostate Specific Antigen
Protein produced by cells of prostate gland
Elevated indicates possible Carcinoma prostate
PSA : 4 – 10 ng /ml , indicates 25-35% risk of cancer diagnosis
PSA : 10 – 20 ng /ml indicates 65% risk of cancer diagnosis
PSA : > 20 ng /ml indicates possible metastatic disease

16. Staging of prostatic adenoCarcinoma ,TNM system
Clinical inapparent tumor not palpable or visible by imaging T2
Tumor confined to prostate(palpable or visible by imaging) T3
Tumor extending through prostatic capsule T4
Tumor fixed or invading adjacent structure other than seminal vesicle

17. Lymph node staging Metastasis N0-no lymph node involved
N1-lymph node involved
Metastasis
M0- no metastasis
M1-distant metastasis present

18. Metastatic prostatic carcinoma to vertebral column

19. Gleason's scoring system
Settled by Dr Donald Gleason 1976
Based on microscopic tumor pattern assessed by pathologist while examining ,GS is based on degree of loss of normal architecture of gland.
Technically it is tumor grade.

20. Gleason's grades , a histolopathological specimen into 5 grades.

21. Gleason's scoring system
Gleason's grade
- primary grade: represent most prominent grade i.e more than 50% of sections examined Show this grade.
- secondary grade : represent second predominant pattern
Gleason's score =
primary grade + secondary grade.