Prostate cancer is the most common cancer in men. While some prostate cancers are small and clinically insignificant, others can be rapidly fatal. The percentage of free PSA to total PSA is lower in men with prostate cancer. Microscopically, prostate cancer shows pleomorphic cells in single layer glands without secretions, unlike the normal double layer glands. Gleason scoring is used to grade prostate cancers from 1 to 10 based on their appearance under microscopy. Staging helps determine prognosis, with stage 1 having a 90% 5-year survival rate compared to 10% for stage 4 cancers.

2. CLINICAL PATHOLOGY
The foundation of clinical medicine.
Shashidhar Venkatesh Murthy
A/Prof & Head of Pathology
College of Medicine & Dentistry
BPH4: Urinary Tract Dis: Prostate Cancer

3. 3
Prostatic Cancer: Introduction
 Many prostatic carcinomas are small and clinically insignificant.
 If tested, seen in many elderly dying of other causes* (incidental Ca)
 But some are rapidly fatal, no specific test to detect early*
 Population screening of PSA – controversial, now discouraged***
 % of free PSA to total PSA is lower in men with prostate cancer.
 Adenocarcinoma, Most common male cancer, elderly (>50y),
 But second common cause of cancer death in males. (next to lung)

4. 4
Adeno-Ca Prostate
BPH
Cancer
Gross:
1. Irregular, stony hard
2. Peripheral / posterior

5. 5
Prostatic Cancer: Etiopathogenesis
 Etiology: ?Androgens, genes (ETS, PTEN) & ?env / diet. (Not BPH)
 PSA* proteolytic enzyme, liquefies semen. Not cancer specific.
Normal Serum PSA < 4.0ng/L.  in Prostate damage / malignancy.
 Lower in non malignant but significant overlap*.
 Patients (54%) lacking both PTEN & ETV had ‘good prognosis’
(85.5% alive at 11 years)* - localized cancer without killing…!
*BJC
PIN: Prostatic Intraepithelial Neoplasia
 Pathogenesis: Dysplasia  PIN  cancer. Loss of double layer in Ca

7. 7
Prostatic Cancer: Microscopy
Microscopy:
1. Pleomorphic cells
2. Single layer glands
3. No secretions.
Normal
Cancer
Gross: Hard, gritty / stoney
Normal
Cancer

8. 8
Prostatic Ca: Gleason Scoring:
Gleason Scoring: (note limitations*)
1. Biopsy microscopy study.
2. Two prominent areas.
3. Add the values. (2 10 max)
4. E.g. 3 + 4 = 7
1
2
5
Glands

9. 9
Prostate Cancer: Summary
 Staging: Stage-1 90% 5 year survival to
Stage-4 10% survival.
Summary:
 Adenocarcinoma, Commonest men cancer.
 Two clinical types: good & bad prognosis.
 Many cancers are small, non palpable (DRE), asymptomatic
discovered on needle biopsy following raised PSA level***.
 20 to 40% of localised prostate cancer have normal PSA value.
 PSA is useful but imperfect marker*
 Progressive increase in PSA is more useful in monitoring.
 Low grade, localized cancers best managed by wait & watch.