prostate carcinoma

Prostate Carcinoma

Prostate Carcinoma

• Many men are found to have had incidental microscopic

foci of prostate cancer at postmortem examination, and

most prostate cancers are slow growing and do not

manifest during the man's lifetime.

• Thus, many men die with prostate cancer rather than die

from prostate cancer.

Prostate Carcinoma

• 95% of prostate cancers are adenocarcinomas

developing in the acini of prostatic ducts.

Pathology

Prostate Carcinoma

• 70% of cancers occur in the peripheral zone

(PZ), and approximately 20% are found in the

transition zone (TZ).

Pathology

Prostate Carcinoma

• Local spread: capsular penetration, invasion of the seminal vesicles, or local

extension along the neurovascular bundles.

• Lymphatic spread: obturator LNs and from there to the common iliac and

para-aortic lymph nodes.

• Hematogenous spread: bones, and lungs. Skeletal metastases are common

in advanced prostate cancer, but hepatic metastases are uncommon.

Spread

Prostate Carcinoma

• Asymptomatic.

• Symptoms of advanced disease with weight loss,

lethargy, bladder outflow obstruction, or bone pain.

Clinical presentation

Prostate Carcinoma

• Serum PSA levels increase with age:

PSA

Patients aged 40-49 years, 0-2.5 ng/mL




Prostate Carcinoma

• Elevated serum PSA levels may also be

associated with prostatitis, prostate infarction,

PIN, prostate biopsy, transurethral resection of the

prostate, and urethral catheterization.

PSA

Prostate Carcinoma

• Serum PSA levels are lowered with finasteride

treatment for benign prostatic hyperplasia

PSA

Prostate Carcinoma

Imaging

Prostate Carcinoma

• Sclerotic metastases or lytic

lesions with bone destruction.

Plain X-Ray

Prostate Carcinoma

• CT has a limited role in assessing

prostatic cancer, but it may be

helpful in detecting nodal

involvement and metastases.

CT

Prostate Carcinoma

• MRI can demonstrate the internal anatomy of the prostate, and it can

identify areas of altered signal intensity, which representing focal

pathology in the gland.

• MRI is used primarily for staging, but the availability of interventional

MRI units means that MRI is likely to have a future role in the

diagnosis of prostate cancer.

MRI

Prostate Carcinoma

MRI

Prostate Carcinoma

ULTRASOUND

• TRUS plays a central role in the contemporary

diagnosis of prostate cancer because it enables

accurate image-guided biopsy of the gland.

Prostate Carcinoma

ULTRASOUND

Hypoechoic area in the PZ.

prostate carcinoma

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