Prostate carcinoma what is it and how long a person will live. Treatment and prognosis in the diagnosis of prostate carcinoma Increased cfc in the blood prostate carcinoma

Valery Zolotov

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Prostate carcinoma is an extremely serious disease in men. Which, as a rule, develops from the tissue of the prostate glands.

It is this disease that is the main prognosis for men over 50.

The causes of this pathology in men have not yet been clarified. It is only known that prostate carcinoma is directly related to testosterone. The higher the level of this substance in the blood of a man, the greater the chance of developing this disease and the more malignant the pathology will be.

The prognosis for the outcome of the disease depends on the stage at which the disease was detected and on the individual characteristics of the person.

If prostate carcinoma was detected in the early stages, then with adequate treatment the prognosis is quite optimistic, working capacity, as a rule, is fully restored. If the disease was detected only on the third or - then the prognosis, in this case, will be unfavorable. After all, this disease is often fatal.

Also, in the event of metastases, the patient will not be able to fully recover. You can only slow down or at best stop the development of the disease.

Prostate cancer occurrence

As a rule, symptoms begin to appear too late and there is little chance of a complete recovery of the patient. The disease can manifest itself with more frequent urination, blood in semen and urine, pain in the perineum.

However, it is far from the fact that the patient will notice these symptoms. It often happens that a patient seeks doctors at a later stage of his illness. In this case, the first signs of the manifestation of the disease can be considered pain in the chest, in the bones, namely the pelvis, hips or spine.

There have been cases when men applied at the final stages of the disease, in this case, symptoms can be considered a sharp urinary retention, complete or partial impotence, a person can lose weight dramatically, turn pale, his skin can acquire an earthy tint.

A man decreases or increases his risk of developing prostate cancer throughout his life.

The prognosis for prostate carcinoma can be considered:

• progressive prostate adenoma;
• work with cadmium (printing and welding works, rubber production);
• poor heredity (relatives have suffered or are still sick with prostate cancer);
• improper diet (little fiber, many animals, etc.);
• bad ecology;
• elderly age.

Features:

This pathology differs from other oncological diseases in malignant and slow course. Compared to others, this species grows slowly. From appearance in microscopic size to the last stage, it takes ten to fifteen years on average.

It is complicated by the fact that throughout the development of the disease, it can give metastases, that is, even in the early stages, it can spread to other organs. As a rule, they spread, most often, and lymph nodes, lungs, liver, adrenal glands.

By this he is one of the most dangerous cancer diseases. Until that moment, not yet, the development of the disease can be stopped. It is no longer possible to do this later.

In case of any manifestations of certain symptoms, we strongly recommend that you consult a medical specialist, do not postpone a visit to a doctor. This only increases the chances of an unfavorable development of the disease.

If you have problems with urination, immediately contact your urologist. Do not worry too much about diagnosing yourself. Perhaps it's just a prostate adenoma.

Diagnosis of a patient with suspected cancer is carried out in several stages.

First, the doctor will check the condition of the prostate with a rectal examination. This is one of the simplest test methods to find out if you have prostate cancer or not. Unfortunately, the tumor is felt only in the later stages.

So if the doctor has not found anything in you yet, you should not immediately rejoice. It will be necessary to conduct a blood test for prostate-specific antigen, or in another way PSA.

PSA is a substance that can help you determine whether you have prostate carcinoma or not. In addition, to clarify the diagnosis, the patient can be prescribed computed tomography or ultrasound of the prostate, as well as radioisotope and X-ray studies.

The final diagnosis will be made after a prostate biopsy. Using a special needle, a small piece of the gland will be taken from you through the rectum or perineum for examination and diagnosis.

Prevention

The prognosis will not be encouraging if you have not performed prophylaxis for prostate carcinoma.

