Carcinoma of the Prostate

Carcinoma of the ProstateDr. Didit Pramudhito, Sp.UDepartemen Bedah RSMH/FK UNSRIProstate cancer is the most common cancer diagnosed and is the second leading cause of the cancer death in American men.Many prostate cancers are indolent Exposure with cadmium (in cigarette smoke), alkaline batteries and welding industri may increase the risk for carcinoma of the prostate

Etiology: chromosome 1, 8p, 10q, 13q,16q, 17p and 18qPathology: 95 % adenocarcinoma 60 % - 70 % Carcinoma of the prostate originate in the peripheral zone10 % - 21 % originate in transition zone5 % - 10 % in the central zone.Grading & Staging The Gleason grading system is the most commonly employed grading system in the US. Well differentiated : 2- 4 Moderately differentiated : 5-6 Poorly differentiated : 8-10TNM Staging system Tis: carcinoma in situ T1a: 5% turp tissue has cancer, normal DRE T1c: elevated PSA, normal DRE&TRUS T2a: palpable by DRE, or visible by TRUS on one side only T2b: palpable by DRE, or visible by TRUS on both side T3a: extracapsular extension on one or both side T3b: Seminal vesicle involvement T4: extends into bladder neck, sphincter, rectum, levator muscle or into pelvic sidewall.N regional lymph nodes N1 : metastasis in a regional lymph nodesM distant metastasis M1a: distant metastasis in non regional lymph nodes M1b: distant metastasis to bone M1c: distant metastasis to other sites

Clinical FindingSymptoms: early stage asymptomatic. the presence of symptoms often suggests locally advanced or metastatic disease. Obstuctive or irritative voiding complaint. Metastatic disease to the bones may cause bone painSign: DRE induration prostateTumor marker: PSA 4 ng/mlImaging: TRUS, endorectal MRI, Axial MRI,CT Bone scan

Differential DiagnosisNot all patients with an elevated PSA concentration have CaP.BPH, urethral instrumentation, infection, prostate, prostate massage.TreatmentWatchful waitingRadical prostatectomyRadiation therapy