Prostate cancer

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Prostate cancer

• Tim Bracey
• Histopathology

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What are we going to talk about?

• Anatomy of prostate
• Very basic histology!
• How prostate cancer starts and spreads
• Epidemiology and risk factors
• Presenting symptoms and signs
• Investigations and Management

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Anatomy

• Name 5 main anatomical relations of the prostate

1. Bladder base (base)
2. Pelvic floor (apex)
3. Seminal vesicles
4. Rectum
5. Urethra

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Histology

• From which cells do prostate cancers arise?
• What types of cancers arise in the prostate?

Dysplasia (PIN) Genetic changes
Normal glands and stroma
Prostatic adenocarcinoma
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Where does prostate cancer start?
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How does prostate cancer spread?

• Direct
• Lymphatic
• Blood
• Commonly to bone

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Epidemiology 1

• What percentage of 80 yr old men have prostate
  ca?
• From 50-80 in autopsy studies!

Prevalence from autopsy studies Clinical
Prevalence
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Epidemiology 2

• Why did incidence rise in 1990s?

• Probably secondary to PSA testing!

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Aetiology

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

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Clinical Features

• Name 2 general and 2 specific presenting features
  for prostate ca

• LUTS
• Poor stream
• Hesitancy
• Nocturia
• Term dribbling
• Spread to other organs

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Investigations

• Name 5 clinical tests or investigations for a
  patient with suspected prostate ca
• Bedside DRE
• Bloods FBC, UE, Ca, GS, PSA
• Imaging CXR, USS, CT, MRI, bone scan
• Invasive TRUS biopsy
• Note 10 are incidental on TURP for BPH

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Management

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

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What have we talked about?

• Anatomy
• Histology
• Epidemiology, Aetiology and Risk Factors
• Clinical Presentation and investigations
• Basics of Management
• Any Questions?