1. physical activity can significantly reduce the risk of prostate cancer, in addition, it is worth reducing tobacco smoking, alcohol abuse and it is recommended to increase the level of physical activity that will help you, if you are overweight, lose it. And excess weight can be a factor in the onset of this disease;
2. special attention should be paid to diet. It is recommended to consume vegetables and fruits daily, namely cabbage, broccoli, tomatoes, grapes, soybeans. And also it is worth limiting the use of foods that contain calcium and animal fats. Scientists have noticed the fact that prostate cancer is unevenly distributed in the world. A country like Japan has a fairly low incidence. It is believed that this is due to the fact that the inhabitants of this country consume a lot of vegetable fats, such as soy. It contains a huge amount of phytoestrogens, which are very similar in composition to female sex hormones. These substances significantly reduce testosterone levels in the blood and, as a result, lower the risk of prostate cancer. Alpha-tocopherol and carotenoids play a significant role in the prevention of prostate cancer, they are found mainly in herbal products;
3. also, the prognosis for your life after fifty will be much more optimistic if you consume vitamin E. And besides, scientists have noticed the fact that the use of Finasteride every day reduces the risk of prostate carcinoma by thirty percent.

Researchers of this disease around the world note that physical activity and activity can reduce the risk of prostate carcinoma.

Also, the prognosis for prostate cancer can be attributed to hormonal imbalances and environmental factors such as exposure to ultraviolet rays. In addition, the prognosis will be some past viral infections, scientists are discussing the theory of XMRV infection.

Treatment methods

There are several methods of treating prostate cancer, in most cases it depends on the stage at which the disease was detected and the individual characteristics of the patient.

In the early stages, namely in the case when there are no metastases, the prostate can be removed along with the seminal vesicles. Radiation therapy or ultrasound ablation can also be used, during which the patient is exposed to the tumor site with focused high-intensity ultrasound.

As a rule, in the early stages, prostate cancer is easily treatable, and removal of the tumor is possible only if metastases have not yet appeared. In this case, the forecast will be very optimistic.

There is also a treatment with pills, with the help of which testosterone is reduced or completely blocked. This method of disease control is used at a later stage. This method will not be able to guarantee you a complete cure, but it will give the patient good health and reduce the symptoms of the disease.

At stages 3 and 4, when metastases have already appeared, radiation therapy is used, as a rule, in conjunction with hormonal therapy. With the help of irradiation of the prostate and lymph nodes nearby.

Monotherapy is also used, which means prescribing drugs for life. Cancellation is possible only in 2 cases, either in the case of complete recovery of the patient, or intolerance to this drug.

Remember that prostate carcinoma is not a disease that can be delayed, the outcome of treatment depends on you and only you, whether you can notice or suspect the occurrence of certain symptoms in time. Do not forget about the prevention of prostate cancer.

Lead a healthy lifestyle, try not to abuse alcohol and tobacco, and your chances of acquiring this "sentence" will be lower than that of eighty percent of all men.

If you find out that you have prostate cancer, you should not be very upset or panic. Many men live with it for years or even decades. In the twenty-first century, cancer has long ceased to be something seriously threatening. If you do not start treating pneumonia in time, a lethal outcome is also possible. Our medicine effectively fights cancer. All the more so with those that develop slowly.

If you have prostate cancer was detected in the early stages, then we hasten to please you that the chances of your full recovery are close to one hundred percent. At the later stages of the development of the disease, it is also possible to resist the disease, radiation therapy, chemotherapy are just the "tip of the iceberg" of methods of treating cancer.

You should not immediately give up and give up, there were cases when people were cured only at the expense of their own will. And medicine will also help you! Even if she is not able to completely restore you, she can reduce pain and stop the development of the disease.

It's important to know! Always listen to your healthcare professional! His goal is your early recovery, he will not prescribe procedures that cannot help you!

Do not forget to undergo an annual medical examination, it is better to spend time examining your body once a year, rather than then treating similar diseases in the later stages.

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Prostate cancer is one of the most common cancers in men. Although it develops slowly, thousands of men die from the disease every year. On average, prostate cancer can be diagnosed in every sixth man, and this probability only increases with age.

What is prostate cancer and where does it arise

The prostate, or prostate gland, is located in the male body under the bladder. It borders on the rectum (which allows the doctor to palpate its posterior surface during examination). The initial part of the urethra passes through the prostate gland, where the excretory ducts of the gland open. Blood to the prostate and bladder is supplied by the lower urinary artery, which departs from the internal iliac artery. On both sides of the prostate gland is located along the neurovascular bundle, part of the lower hypogastric (pelvic) plexus. The prostate plexus is essential for erectile function.

