Prostate CancerProstate Cancer

Prostate cancer is the most common Prostate cancer is the most common cancer detected in American men. cancer detected in American men.

The lifetime risk of a 50-year-old man for The lifetime risk of a 50-year-old man for latent CaP is 40%; for clinically apparent latent CaP is 40%; for clinically apparent CaP, 9.5%; and for death from CaP, 2.9%. CaP, 9.5%; and for death from CaP, 2.9%.

Risk FactorRisk Factor

AgingAging

RaceRace

A positive family history of CaP A positive family history of CaP

Diet: low fat, plant-based diet, Total fat Diet: low fat, plant-based diet, Total fat intake, animal fat intake, and red meat intake, animal fat intake, and red meat intake intake

Previous vasectomy Previous vasectomy

PathologyPathology

Adenocarcinoma(95%)Adenocarcinoma(95%)

Others: TCCOthers: TCC

Neurendocrine tumorNeurendocrine tumor

SarcomaSarcoma

Approximately, 60–70% of cases of CaP Approximately, 60–70% of cases of CaP originate in the peripheral zone, while 10–originate in the peripheral zone, while 10–20% originate in the transition zone, and 20% originate in the transition zone, and 5–10% in the central zone. 5–10% in the central zone.

PathologyPathology

The Gleason grading system is the most The Gleason grading system is the most commonly employed grading system.commonly employed grading system. Gleason grading system that relies upon the Gleason grading system that relies upon the low-power appearance of the glandular low-power appearance of the glandular architecture under the microscope.architecture under the microscope. In assigning a grade to a given tumor, In assigning a grade to a given tumor, pathologists assign a primary grade to the pathologists assign a primary grade to the pattern of cancer that is most commonly pattern of cancer that is most commonly observed and a secondary grade to the second observed and a secondary grade to the second most commonly observed pattern in the most commonly observed pattern in the specimen. specimen.

Gleason grade 1&2Gleason grade 1&2

Gleason grade 3-4&5Gleason grade 3-4&5

PathologyPathology

Well-differentiated tumors havea Gleason Well-differentiated tumors havea Gleason sum of 2–4,sum of 2–4,

Moderately differentiated tumors have a Moderately differentiated tumors have a Gleason sum of 5–6,Gleason sum of 5–6,

Poorly differentiatedtumors have a Poorly differentiatedtumors have a Gleason sum of 8–10. Gleason sum of 8–10.

Premalignant lesionsPremalignant lesions

SymptomsSymptoms

Most patients with early-stage CaP are Most patients with early-stage CaP are asymptomatic. asymptomatic.

The presence of symptoms often suggests The presence of symptoms often suggests locally advanced or metastatic disease. locally advanced or metastatic disease.

Obstructive or irritative voiding complaints Obstructive or irritative voiding complaints

Bone pain Bone pain

Spinal cord compressionSpinal cord compression

Serum tumor markerSerum tumor marker

PSA is a serine protease produced by PSA is a serine protease produced by benign and malignant prostate tissues. It benign and malignant prostate tissues. It circulates in the serum as uncomplexed circulates in the serum as uncomplexed (free or unbound) or complexed (bound) (free or unbound) or complexed (bound) forms.forms.

Normal PSA values are those ≤4 ng/mL.Normal PSA values are those ≤4 ng/mL.

The positive predictive value of a serum The positive predictive value of a serum PSA between 4nd 10 ng/mL is PSA between 4nd 10 ng/mL is approximately 20–30%. approximately 20–30%.

PSA VariantsPSA Variants

PSA density—PSA levels are elevated PSA density—PSA levels are elevated approximately0.12 ng/mL/g of BPH tissue. approximately0.12 ng/mL/g of BPH tissue.

Some investigators advocate prostate Some investigators advocate prostate biopsy only if the PSA density exceeds 0.1 biopsy only if the PSA density exceeds 0.1 or 0.15.or 0.15.

PSA velocity—PSA velocity refers to the PSA velocity—PSA velocity refers to the rate of change of serum PSA. Patients rate of change of serum PSA. Patients whose serum PSA increases by 0.75 whose serum PSA increases by 0.75 ng/mL/y appear to be at an increased risk ng/mL/y appear to be at an increased risk of harboring cancer. of harboring cancer.

Age adjusted PSAAge adjusted PSA

DiagnosisDiagnosis

Serum tumor markerSerum tumor marker

DREDRE

TRUS biopsy of TRUS biopsy of prostateprostate

CT Scan CT Scan

Bone ScanBone Scan

TreatmentTreatment

Radical ProstatectomyRadical Prostatectomy

RadiotherapyRadiotherapy

SurveillanceSurveillance

Watchful waitingWatchful waiting

Hormone therapyHormone therapy

Other treatmentOther treatment

The most prostatic carcinomas are hormone The most prostatic carcinomas are hormone dependent anthat approximately 70–80% of men dependent anthat approximately 70–80% of men with metastatic Carespond to various forms of with metastatic Carespond to various forms of androgen deprivation. Testosterone, is produced androgen deprivation. Testosterone, is produced by the Leydig cells in the testes (95%), by the Leydig cells in the testes (95%), Free testosterone enters prostate cells and is Free testosterone enters prostate cells and is converted to dihydrotestosterone (DHT), the converted to dihydrotestosterone (DHT), the major intracellular androgen DHT binds to a major intracellular androgen DHT binds to a cytoplasmic receptor protein and the complex cytoplasmic receptor protein and the complex moves to the cell nucleus, where it modulate moves to the cell nucleus, where it modulate transcription. transcription.