Principles and Practice II
Chapter 33 Notes:
PROSTATE:
Most common malignancy in males
1/9 lifetime risk for men
Stage and grade = most important prognostic factors
PSA = prostate specific antigen level, protein in the blood produced by the prostate
ASTRO determined that posttreatment success should be determined by the continued
monitoring of PSA scores, Gleason score (histologic grade), and staging
The prostate gland is attached anteriorly to the pubic symphysis by the puboprostatic ligament
and separated posteriorly from the rectum by Denonvilliers’ fascia (retrovesical septum)
The Denonvilliers’ fascia attaches above to the peritoneum and below to the urogenital
diaphragm
The seminal vesicles and vas deferens pierce the posterosuperior aspect of the gland and enter
the urethra at the verumontanum
Most prostate cancers are multifocal and develop in the periphery of the gland
Most commonly mets to the T-spine
ACS recommends screening at the age of 50 for men without family history of prostate cancer
Age 40-45 with history
Histologic confirmation is needed for a prostatic carcinoma diagnosis
Transrectal ultrasound-guided biopsy is the standard method of diagnosis
This may also be done with fusion of an MRI where 12 or more biopsies are taken
Prostate carcinoma can be asymptomatic until it reaches a significant size
Digital rectal exam should be performed annually in men over 50 years, 70% sensitivity, 50%
specificity
PSA levels are regularly 4ng/mL but must be adjusted for age
An elevated PSA value with no palpable disease is now the most common presentation because
of increased screening and awareness
PSA is also increased in the follow-up of patients treated with RT or radical prostatectomy (in the
months following a radical prostatectomy, PSA levels should be undetectable)
Most malignant tumors of the prostate are adenocarcinomas
Gleason devised a quantitative histologic grading system based on the morphologic tumor
characteristics
-the pathologist evaluates the predominant degree of differentiation (primary pattern) and
the less frequent component (secondary pattern) based on the morphology of the lesion
-the primary and secondary tumor grades are each labelled from 1 to 5 and the
two grades are added to make the Gleason score
, -Gleason score correlates closely with prognosis; lower scores indicate slow-
growing nonaggressive tumor, and a higher score indicate more invasive
metastatic tumors
T1 = not detectable on a digital rectal exam
T2 = palpable and defined within the capsule of the prostate gland
T3 = locally extensive, possibly into the seminal vesicles
T4 = fixed to the pelvic sidewall or invading adjacent structures like the rectum or bladder
Regional nodal status:
Negative = N0
Positive = N1
Distant disease:
Nonregional nodes = M1a
Bone = M1b
Other sites = M1c
(T1a, found incidentally, not a clinical problem for many years most times)
Watchful waiting is a viable treatment option for:
-Gleason score 2-6
-T1 and T2 stage tumor
-PSA less than 10ng/mL
-life expectancy of more than 10 years
-life expectancy less than 5 years (any stage disease)
Candidates for radical prostatectomy:
-good general medical condition
-life expectancy of at least 10 years
The most recent advancement in prostate surgery is the robotic-assisted laparoscopic
prostatectomy
Radiation + hormone therapy = 76%-78% overall/5-year survival
Radiation alone = 45%-60% overall/5-year survival
MAB (maximal androgen blockage) is the mainstay of hormone therapy
-injection of luteinizing releasing hormone (LHRH) and gonadotropin releasing hormone
given monthly or every 3 months
-these injections stop the production of testosterone
Chemo only works for patients whose tumor doesn’t respond to hormone therapy or whose
tumor has spread outside of the prostate
High risk patients:
-Gleason score 8 or higher
Chapter 33 Notes:
PROSTATE:
Most common malignancy in males
1/9 lifetime risk for men
Stage and grade = most important prognostic factors
PSA = prostate specific antigen level, protein in the blood produced by the prostate
ASTRO determined that posttreatment success should be determined by the continued
monitoring of PSA scores, Gleason score (histologic grade), and staging
The prostate gland is attached anteriorly to the pubic symphysis by the puboprostatic ligament
and separated posteriorly from the rectum by Denonvilliers’ fascia (retrovesical septum)
The Denonvilliers’ fascia attaches above to the peritoneum and below to the urogenital
diaphragm
The seminal vesicles and vas deferens pierce the posterosuperior aspect of the gland and enter
the urethra at the verumontanum
Most prostate cancers are multifocal and develop in the periphery of the gland
Most commonly mets to the T-spine
ACS recommends screening at the age of 50 for men without family history of prostate cancer
Age 40-45 with history
Histologic confirmation is needed for a prostatic carcinoma diagnosis
Transrectal ultrasound-guided biopsy is the standard method of diagnosis
This may also be done with fusion of an MRI where 12 or more biopsies are taken
Prostate carcinoma can be asymptomatic until it reaches a significant size
Digital rectal exam should be performed annually in men over 50 years, 70% sensitivity, 50%
specificity
PSA levels are regularly 4ng/mL but must be adjusted for age
An elevated PSA value with no palpable disease is now the most common presentation because
of increased screening and awareness
PSA is also increased in the follow-up of patients treated with RT or radical prostatectomy (in the
months following a radical prostatectomy, PSA levels should be undetectable)
Most malignant tumors of the prostate are adenocarcinomas
Gleason devised a quantitative histologic grading system based on the morphologic tumor
characteristics
-the pathologist evaluates the predominant degree of differentiation (primary pattern) and
the less frequent component (secondary pattern) based on the morphology of the lesion
-the primary and secondary tumor grades are each labelled from 1 to 5 and the
two grades are added to make the Gleason score
, -Gleason score correlates closely with prognosis; lower scores indicate slow-
growing nonaggressive tumor, and a higher score indicate more invasive
metastatic tumors
T1 = not detectable on a digital rectal exam
T2 = palpable and defined within the capsule of the prostate gland
T3 = locally extensive, possibly into the seminal vesicles
T4 = fixed to the pelvic sidewall or invading adjacent structures like the rectum or bladder
Regional nodal status:
Negative = N0
Positive = N1
Distant disease:
Nonregional nodes = M1a
Bone = M1b
Other sites = M1c
(T1a, found incidentally, not a clinical problem for many years most times)
Watchful waiting is a viable treatment option for:
-Gleason score 2-6
-T1 and T2 stage tumor
-PSA less than 10ng/mL
-life expectancy of more than 10 years
-life expectancy less than 5 years (any stage disease)
Candidates for radical prostatectomy:
-good general medical condition
-life expectancy of at least 10 years
The most recent advancement in prostate surgery is the robotic-assisted laparoscopic
prostatectomy
Radiation + hormone therapy = 76%-78% overall/5-year survival
Radiation alone = 45%-60% overall/5-year survival
MAB (maximal androgen blockage) is the mainstay of hormone therapy
-injection of luteinizing releasing hormone (LHRH) and gonadotropin releasing hormone
given monthly or every 3 months
-these injections stop the production of testosterone
Chemo only works for patients whose tumor doesn’t respond to hormone therapy or whose
tumor has spread outside of the prostate
High risk patients:
-Gleason score 8 or higher