Prostate cancer occurs when the cells of the prostate gland begin to divide at a faster rate than is required to replace the number of dead cells. This leads to uncontrolled tumor growth. After degeneration, further gene mutations can lead to tumor progression and metastases. Most cancers (95%) of the prostate are adenocarcinoma, a tumor that arises from the glandular epithelium. In much rarer cases (only 4% of all tumors), prostate cancer arises from the urothelium, the tissue that lines the urethra. 1% of diagnosed tumors are squamous cell carcinoma. Less often (there are literally several episodes), prostate cancer develops from neuroendocrine stem cells that are present in the prostate gland.

The most susceptible to the appearance of cancer is the peripheral zone of the prostate gland - there cancer occurs in 70% of cases. 15-20% belong to the central zone, and 10-15% - to the transitional zone. From the prostate gland, cancer can spread into the ejaculatory ducts, seminal vesicles, go to the neck of the bladder and penetrate through the prostatic capsule into the vessels.

The doubling time (when the mass of the cells that make up a cancerous tumor doubles in size) in prostate cancer exceeds four years; in rare cases, this period is reduced to two years. The larger the tumor, the less time it takes for it to double its mass, the more aggressive the cancer, the higher its Gleason score.

Causes of Prostate Cancer

Genetic predisposition

In favor of a genetic predisposition to prostate cancer is the fact that the frequency of its occurrence varies in different parts of the world, and the upper indicator is more than 50 times higher than the lower one! Most often, residents of North America, Australia and North and Central Europe get sick, and least often the population of Southeast Asia and North Africa. However, those of the inhabitants of Asian countries who migrated to other countries get sick more often than their brothers who remained in their historical homeland. This demonstrates the importance of environmental factors, especially diet.

Sub-Saharan Africans are more likely to suffer from prostate cancer than whites and Asians, even though they have similar lifestyles. Although the death rate from prostate cancer continues to decline worldwide, black men die from it on average twice as often. It may be true that differences in access to skilled health care, income, education and health insurance play a role.

Heredity

Family predisposition also plays a role; recent studies have shown that genes associated with prostate cancer are inherited. Heredity can be responsible for about 5-10% of prostate cancers; in men with a family history of prostate cancer, cancer may appear 6-7 years earlier and more likely. Certain gene mutations can also increase the risk of developing prostate cancer. Certain hereditary diseases such as Lynch's syndrome also contribute to the appearance of prostate cancer.

Interestingly, prostate cancer is most often found in men who have died for other reasons; at the age of 80, the ratio of diagnosed prostate cancer to latent cancer is 20% versus 80%. This ratio is true for all countries and all peoples.

Diet

Eating foods may play a role in the development of prostate cancer. Although diet itself is not a panacea for prostate cancer (it is caused by a whole range of causes, not all of which have been studied so far), in some cases, a certain type of diet can reduce the likelihood of its occurrence. Or, in the opposite case, increase this chance.

One of the links that have been found between the occurrence of prostate cancer and nutrition is the amount of fat consumed. Most of all, fatty foods are loved by men living in Western Europe and North America, respectively, the risk of developing prostate cancer is highest in these regions. Southeast Asians eat the least fat, and they also suffer less from prostate cancer. Interestingly, with the spread of the Western diet in Japan (where they traditionally ate little fatty foods), the number of patients with prostate cancer also increased, and in its aggressive form.

There has also been a correlation between the consumption of red meat and the occurrence of prostate cancer. Studies have shown that prostate cancer in men who eat meat from animals is 2.64 times more likely to develop. The risk is even higher if the man likes meat that is well done or regularly eats meat products such as sausages, bacon, brisket, and sausage. True, some scientists believe that excess meat, like excess fat, is more likely to serve as a marker of an overall unhealthy lifestyle, and not their danger as such.

