Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer is one of the most common cancers affecting men. In the United States, the lifetime risk of being diagnosed with prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer is approximately 11%, and the lifetime risk of death is 2.5%. Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer is a slow-growing cancer that takes years, or even decades, to develop into advanced disease. Several men with prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer are asymptomatic. Late-stage cancer can present with bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, urinary symptoms, and/or weight loss Weight loss Decrease in existing body weight. Bariatric Surgery. Most cases of prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer are identified based on diagnostic tests Diagnostic tests Diagnostic tests are important aspects in making a diagnosis. Some of the most important epidemiological values of diagnostic tests include sensitivity and specificity, false positives and false negatives, positive and negative predictive values, likelihood ratios, and pre-test and post-test probabilities. Epidemiological Values of Diagnostic Tests to determine prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy-specific antigen Antigen Substances that are recognized by the immune system and induce an immune reaction. Vaccination (PSA) levels and are confirmed based on image-guided transrectal biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma. Management of prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer depends on age, life expectancy Life expectancy Based on known statistical data, the number of years which any person of a given age may reasonably expected to live. Population Pyramids, comorbidities Comorbidities The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. St. Louis Encephalitis Virus, risk stratification, and preferences of the patient. Management options include active surveillance Surveillance Developmental Milestones and Normal Growth, androgen deprivation therapy, radiotherapy, chemotherapy Chemotherapy Osteosarcoma, and radical prostatectomy Prostatectomy Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic - removal through an incision above the pubis and through the urinary bladder; retropubic - as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). Benign Prostatic Hyperplasia.
Last updated: 31 Mar, 2022
Inherent factors (major):
Medical factors:
Social and environmental factors:
Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy gland:
Zonal anatomy:
Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy gland and main prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy zones: peripheral, transitional, and central zones in relation to other structures of the male genitourinary system
Image: “Zones of the prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy” by Mikael Häggström. License: CC0Under the influence of the factors listed below, prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy epithelium Epithelium The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions. Surface Epithelium: Histology → prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy intraepithelial neoplasia (precursor lesion) → localized adenocarcinoma → metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis and androgen-resistant cancer
Pathogenesis of
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer:
Normal
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy gland comprises basal and luminal cells. Majority of
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancers arise from the peripheral zone. Under the influence of diet,
androgens
Androgens
Androgens are naturally occurring steroid hormones responsible for development and maintenance of the male sex characteristics, including penile, scrotal, and clitoral growth, development of sexual hair, deepening of the voice, and musculoskeletal growth.
Androgens and Antiandrogens, and
inflammation
Inflammation
Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body’s defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function.
Inflammation caused by genetic variants, precursor lesions (prostatic intraepithelial neoplasia) develop. As further genetic or epigenetic alterations occur, the lesions progress to adenocarcinoma. Tumors initially regress with antiandrogen therapy, but eventual androgen
resistance
Resistance
Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow.
Ventilation: Mechanics of Breathing occurs.
Prostate Prostate The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid. Prostate, Seminal, and Bulbourethral Glands: Anatomy-specific antigen Antigen Substances that are recognized by the immune system and induce an immune reaction. Vaccination levels are determined to detect early cancer.
Background:
Interpretation:
Clinical variables to interpret PSA levels:
Diagnosis of
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer:
Image-guided transrectal approach is used to confirm the presence of carcinoma in the
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy gland.
Imaging of a patient with metastatic
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer:
(A) Magnetic resonance imaging (MRI) demonstrates the seminal
vesicles
Vesicles
Female Genitourinary Examination (SV), the
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy lesion (
tumor
Tumor
Inflammation), and extracapsular
extension
Extension
Examination of the Upper Limbs (ECE).
(B)
Bone scan
Bone Scan
Osteosarcoma shows solitary L5
vertebral body
Vertebral body
Main portion of the vertebra which bears majority of the weight.
Vertebral Column: Anatomy
metastasis
Metastasis
The transfer of a neoplasm from one organ or part of the body to another remote from the primary site.
Grading, Staging, and Metastasis.
The following elements are crucial determinants of outcome and are used for risk stratification in selecting a treatment approach:
The TNM staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis is based on the 8th-edition staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis guidelines by the American Joint Committee on Cancer. There are 2 categories of staging Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Grading, Staging, and Metastasis:
Tumor Tumor Inflammation clinical stage (cT) | Description |
---|---|
cTX CTX Paget’s Disease of Bone | Primary tumor Tumor Inflammation cannot be assessed. |
cT0 | No evidence of primary tumor Tumor Inflammation |
cT1 | No palpable disease on
DRE
DRE
A physical examination in which the qualified health care worker inserts a lubricated, gloved finger of one hand into the rectum and may use the other hand to press on the lower abdomen or pelvic area to palpate for abnormalities in the lower rectum, and nearby organs or tissues. The method is commonly used to check the lower rectum, the prostate gland in men, and the uterus and ovaries in women.
Prostate Cancer Screening
|
cT2 | Palpable disease on
DRE
DRE
A physical examination in which the qualified health care worker inserts a lubricated, gloved finger of one hand into the rectum and may use the other hand to press on the lower abdomen or pelvic area to palpate for abnormalities in the lower rectum, and nearby organs or tissues. The method is commonly used to check the lower rectum, the prostate gland in men, and the uterus and ovaries in women.
