1. Prostate cancer Tim Bracey Histopathology

2. Prostate cancer What are we going to talk about? Anatomy of prostate Anatomy of prostate Very basic histology! Very basic histology! How prostate cancer starts and spreads How prostate cancer starts and spreads Epidemiology and risk factors Epidemiology and risk factors Presenting symptoms and signs Presenting symptoms and signs Investigations and Management Investigations and Management

3. Prostate cancer Anatomy Name 5 main anatomical relations of the prostate Name 5 main anatomical relations of the prostate 1. Bladder base (base) 2. Pelvic floor (apex) 3. Seminal vesicles 4. Rectum 5. Urethra

4. Prostate cancer Normal glands and stroma Prostatic adenocarcinoma Histology From which cells do prostate cancers arise? From which cells do prostate cancers arise? What types of cancers arise in the prostate? What types of cancers arise in the prostate? Dysplasia (PIN) Genetic changes

5. Prostate cancer Where does prostate cancer start?

6. Prostate cancer How does prostate cancer spread? Direct Direct Lymphatic Lymphatic Blood Blood Commonly to bone Commonly to bone

7. Prostate cancer Epidemiology 1 What percentage of 80 yr old men have prostate ca? What percentage of 80 yr old men have prostate ca? From 50-80% in autopsy studies! From 50-80% in autopsy studies! Prevalence from autopsy studiesClinical Prevalence

8. Prostate cancer Epidemiology 2 Why did incidence rise in 1990’s? Why did incidence rise in 1990’s? Probably secondary to PSA testing! Probably secondary to PSA testing!

9. Prostate cancer Aetiology Name 2 endogenous and 2 exogenous aetiological factors for prostate ca Name 2 endogenous and 2 exogenous aetiological factors for prostate ca Endogenous Endogenous Age, race, genetics, hormone levels Age, race, genetics, hormone levels Exogenous Exogenous Diet: high fat (inc risk), omega 3, selenium, vitA, soya (dec risk) Diet: high fat (inc risk), omega 3, selenium, vitA, soya (dec risk) Vasectomy (+1.56 RR) Vasectomy (+1.56 RR)

10. Prostate cancer Clinical Features Name 2 general and 2 specific presenting features for prostate ca Name 2 general and 2 specific presenting features for prostate ca LUTS LUTS Poor stream Poor stream Hesitancy Hesitancy Nocturia Nocturia Term dribbling Term dribbling Spread to other organs Spread to other organs

11. Prostate cancer Investigations Name 5 clinical tests or investigations for a patient with suspected prostate ca Name 5 clinical tests or investigations for a patient with suspected prostate ca Bedside: DRE Bedside: DRE Bloods: FBC, U+E, Ca, G+S, PSA Bloods: FBC, U+E, Ca, G+S, PSA Imaging: CXR, USS, CT, MRI, bone scan Imaging: CXR, USS, CT, MRI, bone scan Invasive: TRUS biopsy Invasive: TRUS biopsy Note 10% are incidental on TURP for BPH Note 10% are incidental on TURP for BPH

12. Prostate cancer

13. Management What are the principles of management of a patient with prostate cancer? What are the principles of management of a patient with prostate cancer? Conservative Conservative “Die with not from”, Watchful waiting, palliation “Die with not from”, Watchful waiting, palliation Medical Medical Hormonal treatment, Radiotherapy Hormonal treatment, Radiotherapy Medical therapy is targeted at all parts of the endocrine axis Medical therapy is targeted at all parts of the endocrine axis LHRH, anti-androgens or complete blockade, oestrogens, some men opt for orchidectomy (eunochs don’t get prostate cancer!) LHRH, anti-androgens or complete blockade, oestrogens, some men opt for orchidectomy (eunochs don’t get prostate cancer!) Surgical Surgical Radical prostatectomy (open or lap), TURP for LUTS Radical prostatectomy (open or lap), TURP for LUTS

14. Prostate cancer What have we talked about? Anatomy Anatomy Histology Histology Epidemiology, Aetiology and Risk Factors Epidemiology, Aetiology and Risk Factors Clinical Presentation and investigations Clinical Presentation and investigations Basics of Management Basics of Management Any Questions? Any Questions?