However, if a man wants to reduce the likelihood of developing prostate cancer, it is advisable to eat less fried, fatty and red meat. For example, people who are accustomed to eating a Mediterranean diet (an abundance of fruits, vegetables, grains, the use of olive oil, and the use of poultry and seafood as sources of animal protein) suffer from prostate cancer to a lesser extent.

Obesity

Many studies have shown that obese people are more prone to developing prostate cancer than their thin counterparts, and the cancer in such cases is more aggressive. True, the reason may be that obese people are more difficult to diagnose prostate cancer in the early stages. Large people have a large prostate gland, making it more difficult for a doctor to determine with a biopsy if it contains cancer cells. An enlarged prostate also releases an increased amount of antigen associated with prostate cancer, making it difficult for the doctor to make a diagnosis.

Hormones

It is believed that hormones influence the occurrence of prostate cancer. An indirect proof of this theory is that men who for some reason have undergone castration do not have adenocarcinoma of the prostate gland. Studies have shown that the risk of developing a tumor is increased by an increased level of luteinizing hum and the testosterone / dihydrotestosterone ratio.

In many cases, the cause of squamous cell carcinoma of the prostate gland is radiation or hormone therapy.

Age

The older the man, the more likely he will develop prostate cancer. Cases of this disease are rarely diagnosed in men younger than 40. Men over 55 are more likely to be diagnosed with metastatic prostate cancer.

Prostate cancer symptoms

Prostate cancer is now diagnosed in its early stages, when there are no cancer symptoms. This happened due to the discovery of the diagnostic value of the prostate specific antigen (PSA), which contributed to a significant reduction in mortality from prostate cancer. Diagnosis is based on serum PSA levels, x-rays, or digital rectal examination. In addition, prostate cancer can be detected by analyzing the removed tissue in the treatment of benign prostatic hyperplasia.

Until the 80s of the last century, when there was no information about the diagnostic importance of PSA, symptoms included complaints of difficulty urinating, back pain, and blood in the urine.

With a progressive disease, the symptoms are different:

Bone pain, with or without pathological fractures (prostate cancer generally tends to form metastases in the bone tissue; such pain is one of the symptoms of tumor spread).

Focal neurological deficit that occurs when spinal cord tumors are compressed.

Lower back pain, edema due to obstruction of venous and lymphatic vessels (if prostate cancer has gone through nodular metastasis).

Uremia caused by obstruction of the ureter due to an enlarged prostate.

Prostate Cancer Diagnosis

First of all, the doctor conducts a digital examination of the rectum - when through the anus, the doctor's index finger in a glove is inserted into the rectum. Due to the location of the prostate, its posterior part can be easily felt through the rectal wall. When examining, it is important to pay attention to asymmetry and differences in tissue density. True, with a digital examination, it is difficult to distinguish benign formations on the prostate gland from cancer - to the touch, cysts or stones do not differ from cancerous tumors.

The second main component of the diagnosis in case of suspected prostate cancer is the analysis of blood serum for the content of prostate specific antigen (PSA). The rate of its content in blood serum depends on age - from 2.5 ng / ml in patients from 40 to 49 years old to 6.5 ng / ml in elderly men over 70 years old. If the PSA content reaches a value above 10 ng / ml, then a biopsy is required.

A biopsy of the prostate gland is carried out using a special device - a pistol and needles, and it is carried out under the control of transrectal ultrasound (TRUS). The needle enters the prostate through the rectal wall (therefore, before the biopsy, the patient will have to prepare - take a laxative and do a cleansing enema). The tissue is taken not only from suspicious areas, but also over the entire surface of the prostate (up to 24 points). Unfortunately, biopsies often produce false negative results, so multiple biopsies may be required to accurately identify prostate cancer. Complications are also possible with a biopsy: the patient may experience pain, his temperature rises, traces of blood may be found in the blood, and (in rare cases) it may lead to sepsis. The risk of complications with repeat biopsies increases.

With progressive disease, it is useful to test the blood for creatinine and liver enzymes. The patient will also need to do a urinalysis to determine if there is blood or any infection in it. These data should be considered when planning treatment for prostate cancer.

Computed tomography is only used if prostate cancer has a high risk of lymph node metastases.

As a rule, in all studies, the diagnosis is not difficult for a doctor - it is difficult to confuse prostate cancer with anything else.

