Урология - BPH. Prostatic cancer

The disease is rare in Orientals, but more common in blacks. It is also common among the whites in New Zealand and Scandinavian countries.

The cause of prostate cancer is unknown, although some studies have shown a relationship between high dietary fat intake and increased testosterone levels. When testosterone levels are lowered either by surgical removal of the testicles (castration, orchiectomy) or by medication, prostate cancer can slowly get better.

There is no known association with (BPH).

Pathmorphology

Develops usually from epithelium of alveolotubular glands of prostate. Appears usually at caudal part. The most frequent form is adenocarcinoma of different grade. More rarely – solid, transitional cell, squamose cell carcinoma.

Gleason score (2-10)

Local spread. The growth commences as a rule in the posterior lobe. It cannot extend backwards due to the presence of the strong fascia of Denonvilliers.

So the lesion tends to grow upwards along the line of the ejaculatory ducts and emerge at the upper border of the prostate to involve the seminal vesicles.

Further upwards extension may obstruct the lower end of one or both ureters.

Lymphatic spread. Lymphatic spread occurs by either permeation or embolism.

Either of the two groups of lymphatics may be involved:

1.Growth may involve lymphatics which pass along the sides of the rectum to reach the lymph nodes along the internal iliac vein.

2.Growth may involve lymphatics which pass over the seminal vesicles and follow the vas deferens to drain into the external iliac lymph nodes.

Blood spread. Spread to distant parts may occur through the blood stream. Cancer prostate is the most common site of primary neoplasm for skeletal metastasis, which is followed by the cancers of the breasts, the kidney, the bronchial tree and the thyroid gland in that order of frequency.

Through the periprostatic veins the tumours cells easily reach the pelvis and vertebral bodies of the lower lumbar vertebrae.

TNM

TX Primary tumor cannot be assessed T0 No evidence of primary tumor

T1 Clinically inapparent tumor not palpable or visible by imaging

T1a Tumor incidental histologic finding in 5% or less of tissue resected T1b Tumor incidental histologic finding in more than 5% of tissue resected

T1c Tumor identified by needle biopsy (e.g. because of elevated PSA) T2 Palpable tumor confined within prostate *

T2a Tumor involves half of a lobe or less

T2b Tumor involves more than half of a lobe, but not both lobes T2c Tumor involves both lobes

T3 Tumor extends through the prostatic capsule T3a unilateral extracapsular extension

T3b bilateral extracapsular extension T3c Tumor invades seminal vesicle(s)

T4 Tumor is fixed or invades adjacent structures other than seminal vesicles

T4a Tumor invades external sphincter and/or bladder neck and/or rectum T4b Tumor invades levator muscles and/or is fixed to pelvic wall*

NX Regional lymph nodes cannot be assessed NO No regional lymph node metastasis

N1 Metastasis in a single lymph node, 2 cm or less in greatest dimension

N2 Metastasis in a single lymph node, more than 2cm but not more than 5 cm ingreatest dimension, or multiple lymph nodes, none more than 5 cm in greatest dimension N3 Metastasis in a lymph node more than 5 cm in greatest dimension

MX Presence of distant metastasis cannot be assessed

MO No distant metastasis M1 Distant metastasis

M1a Non­ regional lymph nodes

M1b Bone

M1c Other sites.

T2a