FSM templates

#1

BPH4: Urinary Tract Dis: Prostate Cancer

CLINICAL PATHOLOGYThe foundation of clinical medicine.Shashidhar Venkatesh MurthyA/Prof & Head of PathologyCollege of Medicine & Dentistry

#2

Prostatic Cancer: IntroductionMany 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.

Adenocarcinoma, Most common male cancer, elderly (>50y), But second common cause of cancer death in males. (next to lung)

#

3

Adeno-Ca Prostate

BPH

Cancer

Gross:Irregular, stony hardPeripheral / posterior

#4

Prostatic Cancer: EtiopathogenesisEtiology: ?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& ETVhad good prognosis (85.5%alive at 11 years)* - localized cancer without killing!*BJC

PIN: Prostatic Intraepithelial NeoplasiaPathogenesis: Dysplasia PIN cancer.Loss of double layer in Ca

#5

#6

Prostatic Cancer: Microscopy

Microscopy:Pleomorphic cellsSingle layer glandsNo secretions.NormalCancer

Gross: Hard, gritty / stoneyNormalCancer

#7

Prostatic Ca: Gleason Scoring:

Gleason Scoring: (note limitations*)Biopsy microscopy study.Two prominent areas.Add the values. (2 10 max)E.g. 3 + 4 = 7

1

2

5Glands

#8

Prostate Cancer: SummaryStaging: 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.

#

9

#10

#11