Prognosis for prostate cancer

Generally, the earlier prostate cancer is diagnosed, the easier the treatment and the better the outcome. Provided the correct diagnosis and qualified treatment are made, the man's ability to work is restored to 100%. Unfortunately, the opposite is also true - the later prostate cancer is diagnosed, the more likely it is to die.

The prognosis for prostate cancer depends on the following factors:

Prostate specific antigen level.

Gleason level. If a tumor is defined on a scale as level 4 or 5 (low-grade cancers), it is more aggressive, but at the same time better amenable to chemotherapy and radiation therapy. Level 1 and 2 highly differentiated tumors, although less prone to metastasis, respond less well to treatment.

The spread of the tumor and the presence of metastases. Despite the fact that the incidence of metastatic prostate cancer is decreasing from year to year (from 20% in the 70s to 3.4% in the 90s), the risk of developing cancer in other organs and tissues in men remains high.

The patient's age. The older the patient, the more difficult the treatment and the more unfavorable the prognosis.

The type of anesthesia. According to research, the prognosis for prostate cancer may even depend on the anesthesia used during surgery. The results of the study showed that the mortality rate in men who underwent surgery with general anesthesia was 30% higher than in men who were treated with sparing techniques without the use of opioids.

Prostate cancer treatment

When prescribing treatment, the doctor takes into account both the severity of prostate cancer, the possible risks for the patient, his quality of life and the likely prognosis of the disease. Generally, the earlier prostate cancer is diagnosed, the easier it is to treat.

Surgical removal of the prostate (radical prostatectomy)

Surgical treatment is indicated for localized cancer in the absence of metastases; as a rule, it is prescribed for younger patients. In a prostatectomy, the entire gland is removed along with the seminal vesicles. However, even radical prostatectomy is not a guarantee of long life. According to research, within 15 years after surgery, 7% of patients died - mainly from squamous cell carcinoma of the seminal vesicles.

Radiation therapy

Both the prostate itself and nearby lymph nodes can be exposed to radiation. There are several types of radiation therapy - external, adjurvant, a combination of external therapy and interstitial implantation of radioactive drugs (brachytherapy), and so on; the doctor will help you choose the most suitable method for treating prostate cancer. Complications of radiation therapy can include the following: rectal bleeding, diarrhea, urinary incontinence, blood in the urine, and erectile dysfunction. Also, radiation therapy for prostate cancer may slightly increase the chances of rectal and bladder cancer.

Ultrasound ablation

With this method of treatment, the tumor is exposed to a powerful beam of ultrasonic waves. Often, ultrasound ablation is used to treat relapses after surgery or radiation therapy.

Hormone therapy

Treatment of prostate cancer with hormones is one of the rarest methods, usually used if the cancer reoccurs after the removal of the prostate or if the patient is old and other treatments are not possible. Hormonal treatment for prostate cancer consists in the introduction into the patient's body of substances that cause a decrease in the level of male sex hormones. The disadvantages of this kind of therapy are a decrease in libido and potency, possible swelling of the mammary glands, and so on; however, they rarely occur.

Unfortunately, all treatment options are fraught with side effects. If prostate cancer is detected at an early stage and the man is not worried about the symptoms, the doctor may suggest that he adhere to a wait-and-see tactic - when intervention in the patient's body does not occur until the tumor is threatened with spread. In this case, it is necessary to carefully monitor the patient's health, symptoms and behavior of the tumor.

Recently, new methods of treating prostate cancer have appeared - for example, cryotherapy (when the affected tissues of the prostate are exposed to low temperatures and are destroyed) and the TOOKAD method (when a tumor, treated with a special drug, is exposed to a laser). These operations are much less traumatic than traditional ones, the risk of complications is lower, but how effective they are in the long term is still unknown.

Treatment in the later stages of the disease

In some cases, prostate cancer is diagnosed at an advanced stage, when it has already begun to metastasize. It is impossible to cure it, it remains only to stop the symptoms as much as possible (for example, to relieve pain), as far as possible to try to slow down the progression of the disease and thereby prolong the patient's life.