Prostate Cancer Screening, but confined within the
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy
|
cT3 | Palpable outside the
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy laterally, or involving the seminal
vesicles
Vesicles
Female Genitourinary Examination
|
cT4 | Tumor Tumor Inflammation is fixed, or it can invade the adjacent structures (external sphincter, rectum Rectum The rectum and anal canal are the most terminal parts of the lower GI tract/large intestine that form a functional unit and control defecation. Fecal continence is maintained by several important anatomic structures including rectal folds, anal valves, the sling-like puborectalis muscle, and internal and external anal sphincters. Rectum and Anal Canal: Anatomy, bladder Bladder A musculomembranous sac along the urinary tract. Urine flows from the kidneys into the bladder via the ureters, and is held there until urination. Pyelonephritis and Perinephric Abscess, levator ani, or pelvic wall). |
Tumor Tumor Inflammation pathological stage (pT)* | Description |
---|---|
pT2 | Organ confined |
pT3 | Extra-prostatic
extension
Extension
Examination of the Upper Limbs
|
pT4 | Tumor Tumor Inflammation is fixed or invades other adjacent structures (external sphincter, rectum Rectum The rectum and anal canal are the most terminal parts of the lower GI tract/large intestine that form a functional unit and control defecation. Fecal continence is maintained by several important anatomic structures including rectal folds, anal valves, the sling-like puborectalis muscle, and internal and external anal sphincters. Rectum and Anal Canal: Anatomy, bladder Bladder A musculomembranous sac along the urinary tract. Urine flows from the kidneys into the bladder via the ureters, and is held there until urination. Pyelonephritis and Perinephric Abscess, levator ani, or pelvic wall). |
Clinical node stage (cN) | Description |
---|---|
cNX | Regional lymph nodes Lymph Nodes They are oval or bean shaped bodies (1 – 30 mm in diameter) located along the lymphatic system. Lymphatic Drainage System: Anatomy not assessed |
cN0 | No regional lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs-node involvement |
cN1 | Metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis in regional lymph Lymph The interstitial fluid that is in the lymphatic system. Secondary Lymphatic Organs node(s) |
Metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis stage | Description |
---|---|
M0 | No distant metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis |
M1 | Distant
metastasis
Metastasis
The transfer of a neoplasm from one organ or part of the body to another remote from the primary site.
Grading, Staging, and Metastasis to:
|
Grade group is based on the Gleason score.
Grade group | Gleason score | Pattern |
---|---|---|
1 | Gleason ≤ 6 | Well-differentiated tumors |
2 | Gleason 3 + 4 = 7 | Predominantly well-formed glands with few poorly formed glands |
3 | Gleason 4 + 3 = 7 | Predominantly poorly formed glands with less well-formed glands |
4 | Gleason 8 | Only poorly formed glands or predominantly well-formed glands and a lesser component with a lack of glands |
5 | Gleason 9‒10 | Advanced; lacks gland formation or exhibits necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage |
Micrograph of
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer with Gleason score 6 (3 + 3):
In this image, generally well-differentiated glands are seen.
Micrograph of
prostate
Prostate
The prostate is a gland in the male reproductive system. The gland surrounds the bladder neck and a portion of the urethra. The prostate is an exocrine gland that produces a weakly acidic secretion, which accounts for roughly 20% of the seminal fluid.
Prostate, Seminal, and Bulbourethral Glands: Anatomy cancer with Gleason score 10:
In this image, the architecture is very different from normal prostatic tissue, with solid sheets of cells instead of well-defined glands.
The TNM stage, PSA, and histological grade group can be used to determine the prognostic stage group.
Stage | Tumor Tumor Inflammation (T) | Node (N) | Metastasis Metastasis The transfer of a neoplasm from one organ or part of the body to another remote from the primary site. Grading, Staging, and Metastasis (M) | PSA (ng/mL) | Grade group | |
---|---|---|---|---|---|---|
I | cT1a‒c, cT2a, pT2 | N0 | M0 | < 10 | 1 | |
II | IIA | cT1a‒c, cT2a, pT2 | N0 | M0 | ≥ 10, < 20 | 1 |
cT2b–c | < 20 | |||||
IIB | T1‒T2 | N0 | M0 | < 20 | 2 | |
IIC | T1‒T2 | N0 | M0 | < 20 | 3‒4 | |
III | IIIA | T1‒T2 | N0 | M0 | ≥ 20 | 1‒4 |
IIIB | T3 T3 A T3 thyroid hormone normally synthesized and secreted by the thyroid gland in much smaller quantities than thyroxine (T4). Most T3 is derived from peripheral monodeiodination of T4 at the 5′ position of the outer ring of the iodothyronine nucleus. The hormone finally delivered and used by the tissues is mainly t3. Thyroid Hormones‒ T4 T4 The major hormone derived from the thyroid gland. Thyroxine is synthesized via the iodination of tyrosines (monoiodotyrosine) and the coupling of iodotyrosines (diiodotyrosine) in the thyroglobulin. Thyroxine is released from thyroglobulin by proteolysis and secreted into the blood. Thyroxine is peripherally deiodinated to form triiodothyronine which exerts a broad spectrum of stimulatory effects on cell metabolism. Thyroid Hormones | N0 | M0 | Any | 1‒4 | |
IIIC | Any | N0 | M0 | Any | 5 | |
IV | IVA | Any | N1 | M0 | Any | Any |
IVB | Any | Any | M1 | Any | Any |
Information regarding tumor Tumor Inflammation stage, grade group, Gleason score, and PSA level is used to determine clinical-risk categories.
Active surveillance Surveillance Developmental Milestones and Normal Growth:
Radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma therapy (RT):
Surgery (radical prostatectomy Prostatectomy Complete or partial surgical removal of the prostate. Three primary approaches are commonly employed: suprapubic – removal through an incision above the pubis and through the urinary bladder; retropubic – as for suprapubic but without entering the urinary bladder; and transurethral (transurethral resection of prostate). Benign Prostatic Hyperplasia):
Androgen deprivation therapy (ADT):
Chemotherapy Chemotherapy Osteosarcoma:
Immunotherapy:
Other therapies:
The following management options are based on prognostic stage, and should be guided by the age, health, and preferences of the patient: