Most prostate cancers are slow growing and do not manifest during a man's lifetime. While many men are found to have microscopic prostate cancer at autopsy, most die with rather than from prostate cancer. Prostate cancer most commonly presents as adenocarcinoma in the peripheral zone of the prostate and has local spread through the prostate capsule or seminal vesicles and distant spread via lymph nodes or hematogenously to bones and lungs. Imaging like ultrasound, CT, MRI, and bone scans are used to diagnose and stage prostate cancer.

1. Prostate Carcinoma

2. Prostate Carcinoma
• Many men are found to have had incidental microscopic
foci of prostate cancer at postmortem examination, and
most prostate cancers are slow growing and do not
manifest during the man's lifetime.
• Thus, many men die with prostate cancer rather than die
from prostate cancer.

3. Prostate Carcinoma
• 95% of prostate cancers are adenocarcinomas
developing in the acini of prostatic ducts.
Pathology

4. Prostate Carcinoma
• 70% of cancers occur in the peripheral zone
(PZ), and approximately 20% are found in the
transition zone (TZ).
Pathology

5. Prostate Carcinoma
• Local spread: capsular penetration, invasion of the seminal vesicles, or local
extension along the neurovascular bundles.
• Lymphatic spread: obturator LNs and from there to the common iliac and
para-aortic lymph nodes.
• Hematogenous spread: bones, and lungs. Skeletal metastases are common
in advanced prostate cancer, but hepatic metastases are uncommon.
Spread

6. Prostate Carcinoma
• Asymptomatic.
• Symptoms of advanced disease with weight loss,
lethargy, bladder outflow obstruction, or bone pain.
Clinical presentation

7. Prostate Carcinoma
• Serum PSA levels increase with age:
PSA
 Patients aged 40-49 years, 0-2.5 ng/mL
 Patients aged 50-59 years, 0-3.5 ng/mL
 Patients aged 60-69 years, 0-4.5 ng/mL
 Patients aged 70-79 years, 0-6.5 ng/mL

8. Prostate Carcinoma
• Elevated serum PSA levels may also be
associated with prostatitis, prostate infarction,
PIN, prostate biopsy, transurethral resection of the
prostate, and urethral catheterization.
PSA

9. Prostate Carcinoma
• Serum PSA levels are lowered with finasteride
treatment for benign prostatic hyperplasia
PSA

10. Prostate Carcinoma
Imaging

11. Prostate Carcinoma
• Sclerotic metastases or lytic
lesions with bone destruction.
Plain X-Ray

12. Prostate Carcinoma
• Sclerotic metastases or lytic
lesions with bone destruction.
Plain X-Ray

13. Prostate Carcinoma
• CT has a limited role in assessing
prostatic cancer, but it may be
helpful in detecting nodal
involvement and metastases.
CT

14. Prostate Carcinoma
• CT has a limited role in assessing
prostatic cancer, but it may be
helpful in detecting nodal
involvement and metastases.
CT

15. Prostate Carcinoma
• MRI can demonstrate the internal anatomy of the prostate, and it can
identify areas of altered signal intensity, which representing focal
pathology in the gland.
• MRI is used primarily for staging, but the availability of interventional
MRI units means that MRI is likely to have a future role in the
diagnosis of prostate cancer.
MRI

16. Prostate Carcinoma
MRI

17. Prostate Carcinoma
MRI

18. Prostate Carcinoma
MRI

19. Prostate Carcinoma
ULTRASOUND
• TRUS plays a central role in the contemporary
diagnosis of prostate cancer because it enables
accurate image-guided biopsy of the gland.

20. Prostate Carcinoma
ULTRASOUND
Hypoechoic area in the PZ.

21. Prostate Carcinoma
ULTRASOUND
Hypoechoic area in the PZ.