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Understanding Prostate Cancer
Robert Miller MDwww.aboutcancer.com
Prostate Cancer
Most common cancer in men (28% cancers in men)
Lifetime risk in 1 in 6 white men and 1 in 5 African American
Median Age at diagnosis is 67 (but 3% in 40’s and 22% in 50’s)
Age Distribution of Men Diagnosed with Prostate Cancer 2000-2010
0%
5%
10%
15%
20%
25%
30%
35%
40%
30 40 50 60 70 80 90Age
3%
22%
39%
28%
7%
1%
Understanding prostate cancer
Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
The prostate gland has a capsule around it, and cancers arise close to the capsule, the cancer may invade through the capsule or extend up into the seminal vesicles
Prostate Anatomy…the nerves that can results in impotence are on the side of the gland
There are lymph nodes that may be involved, it is rare to have lymph node spread in low or intermediate risk patients
Prostate Cross Section Anatomy
Prostate
rectum
bladder
Prostate Cross Section Anatomy
Bladder
Prostate
Rectum
Prostate CT Anatomy
Prostate MRI Anatomy
Prostate MRI Anatomy
Prostate Stages
Most men with a low PSA (less than 10) and a low Gleason score (less than 7) have cancer cells in the gland too small to feel or see on CT scans
Too small to feel = Stage I (T1c)
T1c = too small to feel and biopsied because of an
elevated PSA
bladder
cancer
prostate
rectum
If you can feel a lump then it’s called T2
T2 lesion = big enough to feel
MRI = extra capsular spread
T3 if spread to the seminal vesicles
T3 if spread to the seminal vesicles
T3 if spread to the seminal vesicles
Biopsy of seminal vesicles = Gleason 9 adenocarcinoma
Stage IV if spread to the lymph nodes or bone
Stage IV: spread to the lymph nodes
Stage IV: spread to the bones on Sodium
Fluoride PET scan
Prostate Cancer Stage
Prostate Cancer Stage
Prostate Cancer Stage
Prostate Cancer Cure Rate After Radical Prostatectomy Based on Pathologic Stage
Understanding prostate cancer
Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
Prostate Cancer Cure Rate After Radical Prostatectomy Based on PSA Prior to
Surgery
Cure Rate with Surgery Based on PSAand Gleason Score (GS)
PSA (prostate specific antigen) and radiation results
PSA LevelRelapsed after
Radiation
0.1 to 4 4%
4 to 10 7%
10 to 20 22%
20 - 50 48%
over 50 67%
Note that the PSA levels slowly decline after completing radiation
Understanding prostate cancer
Anatomy Importance of Stage Significance of the PSA Importance of the Gleason Score
Understanding a Pathology Report
1. Histology: adenocarcinoma
2. Number of cores involved/ total number of cores
3. Gleason score: 3 + 3
4. Perineural invasion
Prostate cancers are called ADENOCARCINOMA (which just means cancer from glandular tissue). The more the cancer cell is similar to a normal prostate cells, the less dangerous, so well differentiated (Gleason 2 – 5) are much better than intermediate grade (Gleason 6 – 7) and much better than poorly differentiated (Gleason 8-10) cancer cells
Prostate Cancer Cure Rate After Radical Prostatectomy Based on Pathologic Grade (i.e. how mutated the cancer cells appear)
Gleason Scoring System
From the biopsy, the pathologist grades the appearance of the cells. From least serious (slow growing or Grade 1) to the fastest growing and most dangerous or grade 5).
The first number is the most common pattern seen from 1 to 5
Gleason Scoring System
The second number is the next most common pattern seen. So a 4+3 is more serious than 3+4 even though they both are Gleason 7.
So the slowest is a score of 2 and the fastest (most dangerous) is a score of 10.
Gleason Scoring System
The higher the Gleason Score, the lower the cure rates after surgery
Gleason Score
50
55
60
65
70
75
80
85
90
95
6 7 8
5 YearSurvival
10 YearSurvival
60
65
70
75
80
85
90
95
3+3 3+4 4+4 4+5 5+5
5 year cure rate radiation
radiation plus hormones
The higher the Gleason Score, the lower the cure rates after radiation
Gleason Score
Most Common Cancers* brain* breast* colon/rectum* gynecologic* head and neck (mouth, tongue, oral, etc.)* lung* metastatic* prostate* skin cancerOther Specific Cancers
Radiation or Chemotherapy or SurgerySupport and ResourcesAll Other Cancer Topics and cancer calculatorsOther TopicsBest Web Sites
www.aboutcancer.com
Variable Score
PSA 50
Gleason 8
Stage T1c
Calculators (Partin Tables) can be used to predict the odds of extra- capsular spread
Biochemical Recurrence-free Survival Prediction Model Duke Prostate Center.
Prostate Cancer Risk Groups combine all 3 things, the stage, the PSA level and the Gleason score, system used by the NCCN
•Low risk: (T1c, T2a Gleason 6, PSA <10)
•Intermediate risk: (T2b, T2c, Gleason 7, PSA 10-20)
•High risk: (T3, Gleason 8-10 or PSA > 20)
Understanding Prostate Cancer
Robert Miller MDwww.aboutcancer.com
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