Prostate tumours
How prostate adenocarcinoma arises from the luminal cells of the peripheral zone, why losing the basal cell layer marks invasion, how Gleason patterns grade it, and how spread to nodes and bone causes its effects.
By the end, you can
- Describe the zones of the prostate and the two cell layers of its glands, and relate them to where cancer and benign enlargement arise.
- Explain the main risk factors and molecular changes of prostate adenocarcinoma, and the place of high-grade prostatic intraepithelial neoplasia.
- Describe the gross and microscopic appearance of prostate adenocarcinoma and what Gleason patterns and Grade Groups measure.
- Relate local extension, lymphatic spread and osteoblastic bone metastases to the findings they cause.
- Explain why serum PSA rises in prostate cancer and why it is not specific for cancer.
- Recognise the classic microscopic features, grading, staging, risk groups and tests of prostate cancer, explain how surveillance, surgery, radiotherapy and hormonal treatments act on its mechanism, and why castration resistance develops.
What it is
Almost all prostate cancers are acinar adenocarcinomas, malignant tumours of the glandular (luminal) cells, most of which arise in the peripheral zone. They range from small, slow-growing tumours that may never cause harm to aggressive cancers that spread to lymph nodes and bone; the Gleason pattern, reported as a Grade Group, is the strongest single microscopic guide to behaviour. Other prostate tumours are rare.
3 types to tell apart
- Acinar adenocarcinoma
- The usual prostate cancer: small infiltrating glands of luminal cells with no basal cell layer, mostly in the peripheral zone. Graded by Gleason pattern.
- High-grade prostatic intraepithelial neoplasia (HGPIN)
- The main precursor: atypical luminal cells lining existing glands whose basal cell layer is still present. It is not invasive and does not raise PSA by itself.
- Rarer tumours
- Ductal adenocarcinoma, neuroendocrine (small cell) carcinoma, urothelial carcinoma spreading from the bladder or urethra, and sarcomas (rhabdomyosarcoma in children, leiomyosarcoma in adults).
US spelling: tumours → tumors, behaviour → behavior.
Normal function
Two cell layers in a walnut-sized gland
The lies below the bladder with its upwards and its pointing down; the sit above and behind it. Its back faces the , so the posterior part of the gland can be felt with a finger in the rectum.
It has three glandular zones. The peripheral zone, at the back and sides, makes up about 70% of the gland; the central zone surrounds the ejaculatory ducts; the small transition zone wraps the . A fibromuscular stroma of smooth muscle and collagen fills the spaces between glands, and a condensed rim of stroma forms the capsule.
Each gland is lined by two cell layers: tall luminal (secretory) cells, which carry androgen receptors and secrete prostate-specific antigen (PSA) and other proteins into the seminal fluid, and flat basal cells beneath them, on the basement membrane. Very little PSA normally reaches the blood.
| Feature | Transition zone | Peripheral zone |
|---|---|---|
| Position | Wraps the prostatic urethra | Back and sides of the gland, against the rectum |
| Share of a young gland | About 5% | About 70% |
| Main disease | Benign prostatic hyperplasia | Most adenocarcinomas (about 70%) |
| Effect on urine flow | Compresses the urethra early | Usually none until advanced |
| Felt on rectal examination | Smooth, enlarged gland | Firm or hard, irregular nodule |
The central zone (about 25%) surrounds the ejaculatory ducts. Some cancers arise in the transition zone, and the two diseases often coexist.
Underlying change · Step 1 of 4
Luminal cells acquire mutations: from HGPIN to cancer
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 4
What it looks like, and how it is graded
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 4
Through the capsule, to the nodes and to bone
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 4 of 4
Silent at first; symptoms from spread
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 4 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .