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1. Understanding Prostate Cancer
Robert Miller MD
www.aboutcancer.com

2. Prostate Cancer
 Most common cancer in men (28%
cancers in men)
 Lifetime risk in 1 in 6 white men and 1 in
5 African American
 Median Age at diagnosis is 67 (but 3%
in 40’s and 22% in 50’s)

3. Age Distribution of Men Diagnosed with
Prostate Cancer 2000-2010
39%
40%
35%
28%
30%
22%
25%
20%
15%
7%
10%
3%
5% 1%
0%
30 40 50 60 70 80 90
Age

4. Understanding prostate cancer
 Anatomy
 Importance of Stage
 Significance of the PSA
 Importance of the Gleason Score

5. The prostate
gland has a
capsule around
it, and cancers
arise close to the
capsule, the
cancer may
invade through
the capsule or
extend up into
the seminal
vesicles

6. Prostate Anatomy…the nerves that can results in
impotence are on the side of the gland

7. There are lymph nodes that may be involved, it is rare to have
lymph node spread in low or intermediate risk patients

8. Prostate Cross Section Anatomy
bladder Prostate
rectum

9. Prostate Cross Section Anatomy

10. Prostate CT Anatomy
Bladder
Prostate
Rectum

12. Prostate MRI Anatomy

13. Prostate MRI Anatomy

14. Prostate Stages

15. Most men with a low PSA (less than 10)
and a low Gleason score (less than 7) have
cancer cells in the gland too small to feel or
see on CT scans

16. Too small to feel = Stage I (T1c)

17. T1c = too small to feel and
biopsied because of an
elevated PSA

18. rectum
If you
bladder
can feel a
lump
cancer then it’s
called T2
prostate

19. T2 lesion = big enough to feel

20. MRI = extra capsular spread

21. T3 if spread to the seminal vesicles

22. T3 if spread to the seminal vesicles

23. T3 if spread to the seminal vesicles
Biopsy of seminal vesicles = Gleason 9 adenocarcinoma

24. Stage IV if spread to the lymph nodes or
bone

25. Stage IV: spread to the lymph nodes

26. Stage IV: spread to the
bones on Sodium
Fluoride PET scan

27. Prostate Cancer Stage

28. Prostate Cancer Stage

29. Prostate Cancer Stage

30. Prostate Cancer Cure Rate After Radical
Prostatectomy Based on Pathologic Stage

31. Understanding prostate cancer
 Anatomy
 Importance of Stage
 Significance of the PSA
 Importance of the Gleason Score

32. Prostate Cancer Cure Rate After Radical
Prostatectomy Based on PSA Prior to
Surgery

33. Cure Rate with Surgery Based on PSA
and Gleason Score (GS)

34. PSA (prostate specific antigen) and
radiation results
Relapsed after
PSA Level
Radiation
0.1 to 4 4%
4 to 10 7%
10 to 20 22%
20 - 50 48%
over 50 67%

35. Note that the PSA levels slowly decline
after completing radiation

36. Understanding prostate cancer
 Anatomy
 Importance of Stage
 Significance of the PSA
 Importance of the Gleason Score

37. Understanding a Pathology
Report
1. Histology: adenocarcinoma
2. Number of cores involved/ total number of cores
3. Gleason score: 3 + 3
4. Perineural invasion

38. Prostate cancers are called ADENOCARCINOMA (which just means cancer from
glandular tissue). The more the cancer cell is similar to a normal prostate cells, the less
dangerous, so well differentiated (Gleason 2 – 5) are much better than intermediate
grade (Gleason 6 – 7) and much better than poorly differentiated (Gleason 8-10) cancer
cells

39. Prostate Cancer Cure Rate After Radical
Prostatectomy Based on Pathologic Grade
(i.e. how mutated the cancer cells appear)

40. Gleason Scoring System
From the biopsy, the pathologist grades
the appearance of the cells. From least
serious (slow growing or Grade 1) to
the fastest growing and most dangerous
or grade 5).
The first number is the most common
pattern seen from 1 to 5

41. Gleason Scoring System
The second number is the next most
common pattern seen. So a 4+3 is more
serious than 3+4 even though they both
are Gleason 7.
So the slowest is a score of 2 and the
fastest (most dangerous) is a score of
10.

42. Gleason Scoring
System

43. The higher the Gleason Score, the
lower the cure rates after surgery
95
90 5 Year
85 Survival
80 10 Year
75 Survival
70
65
60
55
50
6 7 8
Gleason Score

44. The higher the Gleason Score, the
lower the cure rates after radiation
95 5 year cure rate radiation
radiation plus hormones
90
85
80
75
70
65
60
3+3 3+4 4+4 4+5 5+5
Gleason Score

45. www.aboutcancer.com
Most Common Cancers
* brain
* breast
* colon/rectum
* gynecologic
* head and neck (mouth, tongue, oral, etc.)
* lung
* metastatic
* prostate
* skin cancer
Other Specific Cancers
Radiation or Chemotherapy or Surgery
Support and Resources
All Other Cancer Topics and cancer calculators
Other Topics
Best Web Sites

47. Variable Score
PSA 50
Gleason 8
Stage T1c

48. Calculators (Partin Tables) can be used to
predict the odds of extra- capsular spread

50. Biochemical Recurrence-free Survival
Prediction Model Duke Prostate Center.

51. Prostate Cancer Risk Groups
combine all 3 things, the stage, the
PSA level and the Gleason score,
system used by the NCCN
•Low risk: (T1c, T2a Gleason 6, PSA <10)
•Intermediate risk: (T2b, T2c, Gleason 7, PSA 10-20)
•High risk: (T3, Gleason 8-10 or PSA > 20)

52. Understanding Prostate Cancer
Robert Miller MD
www.aboutcancer.com