Clinical meaning
Prostate adenocarcinoma arises from glandular epithelial cells, predominantly in the peripheral zone of the prostate. Malignant transformation involves inactivation of tumor suppressor genes (PTEN, TP53) and activation of androgen receptor signaling pathways. The tumor is graded using the Gleason scoring system, which evaluates glandular architecture on biopsy (two patterns scored 1-5, summed for composite score 2-10). Higher Gleason scores indicate more aggressive, poorly differentiated tumors. Staging uses the TNM system. Metastasis occurs through lymphatic spread to pelvic and retroperitoneal nodes and hematogenous spread to bone (osteoblastic lesions), liver, and lungs. Prostate cancer is androgen-dependent; testosterone stimulates growth through the androgen receptor. The nurse coordinates screening protocols, manages post-surgical care, monitors for treatment complications, and provides comprehensive patient education.
Exam relevance
Risk factors: - Age >50 years (65% of cases diagnosed after age 65) - Black race (1.6x higher incidence, 2.4x higher mortality than White men) - First-degree relative with prostate cancer - BRCA1/BRCA2 gene mutations - High dietary fat intake and obesity - Exposure to Agent Orange (Vietnam veterans) - Smoking (associated with aggressive disease and mortality) - Lynch syndrome (hereditary nonpolyposis colorectal cancer)