## Prostate Cancer Pathology: Distinguishing True from False ### Correct Statements (Options 0, 1, 2) **Key Point:** Prostate cancer has distinct anatomical, histological, and prognostic features that guide clinical management. | Feature | Detail | |---------|--------| | **Peripheral zone origin** | ~70% of cancers arise here (vs. transition zone for BPH); explains why DRE can detect nodules | | **Gleason grading** | Sum of primary + secondary patterns (2–10); higher score = worse prognosis; most powerful predictor | | **Perineural invasion** | Tumor cells invade nerve sheaths; strong adverse prognostic indicator; associated with higher grade and stage | | **Histology** | Acinar adenocarcinoma most common; loss of normal glandular architecture | ### Why Option 3 Is Incorrect **High-Yield:** While prostate cancer is indeed common in Indian men, it is **NOT** the most common malignancy overall. **Lung cancer** (in men) and **breast cancer** (in women) remain the leading cancers in India. Prostate cancer ranks 3rd–4th in incidence among Indian men, depending on the registry. The statement conflates regional prevalence with global epidemiology. **Clinical Pearl:** Prostate cancer incidence in India has risen with aging populations and improved screening, but it still trails lung and gastric cancers in overall burden. ### Gleason Grading System ```mermaid flowchart TD A[Gleason Score = Primary + Secondary Pattern]:::outcome A --> B{Score Range} B -->|2–6| C[Well-differentiated, low risk]:::action B -->|7| D[Intermediate risk]:::action B -->|8–10| E[Poorly-differentiated, high risk]:::urgent E --> F[Increased perineural invasion, metastatic potential]:::outcome ``` **Mnemonic:** **PGP** — **P**eripheral zone, **G**leason grading, **P**erineural invasion (the "Big 3" of prostate cancer pathology).
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