Cancer - prostate
Description
- Adenocarcinoma of the peripheral zone in >95% (BPH is transition zone - different problem)
- Androgen-driven throughout its natural history - every systemic therapy targets the androgen axis until it fails
Disease states - the organising framework
| State | Definition |
|---|---|
| Localised | Confined to prostate; risk-stratified low/intermediate/high |
| Locally advanced | T3-4 or node-positive |
| Biochemical recurrence | Rising PSA after definitive therapy, no visible disease |
| mHSPC (hormone/castration-sensitive) | Metastatic, not yet treated with ADT |
| nmCRPC | Rising PSA on castrate testosterone, no metastases on conventional imaging |
| mCRPC | Progression despite castrate testosterone (<1.7 nmol/L) - by PSA, symptoms, or imaging |
Grading - ISUP Grade Group
| Grade Group | Gleason |
|---|---|
| 1 | <=6 (indolent; many never need treatment) |
| 2 | 3+4 = 7 |
| 3 | 4+3 = 7 (worse than 3+4 - the majority pattern matters) |
| 4 | 8 |
| 5 | 9-10 |
Variant histology
- Ductal, intraductal - aggressive, often PSA-low
- Neuroendocrine / small cell transformation - emerges under prolonged AR blockade; low PSA with rapidly growing visceral disease, treat as small cell
6 more sections, plus exam facts
Premium unlocks every note across every specialty, and the full exam fact library behind it.
Get premium access