Prostate cancer Tim Bracey Histopathology Prostate cancer What

Prostate cancer Tim Bracey Histopathology Prostate cancer

What are we going to talk about? Anatomy of prostate n Very basic histology! n How prostate cancer starts and spreads n Epidemiology and risk factors n Presenting symptoms and signs n Investigations and Management n Prostate cancer

Anatomy n Name 5 main anatomical relations of the prostate 1. 2. 3. 4. 5. Prostate cancer Bladder base (base) Pelvic floor (apex) Seminal vesicles Rectum Urethra

Histology n n From which cells do prostate cancers arise? What types of cancers arise in the prostate? Dysplasia (PIN) Genetic changes Normal glands and stroma Prostate cancer Prostatic adenocarcinoma

Where does prostate cancer start? Prostate cancer

How does prostate cancer spread? Direct n Lymphatic n Blood n n Prostate cancer Commonly to bone

Epidemiology 1 n What percentage of 80 yr old men have prostate ca? n From 50 -80% in autopsy studies! Prevalence from autopsy studies Prostate cancer Clinical Prevalence

Epidemiology 2 n n Why did incidence rise in 1990’s? Probably secondary to PSA testing! Prostate cancer

Aetiology Name 2 endogenous and 2 exogenous aetiological factors for prostate ca n Endogenous n n n Age, race, genetics, hormone levels Exogenous Diet: high fat (inc risk), omega 3, selenium, vit. A, soya (dec risk) n Vasectomy (+1. 56 RR) n Prostate cancer

Clinical Features n Name 2 general and 2 specific presenting features for prostate ca n LUTS n n n Prostate cancer Poor stream Hesitancy Nocturia Term dribbling Spread to other organs

Investigations Name 5 clinical tests or investigations for a patient with suspected prostate ca n Bedside: DRE n Bloods: FBC, U+E, Ca, G+S, PSA n Imaging: CXR, USS, CT, MRI, bone scan n Invasive: TRUS biopsy n n Note 10% are incidental on TURP for BPH Prostate cancer

Prostate cancer

Management n n What are the principles of management of a patient with prostate cancer? Conservative n n “Die with not from”, Watchful waiting, palliation Medical n n Hormonal treatment, Radiotherapy Medical therapy is targeted at all parts of the endocrine axis n n LHRH, anti-androgens or complete blockade, oestrogens, some men opt for orchidectomy (eunochs don’t get prostate cancer!) Surgical n Radical prostatectomy (open Prostate cancer or lap), TURP for LUTS

What have we talked about? Anatomy n Histology n Epidemiology, Aetiology and Risk Factors n Clinical Presentation and investigations n Basics of Management n Any Questions? n Prostate cancer