Carcinoma of Prostate

Carcinoma of Prostate

By
Issam S. Al-Azzawi, MD,FICMS,FEBU

Head of Urology Department

Al-Mustansiriya University

Incidence : Increase with age /over 65 Very common in west countries In Iraq : It is under estimated Aetiology : Genetic, Race, Diet ?

Pathology

Adeno carcinoma

Periphral zone

Grading : Gleason system




Pathology : TNM Staging system





Pathology : Types of Prostate Ca.1. Microscopic Latent cancer2.Early localized P cancer3. Advanced localized P cancer4. Metastatic P cancer

Metastasis of Prostate cancer

Local spread : seminal vesicles, B neck, trigone, distal sphincter

Lymph spread : Obturator, Int iliac, ext iliac / Mediastinal / Supraclavicular

Blood spread : Bones, liver , lungs




Clinical features
Asymptomatic
Features of BOO / LUTS
Hematuria
Pelvic pain
Bone pain / malaise / Anemia
Renal failure
Pathologic fractures / paraplegia

Digital Rectal Examination ( DRE )

Irregular induration
Hard nodule
Fixed rectal mucosa

Investigations

Lab . Tests
Urinalysis
CBC
Renal function tests
S. acid phosphatase
S. PSA : For screening / Follow up
less than 4 ng/ ml normal
4 – 10 ng / ml gray zone
more than 10 ng/ml suggestive of Ca.


Transrectal Ultrasound ( TRUS ) + Biopsy

MRI and CT Scan

X-Ray of bones + Isotope Bone scan

Other Investigations for Prostate Ca.Abdominal U/SIVUCXRLaparoscopic pelvic lymphadenectomy

Treatment of prostate cancer

1. conservative ( watchful waiting )
2. Radical prostatectomy ( open, Laparoscopic, Robotic )
3. Radical Radiotherapy
4. Brachytherapy / Cryotherapy / HIFU
5. TURP
6. Androgen ablation
7. Molecular targeted therapy
8. Supportive therapy : Bisphosphonates , analgesics, Tx of anemia, Tx of uraemia, Orthopedic intervention


Treatment of prostate cancer
Minimal invasive Tx :

1. Brachytherapy

2. Cryotherapy

3. High intensity focused U/S ( HIFU )

Androgen ablation

1. Antiandrogens ( Flutamide, Bicalutamide)
2. LHRH agonists ( Zoladex )
3. Estrogens
4. Bilateral Orchiectomy

Complete androgen blockade