PROSTATIC CANCER (ADENOCARCINOMA OF

THE PROSTATE)

BY: PHELOKAZI NGQONDO

212350757

CONTENTS INTODUCTION AETIOLOGY AND PATHOGENESIS DIAGNOSIS SIGNS AND SYMPTOMS CASE STUDY TREATMENT DISCUSSION

INTRODUCTIONTHE PROSTATE GLAND

It is the small walnut-sized gland that exists only in men .

It is situated just below the bladder in the lower pelvis .

Due to undefined reasons,cells in this gland start to grow in an out-of-control and unregulated manner.

And this is called Prostate cancer.

CONTINUED…

Fig 1:shows the location of the prostate

AETIOLOGY AND PATHOGENESIS

The development of cancer is viewed in a two-step process. Initiation through genetic alterations in the

cell.Cancer promotion (process allowing cancer

cells to grow and progress). Epidermiological studies suggest a

variety of aetiological factors, which are-:AgeRaceFamily history of prostatic cancer.

CONTINUED…Life style factorHigh intake saturated fat intakeLow intake of carotinoidsVasectomyOther sexual factorsExcessive weightEnergy balance

DIAGNOSISThis done by -:

Digital rectal examinationProstate-specific antigen testImaging studies Histology Haematology and Chemistry

CONTINUED…DIGITAL RECTAL EXAMINATION

This cannot be used alone in the early stages of cancer because it can miss 30-40% of the cancer.

Fig 2: shows risk percentage of prostatic cancer versus PSA levels in the blood.

CONTINUED…PROSTATE-SPECIFIC ANTIGEN

TESTIt measures the enzyme being produced by glandular cells of the prostate.

It is expressed as ng/mL.PSA is normally found in small amounts in the blood.

PSA levels rise when there is an abnormality in the prostate.

CONTINUED…

Fig 3:shows normal values of PSA found in each of the cases

PSA (ng/mL) RISK OF PROSTATIC CANCER RISK OF AGGRESSIVE PROSTATIC CANCER

<0.5 7% 1%

0.6-1.0 10% 1%

1.1-2.0 17% 2%

2.1-3.0 24% 5%

3.1-4.0 27% 7%

     

     

CONTINUED… IMAGING STUDIES

Some men need to undergo a bone scan to determine the spreading of the cancer to bone.

fig 4: Radionuclide bone scan showing metastatic bone disease secondary to prostatic adenocarcinoma. Osseous sites of increased uptake can be identified in the spine (T1 to T12) and ribs.

SIGNS AND SYMPTOMS There are no signs in the early

stages. Men with advanced disease may

experienceDifficulty in urination.Erectile dysfunction/ decrease

firmness of erection. In some men the symptoms originate

in areas of the body where the cancer has spread

CASE STUDY Patient profileA 66-year-old black man with a

family history of prostatic cancer.

He woke up one morning with a difficulty in urination accompanied by severe sweating.

CONTINUED… His physical exam was normal and

the digital rectal examination revealed a slightly enlarged prostate.

The doctor suspected prostatic cancer and requested a PSA test which showed a PSA level of 8 ng/mL.

A needle biopsy was sent to histology.

A blood sample was sent to haematology and urine sent to chemistry.

CONTINUED… RESULTS Histology

Fig 5:shows the patient’s prostate gland with some infiltration.

Fig 6:shows a normal prostate gland.

CONTINUED… Haematology and Chemistry

Patient’s results

Normal values

HAEMATOLOGY

Haemoglobin 15 g/ml N 13.5-17.5 g/mL

Haematocrit 43% N 40-52%

WBC 7.5 ×109 /L N 4.0-11.0 ×109 /L

Platelet count 507×109 /L N

150-400×109 /L

CHEMISTRY

Blood urea nitrogen

15 mg/dL N 6-20mg/dL

Creatinine 1.0 mg/dL N 0.9-1.3 mg/dL

Phosphate Normal N O-3.5 ng/mL

PSA 8 ng/mL H 4 ng/mL

TREATMENT Surgery Radical prostatectomy Radiation therapy Hormonal therapy (depending on

cancer risk category and age ,to slow progression)

Cryotherapy (for men at low risk for disease progression)

Immunotherapy chemotherapy

DISCUSSIONThe studies show that:-Early diagnosis is the most

important determinant of outcome in malignant spinal cord compression .

MRI evaluation is the most sensitive diagnostic procedure when accompanied by heightened awareness of the potential threat.

CONTINUED…Cord compression is due to axial

skeletal metastases of prostate cancer.

Patients should be instructed to bring bladder, bowel, and muscle strength changes to the physician’s attention as early as possible.

CONCLUSIONProstatic cancer, like any other

cancer has no specific cause.People should always go get

screened for cancer,more especially those with a family history of cancer.

Cancer treatment is very expensive, especially when cancer has progressed to other body part.

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docetaxel weekly or every 3 weeks vs. mitoxantrone and prednisone for patients with hormone refractory prostate cancer. Proceedings American Society of Clinical Oncology, abstract 4; 2004; New Orleans, LA.

Plenaxis® (abarelix) [full prescribing information] Waltham, MA: Praecis Pharmaceuticals Inc.; 2004.

Nelson WG, Carter HB, DeWeese T, Eisenberger MA. In: Clinical Oncology. Abeloff MD, Armitage JO, Lichter AS, Niederhuber JE, editors. New York, NY: Churchill Livingston; 2004.

Eisenberger MA, Carducci MA. Chemotherapy for prostate cancer. In: Walsh P, Retik A, Darracott Vaughan E, Wein A, editors. Campbell’s Urology. New York, NY: Elsevier; 2001.

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