Jump to content
Adenocarcinoma
Usually originates in PZ - so prostatectomy for BPH is not actually protective against developing cancer later
Incidence in men >80yo is about 70%, but most of these are tiny and may never cause a problem
Gleason score - two histological areas are scored between 1 and 5, giving an overall score of between 2 and 10. This appears to correlate well with the likelihood of spread. Elevated PSA - about 30% of men with elevated PSA will have biopsy-confirmed prostate cancer
20% of men with clinically significant prostate cancer will have normal PSA
T2 disease may present with a nodule on rectal examination, along with irregular induration, stony hard parts, and obliteration of the median sulcus Only locally advanced tumours cause symptoms (T3 and T4), and these are not curable - about 50% progress to bony mets after 3-5 years
Curable tumours (T1 and T2) are found on screening or incidentally
It is not possible to know whether those early tumours were going to progress or not - about 10% progress over 8 years
Metastises to bone, but can also spread via lymphatics
Median survival of M1 disease about 3 years Low-risk: low PSA, small foci of Gleason 6 disease - surveillance generally, even if younger than 70
Intermediate risk - radical prostatectomy or RTX in younger, fitter men
High risk (T3) - early androgen ablation +/- rtx +/- surgery for younger men
Advanced disease (T4 or any nodal or distant mets) is palliative
Radical prostatectomy
Suitable for men with life expectancy >10 years
Can give clear margins in T3a disease
Need to exclude mets prior
