Understanding Prostate Cancer

Robert Miller MDwww.aboutcancer.com

Prostate Cancer

Most common cancer in men (28% cancers in men)

Lifetime risk in 1 in 6 white men and 1 in 5 African American

Median Age at diagnosis is 67 (but 3% in 40’s and 22% in 50’s)

Age Distribution of Men Diagnosed with Prostate Cancer 2000-2010

0%

5%

10%

15%

20%

25%

30%

35%

40%

30 40 50 60 70 80 90Age

3%

22%

39%

28%

7%

1%

Understanding prostate cancer

Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score

The prostate gland has a capsule around it, and cancers arise close to the capsule, the cancer may invade through the capsule or extend up into the seminal vesicles

Prostate Anatomy…the nerves that can results in impotence are on the side of the gland

There are lymph nodes that may be involved, it is rare to have lymph node spread in low or intermediate risk patients

Prostate Cross Section Anatomy

Prostate

rectum

bladder

Prostate Cross Section Anatomy

Bladder

Prostate

Rectum

Prostate CT Anatomy

Prostate MRI Anatomy

Prostate MRI Anatomy

Prostate Stages

Most men with a low PSA (less than 10) and a low Gleason score (less than 7) have cancer cells in the gland too small to feel or see on CT scans

Too small to feel = Stage I (T1c)

T1c = too small to feel and biopsied because of an

elevated PSA

bladder

cancer

prostate

rectum

If you can feel a lump then it’s called T2

T2 lesion = big enough to feel

MRI = extra capsular spread

T3 if spread to the seminal vesicles

T3 if spread to the seminal vesicles

T3 if spread to the seminal vesicles

Biopsy of seminal vesicles = Gleason 9 adenocarcinoma

Stage IV if spread to the lymph nodes or bone

Stage IV: spread to the lymph nodes

Stage IV: spread to the bones on Sodium

Fluoride PET scan

Prostate Cancer Stage

Prostate Cancer Stage

Prostate Cancer Stage

Prostate Cancer Cure Rate After Radical Prostatectomy Based on Pathologic Stage

Understanding prostate cancer

Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score

Prostate Cancer Cure Rate After Radical Prostatectomy Based on PSA Prior to

Surgery

Cure Rate with Surgery Based on PSAand Gleason Score (GS)

PSA (prostate specific antigen) and radiation results

PSA LevelRelapsed after

Radiation

0.1 to 4 4%

4 to 10 7%

10 to 20 22%

20 - 50 48%

over 50 67%

Note that the PSA levels slowly decline after completing radiation

Understanding prostate cancer

Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score

Understanding a Pathology Report

1. Histology: adenocarcinoma

2. Number of cores involved/ total number of cores

3. Gleason score: 3 + 3

4. Perineural invasion

Prostate cancers are called ADENOCARCINOMA (which just means cancer from glandular tissue). The more the cancer cell is similar to a normal prostate cells, the less dangerous, so well differentiated (Gleason 2 – 5) are much better than intermediate grade (Gleason 6 – 7) and much better than poorly differentiated (Gleason 8-10) cancer cells

Prostate Cancer Cure Rate After Radical Prostatectomy Based on Pathologic Grade (i.e. how mutated the cancer cells appear)

Gleason Scoring System

From the biopsy, the pathologist grades the appearance of the cells. From least serious (slow growing or Grade 1) to the fastest growing and most dangerous or grade 5).

The first number is the most common pattern seen from 1 to 5

Gleason Scoring System

The second number is the next most common pattern seen. So a 4+3 is more serious than 3+4 even though they both are Gleason 7.

So the slowest is a score of 2 and the fastest (most dangerous) is a score of 10.

Gleason Scoring System

The higher the Gleason Score, the lower the cure rates after surgery

Gleason Score

50

55

60

65

70

75

80

85

90

95

6 7 8

5 YearSurvival

10 YearSurvival

60

65

70

75

80

85

90

95

3+3 3+4 4+4 4+5 5+5

5 year cure rate radiation

radiation plus hormones

The higher the Gleason Score, the lower the cure rates after radiation

Gleason Score

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Variable Score

PSA 50

Gleason 8

Stage T1c

Calculators (Partin Tables) can be used to predict the odds of extra- capsular spread

Biochemical Recurrence-free Survival Prediction Model Duke Prostate Center.

Prostate Cancer Risk Groups combine all 3 things, the stage, the PSA level and the Gleason score, system used by the NCCN

•Low risk: (T1c, T2a Gleason 6, PSA <10)

•Intermediate risk: (T2b, T2c, Gleason 7, PSA 10-20)

•High risk: (T3, Gleason 8-10 or PSA > 20)

Understanding Prostate Cancer

Robert Miller MDwww.aboutcancer.com