Prostatic Carcinoma

• Common after 65

• marker is Prostate Specific Antigen

• many are androgen dependent

Pathology

• adenocarcinoma

• usually arises in peripheral glandular tissue of prostate

• single layer of cells in gland

Spread

• metastasises to bone

Staging

• Stage A

  • microscopic, found in TURP fragments, A1 is well-differentiated, A2 poorly differentiated

• Stage B

  • palpable rectally, usually asymptomatic

• Stage C

  • whole gland rock hard

  • invade locally

  • local symptoms

• Stage D

  • metastasised to lymph nodes or bone

TNM

• Tumour

  • T₀ unsuspected

  • T₁ histological diagnosis only

  • T₂ palpable - confined within prostate

  • T₃ spread to seminal vesicles

  • T₄ spread to pelvic wall

• Nodes

  • N₁ internal iliac nodes

  • N₂ para-aortic nodes

• M₁ metastatic disease

Grading

• Gleason (1-5)

Sign and symptoms

• bladder outlet obstruction

• changes in bowel habit

• incontinence

• impotence

• obstructive renal failure

• deep vein thrombosis

• 'frozen' pelvis

• pathological fractures

Investigations

•  prostate specific antigen

• X-ray

  • generally sclerotic lesions rather than lytic

Treatment

T₀

• observation

• repeat digital examination and PSA

T₁/T₂

• Total prostatectomy

• radical radiotherapy

• interstitial radiation

T₃/T₄

• external beam radiotherapy  +/- hormonal therapy

• hormonal manipulation

  • LHRH agonists
  • bilateral orchidectomy
  • cyproterone acetate / flutamide
  • stilboestrol

Metastatic

• hormonal manipulation
• radiotherapy and strontium for bone metastases