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Prostate cancer

Prostate cancer. Tim Bracey Histopathology. What are we going to talk about?. Anatomy of prostate Very basic histology! How prostate cancer starts and spreads Epidemiology and risk factors Presenting symptoms and signs Investigations and Management. Anatomy.

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Prostate cancer

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  1. Prostate cancer Tim Bracey Histopathology

  2. What are we going to talk about? • Anatomy of prostate • Very basic histology! • How prostate cancer starts and spreads • Epidemiology and risk factors • Presenting symptoms and signs • Investigations and Management Prostate cancer

  3. Anatomy • Name 5 main anatomical relations of the prostate • Bladder base (base) • Pelvic floor (apex) • Seminal vesicles • Rectum • Urethra Prostate cancer

  4. Histology • From which cells do prostate cancers arise? • What types of cancers arise in the prostate? Dysplasia (PIN) Genetic changes Normal glands and stroma Prostatic adenocarcinoma Prostate cancer

  5. Where does prostate cancer start? Prostate cancer

  6. How does prostate cancer spread? • Direct • Lymphatic • Blood • Commonly to bone Prostate cancer

  7. Epidemiology 1 • What percentage of 80 yr old men have prostate ca? • From 50-80% in autopsy studies! Prevalence from autopsy studies Clinical Prevalence Prostate cancer

  8. Epidemiology 2 • Why did incidence rise in 1990’s? • Probably secondary to PSA testing! Prostate cancer

  9. Aetiology • Name 2 endogenous and 2 exogenous aetiological factors for prostate ca • Endogenous • Age, race, genetics, hormone levels • Exogenous • Diet: high fat (inc risk), omega 3, selenium, vitA, soya (dec risk) • Vasectomy (+1.56 RR) Prostate cancer

  10. Clinical Features • Name 2 general and 2 specific presenting features for prostate ca • LUTS • Poor stream • Hesitancy • Nocturia • Term dribbling • Spread to other organs Prostate cancer

  11. Investigations • Name 5 clinical tests or investigations for a patient with suspected prostate ca • Bedside: DRE • Bloods: FBC, U+E, Ca, G+S, PSA • Imaging: CXR, USS, CT, MRI, bone scan • Invasive: TRUS biopsy • Note 10% are incidental on TURP for BPH Prostate cancer

  12. Prostate cancer

  13. Management • What are the principles of management of a patient with prostate cancer? • Conservative • “Die with not from”, Watchful waiting, palliation • Medical • Hormonal treatment, Radiotherapy • Medical therapy is targeted at all parts of the endocrine axis • LHRH, anti-androgens or complete blockade, oestrogens, some men opt for orchidectomy (eunochs don’t get prostate cancer!) • Surgical • Radical prostatectomy (open or lap), TURP for LUTS Prostate cancer

  14. What have we talked about? • Anatomy • Histology • Epidemiology, Aetiology and Risk Factors • Clinical Presentation and investigations • Basics of Management • Any Questions? Prostate cancer

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