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Pathology of Prostate - Cancer PowerPoint Presentation
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Pathology of Prostate - Cancer

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Pathology of Prostate - Cancer

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  1. 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

  2. 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.

  3. 4 Adeno-Ca Prostate Gross: 1. Irregular, stony hard 2. Peripheral / posterior BPH Cancer

  4. 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

  5. 7 Prostatic Cancer: Microscopy Normal Gross: Hard, gritty / stoney Cancer Normal Cancer Microscopy: 1. Pleomorphic cells 2. Single layer glands 3. No secretions.

  6. 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

  7. 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.