Carcinoma of prostate

Carcinoma of prostate
Are the most common malignant tumors in men over age of 65 years old.
CA prostate usually originate in peripheral zone.
Risk factors:
1. Increasing age
2. Family history: about 10-15% of men who developed prostate CA have positive family history.
3. A African American
4. Total fat intake, animal fat, & red meat associated with increased risk where intake of fish associated with decrease risk.


Pathology
The following types of prostatic cancer can occur:
1- Microscopic latent cancer found on autopsy or at cystoprostatectomy ;
2- Tumor found incidentally during TURP (T1A & 1B ) or following screening of PSA (T1C)
3- Early localized prostatic cancer (T2)
4- Advanced local prostatic cancer ( T3 , T4)
5- Metastatic disease (which may arise form clinically evident tumor (T2 , T3 or T4)

• Only the last two groups cause symptoms& such tumor are not curable

• only screening or the treatment of incidentally found tumor result in cure of the disease .

Screening of CA prostate
The cancer detection rate using measurement of PSA is between 2-4 % &about 30% of men with elevated PSA will have prostatic cancer confirmed by biopsy. Unfortunately 20% of men with clinically evident tumor have normal PSA.
HISTOLOGICAL APPEARANCE
The histological pattern is of adenocarcinoma. A classification of histological pattern based on the degree of glandular differentiation & its relation to stroma has been advised by Gleason (prostatic cancer exhibits heterogenecity within the tissue & so two histological areas of prostate are each scored between 1-5.
The scores are added to give an overall Gleason score of 2-10.
This & the volume of the cancer appear to correlate well with likelihood of spread & prognosis.