[醫如往常] Senior Clerkship Day 109: Pathology: Prostate cancer

Prostate cancer 王醫師
Prostate
• 1536 Massa
• 1538 Vesalius first illustration, father of anatomy
• 1853 prostate cancer
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Cancer
• Solid internal organ
• Not always mass forming
• Asymptomatic,. Transitional zone
• Not self examination


台灣發生率第五名
台灣死亡率第七名


Non specific
Back pain


PSA
NHI 400P
US $22
• Minimal invasive
• Sensitive
• Affordable cost
• Widely available
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Risk stratification by NCCN
Stage
Serum PSA
PSA density
PSA velocity
Gleason score 3+3,. 5+5
Number of cores
Laterality


Biopsy
四個區塊  前中後 共12次


Very low
<2/12
Unilateral 國際沒有管
<50% area
PSA<0.15
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Tumor staging


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Radical prostatectomy
Complications
• Erection problem
• Incontinence
• Nerve damage
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Active surveillance
• Regular follow up
• 3-6 months
• DRE
• PSA
• Treatment when tumor progression
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TRUS P biopsy
Adipose involvement
Seminal vesicle invasion
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Prostate Concretion amyloid
正常不規則
癌化反而變平滑


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Triple immunostain
Brown: basal cell
P63
HMWCK
Magenta: cancer, benign
AMACR


NKX3.1 Cancer表現下降
細胞核 marker
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Specimen identification
宋醫師被切除
告曹醫師
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False negative


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Gleason score
In the present form of the Gleason system, prostate cancer of Gleason patterns 1 and 2 are rarely seen. Gleason pattern 3 is by far the most common.
• Pattern 1 - The cancerous prostate closely resembles normal prostate tissue. The glands are small, well-formed, and closely packed. This corresponds to a well differentiated carcinoma.
• Pattern 2 - The tissue still has well-formed glands, but they are larger and have more tissue between them, implying that the stroma has increased. This also corresponds to a moderately differentiated carcinoma.
• • Pattern 3 – • Recognizable glands, but the cells are darker. Beginning to invade the surrounding tissue or having an infiltrative pattern.
• Pattern 4 – • Few recognizable glands. Many cells are invading the surrounding tissue in neoplastic clumps.
• Pattern 5 – • No / few recognizable glands. Sheets of cells throughout the surrounding tissue.




來自 <https://en.wikipedia.org/wiki/Gleason_grading_system>


Gleason scores range from 2 to 10
Gleason score ≤ 6 (prognostic grade group I);
Gleason score 3+4=7 (prognostic grade group II) indicating the majority is pattern 3;
Gleason score 4+3=7 (prognostic grade group III) where pattern 4 is dominant;[4]
Gleason score 4+4=8 (prognostic grade group IV);
Gleason scores 9-10 (prognostic grade group V).[5]
Prostate cancers with a Gleason score ≤ 6 usually have rather good prognoses.
來自 <https://en.wikipedia.org/wiki/Gleason_grading_system>


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John Hopkins Dr. Epstein
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全部病理九萬件


Home of world famous chicken
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Ddx
Small tumor focus
Innocent looking tumor
• Atrophic variant
• Pseudohyperplastic variant
• Foamy gland variant
Benign mimickers
• Adenosis
• Verumontanum gland hyperplasia
• Nephrogenic adenoma
Extraprostatic origin
• UC; urothelial carcinoma
• Bladder adenocarcinoma
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