Prostate cancerProstate cancer

Tim BraceyTim Bracey

HistopathologyHistopathology

Prostate cancer

What are we going to What are we going to talk about?talk about?

Anatomy of prostateAnatomy of prostate Very basic histology!Very basic histology! How prostate cancer starts and How prostate cancer starts and

spreadsspreads Epidemiology and risk factorsEpidemiology and risk factors Presenting symptoms and signsPresenting symptoms and signs Investigations and ManagementInvestigations and Management

Prostate cancer

AnatomyAnatomy Name 5 main anatomical relations of the prostateName 5 main anatomical relations of the prostate

1.1. Bladder base Bladder base (base)(base)

2.2. Pelvic floor Pelvic floor (apex)(apex)

3.3. Seminal vesiclesSeminal vesicles

4.4. RectumRectum

5.5. UrethraUrethra

Prostate cancerNormal glands and stroma Prostatic adenocarcinoma

HistologyHistology

From which cells do prostate cancers From which cells do prostate cancers arise?arise?

What types of cancers arise in the What types of cancers arise in the prostate?prostate?

Dysplasia (PIN)Genetic changes

Prostate cancer

Where does prostate cancer Where does prostate cancer start? start?

Prostate cancer

How does prostate cancer How does prostate cancer spread?spread?

DirectDirect LymphaticLymphatic BloodBlood

Commonly to Commonly to bonebone

Prostate cancer

Epidemiology 1Epidemiology 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 studies Clinical Prevalence

Prostate cancer

Epidemiology 2Epidemiology 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!

Prostate cancer

AetiologyAetiology

Name 2 endogenous and 2 exogenous Name 2 endogenous and 2 exogenous aetiological factors for prostate caaetiological factors for prostate ca

EndogenousEndogenous Age, race, genetics, hormone levelsAge, race, genetics, hormone levels

ExogenousExogenous Diet: high fat (inc risk), omega 3, Diet: high fat (inc risk), omega 3,

selenium, vitA, soya (dec risk)selenium, vitA, soya (dec risk) Vasectomy (+1.56 RR)Vasectomy (+1.56 RR)

Prostate cancer

Clinical FeaturesClinical Features Name 2 general and 2 specific presenting Name 2 general and 2 specific presenting

features for prostate cafeatures for prostate ca

LUTSLUTS Poor streamPoor stream HesitancyHesitancy NocturiaNocturia Term Term

dribblingdribbling Spread to Spread to

other organsother organs

Prostate cancer

InvestigationsInvestigations

Name 5 clinical tests or investigations Name 5 clinical tests or investigations for a patient with suspected prostate cafor a patient with suspected prostate ca

Bedside: DREBedside: DRE Bloods: FBC, U+E, Ca, G+S, PSABloods: FBC, U+E, Ca, G+S, PSA Imaging: CXR, USS, CT, MRI, bone scanImaging: CXR, USS, CT, MRI, bone scan Invasive: TRUS biopsyInvasive: TRUS biopsy

Note 10% are incidental on TURP for BPHNote 10% are incidental on TURP for BPH

Prostate cancer

Prostate cancer

ManagementManagement What are the principles of management of a What are the principles of management of a

patient with prostate cancer?patient with prostate cancer? ConservativeConservative

““Die with not from”, Watchful waiting, palliationDie with not from”, Watchful waiting, palliation MedicalMedical

Hormonal treatment, RadiotherapyHormonal treatment, Radiotherapy Medical therapy is targeted at all parts of the Medical therapy is targeted at all parts of the

endocrine axisendocrine axis LHRH, anti-androgens or complete blockade, oestrogens, LHRH, anti-androgens or complete blockade, oestrogens,

some men opt for orchidectomy (eunochs don’t get prostate some men opt for orchidectomy (eunochs don’t get prostate cancer!)cancer!)

SurgicalSurgical Radical prostatectomy (open or lap), TURP for LUTSRadical prostatectomy (open or lap), TURP for LUTS

Prostate cancer

What have we talked What have we talked about?about?

AnatomyAnatomy HistologyHistology Epidemiology, Aetiology and Risk Epidemiology, Aetiology and Risk

FactorsFactors Clinical Presentation and Clinical Presentation and

investigationsinvestigations Basics of ManagementBasics of Management Any Questions?Any Questions?