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Prostate

Prostatic carcinoma-general


Reviewers: Gladell Paner, M.D. and Komal Arora, M.D., (see Reviewers page)
Revised: 24 March 2012, last major update January 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

Epidemiology
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● 300,000 cases/year in US (#1 after skin cancer), 41,000 deaths/year (#2 after lung cancer)
● 20% of American men are diagnosed with prostate cancer during their lifetimes; 3% die of prostate cancer
● Age adjusted incidence is increasing
● 99% with clinical disease are age 50+
● Latent cancers: 20% in men in 50ís, 70% in men in 70ís; usually must examine entire gland to find; rarely metastasize (Arch Pathol Lab Med 1995;119:731)
● Clinical disease and high grade prostatic intraepithelial neoplasia (PIN) more common in blacks than whites; blacks have higher stage at presentation, but stage adjusted survival is similar
● Clinical disease rare in Asians (3-4/100,000 vs 50-60/100,000 among US whites); higher rates in Scandinavians; all groups have similar incidence of latent cancers, suggesting importance of environmental or other genetic factors
● No carcinoma if pre-pubertal castration, low incidence with hyperestrogenism (liver cirrhosis)
● Not associated with sexually transmitted disease, smoking, occupational exposure, diet, nodular hyperplasia

Clinical features
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● Detect with digital rectal exam (DRE), transurethral ultrasound (misses 30% of carcinomas that are isoechoic), elevated PSA (above 4 or increasing over time)

Screening
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● Prostate carcinomas secrete 10x the PSA of normal tissue (in the past, 50% had levels > 10 mg/ml), BUT
● Routine screening using PSA with or without DRE does not significantly affect mortality overall or from prostate cancer (BMJ 2010 Sep 14;34), so value of routine screening has been challenged

Case reports
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● Prostatic adenocarcinoma in karyotypic female with congenital adrenal hyperplasia due to 21-OHase deficiency (Am J Clin Pathol 1996;106:660)

Differential diagnosis
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● DD of firm prostate is granulomatous prostatitis, nodular hyperplasia, tuberculosis, infarct, lithiasis
● DD of elevated PSA is nodular hyperplasia (mild increase in PSA), prostatitis, infarct, trauma (biopsy, TURP), rarely other tumors (salivary duct carcinoma may secrete PSA, Am J Clin Pathol 1996;106:242)
● For benign disease, increase in PSA is usually transient

End of Prostate > Prostatic carcinoma-general


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