1. Carcinoma of the prostate

2. INTRODUCTION Prostate cancer is the most common cancer diagnosed and is the second leading cause of cancer death in men in the United States. Prostate cancer is predominantly a disease of the elderly man, with more than 75% of new prostate cancers being diagnosed in men older than 65 years.

3. RISK FACTORS Hereditary Prostate Cancer An estimated 10% of prostate cancers are believed to be inherited Androgen Diet Fat. Calcium. Infection

4. -Lycopene. Lycopene is a carotenoid present at high concentrations in tomatoes. Lycopene is a potent antioxidant. -Selenium. Selenium is a trace mineral component of the antioxidant glutathione peroxidase -Vitamin E. Vitamin E (α-tocopherol) -Vasectomy

5. Diagnosis Clinical features 1-Digital rectal examination (DRE) : 2- Serum level of PSA 3- Transrectal ultrasound (TRUS) +/- biopsy : *Indications for biopsy: Palpable mass on DRE. Elevated PSA. Both high PSA & palpable mass. Risks and Complications Infection Bleeding Urinary retention Vasovagal Reaction

6. 4-Bone scan is indicated if there is a high risk factors (PSA > 10ng/ml ; Gleason score > 8 ), or if the patient is symptomatic 5-Pelvic CT scan and MRI are essential for local staging localization of prostate lesions and targeting for conformal external beam radiation therapy or brachytherapy 6-MRI had a great addition to CT scan for initial staging target localization for radiation therapy

7. Pathology PROSTATIC INTRAEPITHELIAL NEOPLASIA ADENOCARCINOMA Location : Majority (75%) in peripheral zone, 15% in the central zone, and 10-15 % in the periurethral zone. Spread of Tumor Local extension extra capsular Perineural invasion

8. Distant metastasis lymphatics Obturater L.N hematogenous Lumber spine Proximal femur Pelvis Thoracic spine

9. Grade The Gleason system is based on the glandular pattern of the tumor as identified at relatively low magnification. Both the primary (predominant) and the secondary (second most prevalent) architectural patterns are identified and assigned a grade from 1 to 5, with 1 being the most differentiated and 5 being the least differentiated.

10. Mesenchymal Tumors 0.1-0.2% Rhabdomyosarcoma is the most frequent mesenchymal tumor within the prostate and is seen almost exclusively in childhood Leiomyosarcomas are the most common sarcomas involving the prostate in adults. Transitional Cell Carcinoma Primary transitional cell carcinoma of the prostate without bladder involvement accounts for 1% to 4% of all prostate carcinomas.

11. Treatment options for prostate cancer

12. Localized disease Watchful waiting Follow up regimen : recommended to have a six monthly assessment of PSA DRE -Repeat prostate biopsy after the 1st year ( to detect transformation to higher grades. Radical Prostatectomy Retropubic Perineal Laproscopic robotic assisted surgery

13. External-beam Radiation Radiation to the prostate from outside the body Newer techniques (such as 3-D conformal) hope to increase radiation delivery and to decrease toxicity Most common side effects are impotence and rectal irritation

15. Brachytherapy Radiation implants placed directly into the prostate under ultrasound or CT guidance Very high dose radiation to the prostate with little radiation outside the prostatic bed Acute urinary symptoms common, some patients with impotence types 1-Permanent seeds implantation : 2-temporary seeds implantation

18. CRYOTHERAPY

19. Treatment of Locally Advanced or Microscopic Nodal Disease Hormonal therapy plus radiation Hormonal therapy plus surgery ? Chemotherapy

20. Treatment of metastatic disease :this done by hormonal therapy.

21. Hormone refractory disease : This term referred to patient with failed hormonal therapy in metastatic disease. Treatment 2nd line hormonal therapy (ketoconazol ) Chemo therapy (mitoxantron +prednisolone), Docetaxel is a cytotoxic agent and become the agent of choice Abiraterone acetate

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