- Commonest malignancy of male urogenital tract
- There are about 10,000 cases per year in the United Kingdom
- Rare before the age of 50 years
- Found at post-mortem in 50% of men older than 80 years
- 5-10% of operation for benign disease reveal unsuspected prostate cancer
Pathology
- The tumours are adenocarcinomas
- Arise in the posterior part of the gland
- Spread through capsule into perineural spaces, bladder neck, pelvic wall and rectum
- Lymphatic spread is common
- Haematogenous spread occurs to axial skeleton
- Tumours are graded by Gleeson classification
Clinical features
- 60% present with symptoms of bladder outflow obstruction
- 10% are incidental findings at TURP
- Remainder present with bone pain, cord compression or leuco-erythroblastic anaemia
- Renal failure can occur due to bilateral ureteric obstruction
Diagnosis
- With locally advanced tumours diagnosis can be confirmed by rectal examination
- Features include hard nodule or loss of central sulcus
- Transrectal ultrasound is useful in cases of diagnostic doubt
- Transrectal or transperineal biopsy should be performed
- Pelvic CT or MRI is useful in the staging of the disease
- Bone scanning will detect the presence of metastases
- Unlikely to be abnormal if asymptomatic and PSA < 10 ng/ml
Serum prostate specific antigen (PSA)
- Kallikrein-like protein produced by prostatic epithelial cells
- 4 ng/ml is the upper limit of normal
- >10 ng/ml is highly suggestive of prostatic carcinoma
- Can be significantly raised in BPH
- Useful marker for monitoring response to treatment
Treatment
- More men die with than from prostate cancer
- Treatment depends on stage of disease, patient's age and general fitness
- Treatment options are for:
- Local disease
- Observation
- Radical radiotherapy
- Radical prostatectomy
- Locally advanced disease
- Radical radiotherapy
- Hormonal therapy
- Metastatic disease
Hormonal therapy
- 80% of prostate cancers are androgen dependent for their growth
- Hormonal therapy involves androgen depletion
- Produces good palliation until tumours 'escape' from hormonal control
- Androgen depletion can be achieved by:
- Bilateral subcapsular orchidectomy
- LHRH agonists - goseraline
- Anti-androgens - cyproterone acetate, flutamide
- Oestrogens - stilbeostrol
- Complete androgen blockade
Bibliography
Lee F, Patel H R. Prostate cancer: management and controversies. Hosp Med 2002;
63: 465-470
Mazhar D, Waxman J. Prostate cancer. Postgrad Med J 2002; 78: 590-595.
Sandhu S S, Kaisary A V. Localised carcinoma of the prostate: a paradigm of uncertainty. Postgrad
Med J 1997; 73: 691-696.
|