Prostatic adenocarcinoma

Prostatic adenocarcinoma 

Updated: 01/29/2021

© Jun Wang, MD, PhD


General features
  • Predominantly acinar type, less commonly ductal type
  • Most common non cutaneous cancer in men in the United States
  • Predominantly > 50
  • More common in North America, Australia and northern and central Europe
Risk Factors
  • Genetic factors
Ashkenazi Jewish ancestry
BRCA1, BRCA2, Lynch syndrome
CHEK, ATM, HOXB13, etc
  • Environmental factors
High animal fat diet
Cigarette smoking
Obesity, etc
  • Hormones and growth factors
Androgen
Insulin and insulin-like growth factor
  • Protective factors
Lycopenes
Coffee
Soy products
Vitamin D, etc
 
Pathogenesis
  • Hormones, especially androgens and androgen receptor signaling
Amplification/overexpression: Most common
Mutation: Commonly in castrate-resistant cancers, most are gain-of-function mutation
Splice variants: Active AR splice variants (SVs), created by gene splicing or genomic rearrangement
Posttranslational modifications: Phosphorylation, methylation, etc
Intratumoral androgen synthesis

Clinical features
  • Asymptomatic or nonspecific presentations
  • Urinary complaints or retention, back pain, hematuria, etc
  • Symptoms associated with metastasis
Screening approaches
  • Serum prostate specific antigen (PSA)
  • Digital rectal exam
  • Biopsy if abnormal PSA, or rectal exam
Pathological findings
Marker
  • Positive: Racemase, PSA
  • Absence of basal layer: NO reactivity to p63 and 34betaE12
Management
  • Localized tumor
Radical prostatectomy
Radiation therapy
Androgen deprevation therapy
Active surveillance
  • Metastatic cancer:
Rarely curable with current technology
Therapy focus on symptom relief and slow disease progression
  • Prognostic factors: Staging, Gleason grade, tumor volume, capsular status, etc



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