​Pathology - Prostate Carcinoma

​Pathology - Prostate Carcinoma
Risk factors include a family history of prostate cancer or being of African American descent.
Prevalent in males over the age of 50; the most frequent cancer in men and the second most prevalent cause of cancer-related deaths in men.

Gross: Irregular nodules originating from glands in the periphery zone of the posterior lobe.
Microscopic examination reveals adenocarcinoma characterized by well-defined glands lined by cuboidal cells with big nuclei and conspicuous nucleoli. It may also present as undifferentiated with cells developing in cords or sheets, often showing invasion of vascular or lymphatic arteries of the prostatic capsule.
In advanced stages, it can develop into bone osteoblastic metastasis by the spread of cancer cells in the bloodstream.

Often without symptoms, but can cause dysuria, increased urine frequency, or back pain (if cancer has spread to bone); typically identified during a digital rectal examination by detecting an irregular, enlarged, firm lump, and confirmed with a prostatic biopsy.
Lab results show elevated serum levels of PSA and prostatic acid phosphatase, which are useful indicators of tumor growth. There is also an increase in total PSA with a decrease in the free PSA fraction, as well as elevated serum alkaline phosphatase, indicating possible osteoblastic metastasis.

Treatments include prostatectomy, radiation, GnRH analogues (leuprolide), antiandrogens (e.g., flutamide), and chemotherapy.
The Gleason system of grading predicts whether prostate cancer will progress slowly or rapidly depending on the tumor's differentiation.

Annual PSA tests and digital rectal examination should be provided for screening starting at age 50.