carcinoma of the prostate cap

8/12/2019 Carcinoma of the Prostate Cap

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Dr. Nurul Akbar, Sp.U


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Prostate cancer is the most common cancer diagnosedand is the second leading cause of cancer death inAmerican men.Of all cancers, the prevalence of CaP increases the mostrapidly with age.African Americans are at a higher risk for CaP than whites.In addition, African American men tend to present at alater stage of disease than whites.A positive family history of CaP also increases the relative

risk for CaP.High dietary fat intake increases the relative risk for CaPAnother exposure that may increase the risk for CaPinvolves cadmium, which is found in cigarette smoke,alkaline batteries, and in the welding industry.


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The gene responsible for familial CaP resideson chromosome 1.

Several regions of the human genome havebeen identified as possible areas that harbortumor suppressor genes that may be involvedin CaP. The regions most commonly identifiedare chromosomes 8p, 10q, 13q, 16q, 17p, and18q.


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Over 95% of the cancers of the prostate areadenocarcinomas.Of the other 5%, 90% are transitional cellcarcinomas, and the remaining cancers areneuroendocrine ("small cell") carcinomas orsarcomas.

Sixty to 70 percent of cases of CaP originatein the peripheral zone, while 10 20%originate in the transition zone and 5 10% inthe central zone.


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GleasonTNM


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SymptomsMost patients with early-stage CaP are asymptomatic.The presence of symptoms often suggests locallyadvanced or metastatic disease.Obstructive or irritative voiding complaints can result fromlocal growth of the tumor into the urethra or bladder neckor from its direct extension into the trigone of the bladder.Metastatic disease to the bones may cause bone pain.Metastatic disease to the vertebral column with

impingement on the spinal cord may be associated withsymptoms of cord compression, including paresthesiasand weakness of the lower extremities and urinary or fecalincontinence.


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A physical examination, including a DRE, isneeded.Induration, if detected, must alert the physician

to the possibility of cancer and the need forfurther evaluation (ie, PSA, TRUS, and biopsy).Locally advanced disease with bulky regionallymphadenopathy may lead to lymphedema ofthe lower extremities.Specific signs of cord compression relate to thelevel of the compression and may includeweakness or spasticity of the lower extremitiesand a hyperreflexic bulbocavernosus reflex.


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Azotemia can result from bilateral ureteralobstruction either from direct extension into thetrigone or from retroperitoneal adenopathy.

Anemia may be present in metastatic disease.Alkaline phosphatase may be elevated in thepresence of bone metastases.Serum acid phosphatase may be elevated withdisease outside the confines of the prostate.Tumor Markers Prostate-Specific Antigen(PSA)Prostate Biopsy


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TRUSMagnetic Resonance Imaging

CT scanBone Scan


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Not all patients with an elevated PSAconcentration have CaP.Other factors that elevate serum PSA includeBPH, urethral instrumentation, infection,prostatic infarction, or vigorous prostatemassage.

Induration of the prostate is associated notonly with CaP, but also with chronicgranulomatous prostatitis, previous TURP orneedle biopsy, or prostatic calculi.


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Watchful WaitingRadical Prostatectomy

Radiation Therapy External Beam TherapyRadiation Therapy BrachytherapyHormonal Therapy


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Smiths General Urology

carcinoma of the prostate cap

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