In adult males, prostate cancer is the most common neoplasm (after skin cancer ) and the second most common cause of death due to cancer over the age of 65 years. In most of these older men, the disease is not clinically apparent, only 10 % of men over 65 yr develop clinical evidence of the disease. 95% of tumors are adenocarcinoma, arise primarily in peripheral zone.
Aetiology of Prostate Cancer
The cause of prostate cancer is not known but many factors appear to be involved :
Environmental carcinogenic influences
Types of Prostate Cancer
- Microscopic latent cancer found on autopsy.
- Tumors found incidentally during TURP (T1a and T1b) or following screening by PSA measurement ( T1c) .
- Early localized prostate cancer ( T2) .
- Advanced local prostate cancer (T3 &T4)
- Metastatic disease
IT should be noted that only last two groups cause symptoms and such tumors are not curable. Only screening or the treatment of incidentally found tumors can result in cure of the disease.
Clinical Features of Prostate Cancer
Only advanced disease (T2-T4) give rise to symptoms but even advanced disease may be asymptomatic :
- Bladder Outlet Obstruction
- Urinary infection
- pelvic pain or bone pain
- anaemia , pancytopenia
- renal failure
- DRE : Nodules can be palpated, irregular hard, obliteration of median sulcus rectal mucosa may be fixed bleeding on withdrawal of fingers.
Investigation for Diagnosis of Prostate Cancer
1) Prostate specific antigen : It is elevated in serum of approx.60% of men with prostate cancer. Its normal value is <4ng/ml. PSA >10 is suggestive of cancer but >35 is almost diagnostic of advanced ca
2) Biopsy : the diagnosis is established by TRUS guided biopsy in most instances.
3) Ultrasonography :
4) Radiological exam: CXR may reveal metastasis in either lung or XR OF bones may reveal osteosclerotic lesion osteolytic lesion is also common
5) Bone scan: If the PSA is > 20 nmol / L, then a bone scan should be performed.
Treatment of Prostate Cancer
1) Incidentally diagnosed Tla & Tlb disease-
-More than 70 yrs : conservative Treatment.
-Less than 70 yrs : conservative or radical prostatectomy.
2) Localised Tlc & T2 disease :
– In elderly pt : TURP with or without hormone therapy.
– In younger pt : Radical prostatectomy or radical radiotherapy
3) Localised advanced T3 & T4 disease :
– Early androgen ablation :
4) Metastatic disease : Androgen ablation will provide symptomatic relief
5) Radical prostatectomy
Indication of prostatectomy
-Negative bone scan.
-Negative chest radiograph.
-PSA < 20 nmol / ml
Bailey & Love’s Short Practice of Surgery