Shashidhar Venkatesh Murthy A/Prof & Head of Pathology College of Medicine & Dentistry CLINICAL PATHOLOGY The foundation of clinical medicine. BPH4: Urinary Tract Dis: Prostate Cancer
3 Prostatic Cancer: Introduction Adenocarcinoma, Most common male cancer, elderly (>50y), But second common cause of cancer death in males. (next to lung) Many prostatic carcinomas are small and clinically insignificant. If tested, seen in many elderly dying of other causes* (incidental Ca) But some are rapidly fatal, no specific test to detect early* Population screening of PSA – controversial, now discouraged*** % of free PSA to total PSA is lower in men with prostate cancer.
4 Adeno-Ca Prostate Gross: 1. Irregular, stony hard 2. Peripheral / posterior BPH Cancer
5 Prostatic Cancer: Etiopathogenesis Etiology: ?Androgens, genes (ETS, PTEN) & ?env / diet. (Not BPH) PSA* proteolytic enzyme, liquefies semen. Not cancer specific. Normal Serum PSA < 4.0ng/L. in Prostate damage / malignancy. Lower in non malignant but significant overlap*. Patients (54%) lacking both PTEN & ETV had ‘good prognosis’ (85.5% alive at 11 years)* - localized cancer without killing…! *BJC Pathogenesis: Dysplasia PIN cancer. Loss of double layer in Ca PIN: Prostatic Intraepithelial Neoplasia
7 Prostatic Cancer: Microscopy Normal Gross: Hard, gritty / stoney Cancer Normal Cancer Microscopy: 1. Pleomorphic cells 2. Single layer glands 3. No secretions.
8 Prostatic Ca: Gleason Scoring: 1 Gleason Scoring: (note limitations*) 1. Biopsy microscopy study. 2. Two prominent areas. 3. Add the values. (2 10 max) 4. E.g. 3 + 4 = 7 2 5 Glands
9 Prostate Cancer: Summary Staging: Stage-1 90% 5 year survival to Stage-4 10% survival. Summary: Adenocarcinoma, Commonest men cancer. Two clinical types: good & bad prognosis. Many cancers are small, non palpable (DRE), asymptomatic discovered on needle biopsy following raised PSA level***. 20 to 40% of localised prostate cancer have normal PSA value. PSA is useful but imperfect marker* Progressive increase in PSA is more useful in monitoring. Low grade, localized cancers best managed by wait & watch.