Tumors of the prostate

Tumors of the prostate

•         1-Primary into Benign & malignant.

•         2-Secondary involvement of the prostate occurs through direct extension by carcinoma of the urinary bladder, urethra, colorectal , anus & soft tissue tumors.

•         Distant metastases have been seen from lung cancer & melanoma.

Prostatic carcinoma

•         Most common form of cancer in men, Followed closely by lung cancer.

•         Second leading cause of cancer death.

•         Approximately 70 % of men between 70-80 years have prostatic carcinoma.

•         There are some remarkable & puzzling national & racial differences in the incidence of this disease. These differences are thought to be due to environmental influences.

Etiology:

•         Several risk factors e.g. age, race, family history, hormone levels (testosterone & androgen) & environmental influences are suspected of playing roles.

•         Increased consumption of fats has been implicated, its influences the levels of hormones such as testosterone, which in turn affect the growth of prostate.

•         Grossly: affecting peripheral zone of the gland classically in the posterior location.

•          firm yellow with gritty cut section

•         Histology: small closely packed glands (back-to-back) with single cell lining. These cells have large vesicular nuclei with prominent one or more  nucleoli .Invasion of capsule with its lymphatic & vascular channels, perineural invasion or both.

Grading & staging:

•         Use Gleason’s grade. Grading particular importance because there is in general fairly good correlation between the prognosis & degree of differentiation.

Clinical course:

•         60 % of patient presented with localized disease in the prostatic gland.

•         40 % of patient presented with invasion to the surrounded organ specially urinary bladder & tract causing urinary symptoms or metastases by lymphatic to the obturator lymph nodes.

•         Or metastasis by blood to the axial skeleton especially to lumber spine, pelvis & thoracic spine producing osteoblastic reaction.

Investigations:

•         PSA : increase in prostatic carcinoma usually  more than 10  ng/ml

•         PAP : increase in cases with bony metastases

Treatment:

•         Surgery, radiotherapy & hormonal manipulation

prognosis:

•         depend on grading & staging but generally poor.