"SPREAD:
Local - to seminal vesicles & rectum
Lymphatics- pelvic nodes
Blood spread -axial skeleton
DIAGNOSIS :
1) PSA > than 4 ng/dL(normal = 1-4ng/dL).
Abnormal digital rectal examination
2) TRUS Biopsy:
Histology grading - Gleason scale
Grades tumors on a scale of 1 through 5
Scores 2 - 5: Low-grade cancer.
Scores 6 - 7: Intermediate grade. (majority).
Scores 8 - 10: High-grade cancer
STAGING
T1 Not palpable:
-Incidentally found in post TURP resected tissue or
-Identified by needle biopsy done for elevated PSA level
T2 Palpable- Limited to prostate
T3 - Extends through the prostatic capsule +/- seminal vesicle invasion
T4 invades adjacent structures other than seminal vesicles
TREATMENT
1) Active surveillance:for asymptomatic patients > 70 with:
- low-risk localized prostate cancer or
- if other life-limiting disorders coexist
2) Gleason grade < 7 and PSA < 10 ng/L = potentially curable.
- Radical prostatectomy
or
- Brachytherapy
or
- External beam radiation.
3) High Gleason grade /High PSA/Bone mets = palliative
a) Hormone therapy
- LHRH agonists - Gosrelin(Zoladex)
- Anti androgens - Flutamide
Bicalutamide (Casodex)
b) Palliative external beam radiation.
SCREENING:
- risk of over-diagnosis and over-treatment
- PSA testing increases cancer detection but does not decrease mortality.
"