Prostate Cancer PDF

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Klu...

Lecture Material is adapted from © 2017 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 3: Clinical Models Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Prostate Cancer Prostate Cancer Australia http://www.prostate.org.au/  Prostate Cancer Pathophysiology Risk of developing: 1 in 6 Second leading cause of cancer death in men ~85% of man with prostate cancer is diagnosed after age 65 predominantly disease of older men The exact cause is often unknown Risk factors advancing age family history of prostate cancer Black race smoking nutritional factors high intake of fats and meat low intake of lycopene (found in tomato-based products) and fruit McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015 high dietary calcium  Prostate Cancer Pathophysiology Malignant transformation of prostate epithelial cells Series of initiating and promoting events Genetic and environmental influences 5-10% are related to inherited genetic factor or susceptibility gene HPC1: hereditary prostate cancer gene More than 95% of primary prostate cancers are classified as adenocarcinomas Androgens and estrogens appear to support carcinogenesis Promote prostate epithelial cell proliferation Premalignant changes in patients with prostate cancer: Prostatic intraepithelial neoplasia (PIN) PIN lesions progress to prostate adenocarcinoma Neoplasm develops in the peripheral portion of the gland Due to peripheral location tumor does not compress the urethra until later Strayer D, Rubin E. Rubin's Pathology: Clinicopathologic Foundations of Medicine. 7th ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins; 2014  Prostate Cancer Clinical Manifestations Often asymptomatic until advanced (Incidental: digital rectal examination, PSA) When clinical manifestations are present, tumor has expanded Obstructing urethra Same symptoms as BPH Common systemic manifestations Paraneoplastic syndromes Manifestations of metastatic spread Pain in the bone Strayer D, Rubin E. Rubin's Pathology: Clinicopathologic Foundations of Medicine. 7th ed. UK, Wolters Kluwer/Lippincott Williams & Wilkins; 2014  Prostate Cancer Diagnostic Criteria Digital rectal examination Transrectal ultrasound Prostate specific antigen Biopsy via fine needle aspiration transrectally During radical prostatectomy: Pelvic lymph node dissection Radionucleotide bone scans for the presence of metastases Most common site of distant spread http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46632  Prostate Cancer Diagnostic Criteria After diagnosis, staging using TNM classification T1: a clinically inapparent tumor not palpable or visible by imaging T2: the tumor is confined to the prostate T3: the tumor extends through the prostate capsule T4: the tumor is fixed or invades adjacent structures other than the seminal vesicles Survival rates and prognosis depends: Histologic features Staging Local/regional spread: 5-year survival: >99% Distant metastases: 5-year survival: 33.5%  Prostate Cancer Treatment Based on tumor grading, TNM classification, age, overall health Surgery : radical prostatectomy (removal of the entire prostate) Younger men (