Prostate Cancer Lecture Notes

What is Prostate Cancer?

• Prostate adenocarcinoma: tumor or growth originating in the prostate gland.
• Affects only males since only males have a prostate.
• Typically malignant, meaning the tumor cells can metastasize.

Anatomy and Function of the Prostate

• Small gland, walnut-sized, under bladder, in front of rectum.
• Urethra passes through the prostate (prostatic urethra).
• Covered by capsule of connective tissue and smooth muscle.
• Divided into zones:
  • Peripheral Zone: Outermost, largest, 70% of glandular tissue.
  • Central Zone: Contains 25% of glandular tissue and ejaculatory ducts.
  • Transitional Zone: 5% of glandular tissue, part of prostatic urethra, undergoes hyperplasia in older men (benign prostatic hyperplasia).

Microscopic Structure

• Glands surrounded by a basement membrane (collagen).
• Cube-shaped basal cells and neuroendocrine cells.
• Inner ring of luminal columnar cells.
• Luminal cells secrete slightly alkaline prostatic fluid to nourish sperm.
• Produce Prostate Specific Antigen (PSA) to liquefy semen.
• Prostate cells reliant on androgens (e.g., testosterone, androstenedione, dehydroepiandrosterone, dihydrotestosterone).

Pathophysiology of Prostate Cancer

• Typically results from genetic mutation in luminal or basal cells.
• Risk factors: old age, obesity, high fat-low fiber diet.
• BRCA1 and BRCA2 genes linked to prostate cancer and breast cancer.
• Early stages depend on androgens but later stages may not.
• Slow growth rate compared to other cancers.
• Rare types: Transitional cell carcinoma, small cell prostate cancer.

Symptoms and Detection

• Early stages usually asymptomatic due to distance from urethra.
• Advanced stages: difficulty urinating, bleeding, pain with urination/ejaculation.
• Metastasis commonly to bones (vertebrae, pelvis), causing hip/lower back pain.
• Detection methods:
  • Digital rectal examination (irregularly hard lump if in posterior peripheral zone).
  • Transrectal ultrasound or MRI.
  • Elevated PSA levels.
  • Biopsy and Gleason grading system for diagnosis.

Gleason Grading System

• Scores two most common cell patterns (1-5).
• Total Gleason score: sum of primary and secondary patterns (2-10).
• Scores: 1 (normal) to 5 (highly abnormal).
• Gleason score 2: low-grade tumors, Gleason score 10: high-grade tumors.

Treatment

• Localized Tumor: Active surveillance (tumor marker measurement, imaging).
• Advanced Tumor: Surgery, radiation therapy, chemotherapy, hormonal therapy.

Recap

• Prostate adenocarcinoma most common; rare types exist.
• Begins in posterior peripheral zone; detected via digital rectal exam.
• Elevated PSA in serum; treatment options vary based on tumor spread.