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33 Cards in this Set
- Front
- Back
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Epidemiology |
the most common malignancy in the world the #2 cause of death in males (3294 in 2011) |
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what can go wrong with the prostate? |
- inflammation - hyperplasia (centrally- transitional zone) - carcinoma (peripherally) |
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what is corpora amalasia? |
prostatic concretions |
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age and incidence for prostate cancer? |
Median age of diagnosis 68 1 in 7 men by age 75 (however most die with it, rather than from it) |
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3 etiological factors of Prostate carcinoma? |
- genetic - environmental - hormonal |
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how does genetic diversity effect prostate cancer? |
- UNCOMMON= chinese, japaenese males - COMMON= american men (esp african american) however, japanese migrants in USA have increased incidence |
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causes of increased incidence in japaense migrants in USA? |
? increased risk with increased consumption of animal fats ? decreased incidence with lycopenes (in tomatoes), cruciferous vegetable (Brussels sprouts), antioxidants |
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increased risk of prostate cancer in general? |
- first degree relatives (the more you have, the more chances of pros cancer) x20 risk in men with germ line mutations to BRCA2 |
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chances of hereditary prostate cancer |
9% of all prostate cancer 40% of early onset disease (before age 40) |
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genetic mutations involved in prostate cancer |
TMPRSS2- ETS fusion gene - TMPRSS2- androgen receptor - ETS - gene family are transcription factor increased levels of androgens = over expression of transcription factors gene silencing by hypermethylation - RB, MLH1, MSH2, APC, GSTP1 |
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effect of hormones on prostate cancer |
? excess androgen levels - beneficial effect of orchiectomy (surgical casteration - decrease andr. levels but some also produced by adrenal glands) - anti androgenic therapy (can inhibit prostate cancer growth) |
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what are the 4 zones in the prostate? |
- peri-urethral zone - transitional zone - central zone - peripheral zone |
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where is hyperplasia most likely to occur? |
- peri-urethral zone and - transitional zone |
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where is prostate carcinoma most likely to occur? |
peripherally |
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function of prostate and its constituents? |
prostatic glands- produces secretions (PSA, citric acid) which are part of the ejaculate prostatic ducts- drains prostatic secretions with ureter stroma (fibromuscular tissue) - made up of smooth muscle and fibroblast (producing collagen) |
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what is PSA |
Prostate Specific Antigen - anti-clotting factor which declumps and releases sperm into cervix |
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normal and abnormal amounts of PSA |
Normal: <4 ng/ml Concerning: 4-10 ng/ml May be cancer: >10 ng/ml |
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what happens when theres an increase in PSA? |
may increase chances of nodular prostatic hyperplasia (benign) OR carcinoma of the prostate |
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clinical presentation of BPH hyperplasia? |
- nocturia - unsteady stream of urine - pain -burning |
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clinical presentation of prostate cancer? |
prostatism symptoms ( if invaded in to peri-urethral zone and compressing ureter) back pain (bone mets) hard irregular prostate (rectal exam) (however usually undetected) |
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histology of nodular prostatic hyperplasia? |
- 2 cell layer (glands) - irregular glands - dilatation of glands/ducts - papillary foldings - hypertrophy of smooth muscle (forms micro cysts) |
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histology of PIN (prostatic intraepithelial neoplasia)? |
- 2 cell layer (fewer no. of basal cells --> can be hard to see layer) - hyperchromasia - prominent nucleoli - irregular shaped |
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histology of prostate adenocarcinoma |
-1 cell layer (no basal layer) - small, regular shaped glands -prominent nucleoli |
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diagnosis of prostate carcinoma? |
- digital rectal examination - PSA testing (elevated levels in hyperplasia, prostatitis) - transrectal ultrasound and biopsy - CT scan, isotope bone scan for staging |
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therapy for prostate hyperplasia and cancer? |
surgery or radiotherapy for localised disease (risk of erectile dysfunction, urinary incontinence) hormonal therapy for advanced disease |
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role of hormonal therapy in progressed disease? |
Androgen Deprivation Therapy (ADT) given - reduces androgen levels -GnRH (LHRH) agonists - non steroidal anti androgens - assoc with testicular atrophy, decrease libido, erectile dysfunction, hot flushes, breast tenderness |
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radiotherapy in prostate cancer involves what? |
shoving radioactive granules up a guys ass or in his prostate. YUM. |
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disease progression for prostate carcinomas? |
- they may eventually become less dependant on androgens - "androgen indépendant carcinoma" |
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what is "androgen indépendant carcinoma" also known as? |
castration- resistant prostate carcinoma (preferred terminology) |
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prognostic and predictive factors in prostate cancer: |
- more men die with the disease than from it - 5 year survival rate= 92% (pretty good prognosis) --> Grade (gleason's score) --> Stage (TNM) --> PSA (increased levels= worse prognosis) --> therapy choice |
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what is castration- resistant prostate carcinoma? |
- most continue to express androgen receptors (AR) --> amplification of AR (~30%) - hypersensitise carcinoma to low ligand concentrations --> mutant AR 1. can bind to estrogens, progesterones and androgen antagonists 2. non-ligand dependant receptors (constitutively activated) - activation of alternate signalling pathways --> eg p13 kinase/AKT pathway |
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possible research factors with castration resistant disease: |
Tumour Supressor Genes (TSG) - Cell cycle - p53 mutations correlate to castration resistant disease, recurrence after prostatectomy and poor survival Apoptosis - increase BCL2 (anti-apoptotic gene) assoc with development of castration resistant disease and resistance to conventional chemotherapy Stroma- epithelial interaction tumour angiogenesis - increased micro vessel density with tumour correlates with the presence of mets Cell to Cell adhesion - decreases E-cadherein and a-catenin expression --> loss of differentiaton, aggressive disease (likely to mets) and poor prognosis |
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How does prostate carcinoma spread (determines staging of disease)?
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- Direct/ Locally - Through prostatic capsule - to base of bladder and adjacent structures (seminal vesicle) - lymphatic- to pelvic and para-aortic nodes - haematogenous- most commonly to bone (in new bone), also lungs and liver |
