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| Prostatic Adenocarcinoma |
| Etiology •Risk factors include age, race, family history, hormone levels, and environment. |
| Pathogenesis •Pathogenesis is not precisely known but will have to take into account genetic influences, endogenous hormonal changes, and exposure to environmental substances., |
| Epidemiology •Prostatic adenocarcinoma is a disease of older men (over 50) •The incidence of latent prostatic adenocarcinoma is believed to be 10% of men in their fifth decade and increases to 60% of men in their ninth decade. •There are racial differences. Compared to the U.S. white population, prostatic carcinoma has a higher incidence in the black population and a lower incidence in the oriental population. |
| General Gross Description •Prostatic adenocarcinomas tend to arise peripherally rather than centrally. •Grossly, carcinomas are better appreciated by palpation than by visualization. •Carcinomas are usually ill defined areas that may be grey/yellow when compared to the native parenchyma. |
| General Microscopic Description •Prostatic adenocarcinomas are histologically diverse and many individual cases will have more than one histologic pattern. •The current favored histologic classification and grading schema is the Gleason system. See references for detailed discussion of the histologic patterns and criteria. •Prostatic adenocarcinomas are reported by adding the combined score of the two dominant histologic patterns, i.e. Gleason grade 3 + 4 = 7. |
| Clinical Correlation •Stage A carcinomas (confined to the prostate gland and not papable by rectal examination) are usually asymptomatic and may be discovered by elevated serum PSA levels (prostatic specific antigen). •Stage B carcinomas (confined to the prostate gland and are clinically palpable) are usually asymptomatic. •Stage C carcinomas (local extracapsular tissue involvement) may produce obstructive symptoms, pain/discomfort, hematuria. •Stage D carcinomas (distant metastasis) usually have the added involvement the vertebral column and patients may presence with back pain. •Surgery for disease confined to the gland in young men (<70); hormonal therapy by castration, estrogen, or GNRH agonists |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 1229-1244. |
| Prostatic Adenocarcinoma |
| Synopsis by: Harold Yamase M.D. (T77100M81403)[484] |
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