Living with prostate cancer

Prostate cancer usually progresses very slowly; sometimes a person lives with him for decades without any inconvenience and does not need treatment. However, the very fact of cancer (even if there are no symptoms) affects the quality of life primarily for psychological reasons. The person develops anxiety, depression may begin. Support of family, relatives, friends, communication with other patients with prostate cancer can help here.

Prevention of prostate cancer

You can reduce your risk of developing prostate cancer by:

Healthy eating. It is recommended to avoid foods and meals high in fat; instead, preference should be given to fruits, vegetables, whole grain breads. Do not get carried away with dietary supplements - no clinical study has shown that they can prevent cancer. Instead, you should choose foods rich in vitamins and minerals. According to some reports, drinking green tea can have a preventive effect; however, a large-scale clinical study of the anti-cancer properties of green tea has not yet been conducted.

Sports and active lifestyle. Regular exercise can improve your health, help you maintain your weight, and improve your mood. There is evidence that men who do not exercise have higher PSA levels. It is advisable to exercise 3-4 times a week.

Weight control. If the patient's current weight is within the normal range, it is advisable to maintain it in this state. A healthy diet and regular exercise can help. If it exceeds the norm, you should slightly increase the number of exercises and slightly reduce the diet; a consultation with a nutritionist can help.

Regular examinations. When a man reaches 45 years of age, it is advisable to start testing for PSA levels every year - this test will help identify cancer (if it occurs at all) at an early stage, when the disease is easier to treat. People who are in one or another risk group are recommended to undergo a proctologist's examination and be tested for PSA every year.

Medicines and supplements for the prevention of prostate cancer

Cancer cannot be prevented by taking dietary supplements, vitamins, or traditional medicines (or at least until there is research to prove otherwise). Many substances considered to be beneficial - such as vitamin E and vitamin D - do not help prevent prostate disease; the study of their action did not give positive results. There is also no evidence to support the effectiveness of lycopene and pomegranate juice.

According to some studies, the use of 5-alpha reductase inhibitors, including finasteride and dutasteride, can reduce the likelihood of cancer by up to a quarter. However, if a tumor does develop in the prostate gland, the cancer will progress faster.

If you look at the current statistics on the diagnosis of prostate cancer, it immediately becomes clear that this male cancer is one of the most frequently diagnosed. However, it can affect people of different ages. In terms of world mortality rates, prostate carcinoma is in third place, second only to bowel cancer and malignant lung disease in this sad list.

Absolutely all middle-aged men are at risk. For example, adenocarcinoma of the prostate (the most common epithelial cancer) in developed in all plans Germany affects about 50 thousand people every year. At the same time, according to statistics, out of every hundred people who undergo prostate cancer treatment, three are doomed. This is a fairly high mortality rate. Therefore, early diagnosis of this disease and surgical treatment are extremely important.

Poorly differentiated adenocarcinoma is called the most "evil", since this type of tumor is the most dangerous and in most cases has a disappointing prognosis. During the histological examination of the neoplasm, it turns out that the bulk of the tumor cells are atypical and have no normal signs.

Causes of prostate carcinoma

As a rule, the development of prostate carcinoma (neoplasms of a malignant nature) is associated with natural changes in hormonal levels men belonging to the middle and senior age category (from 45 years old and above). The emergence and development of cancer localized in the prostate gland depends on hormones, since a direct relationship has been found between the progressive growth of the neoplasm and the high level of testosterone in the patient's blood. In other words, male sex hormones contribute to the growth of the tumor focus.

However, in some cases, the causes of prostate cancer lie in heredity ... In 2012, researchers from America experimentally identified a gene, the inheritance of which directly increases the risk of developing a malignant tumor in the prostate gland. During the work, scientists discovered a mutation within a gene called HOXB13, which increases the likelihood of diagnosis by several dozen times. Experts believe that thanks to the results of this important study, tests will be created in the future that can identify men who are at high risk.

For carcinoma of the prostate a slow and stable malignant course is characteristic. It is difficult to detect the disease in the early stages, since the first signs of prostate cancer do not appear immediately, and the neoplasm continues to grow. This tumor is characterized by a special insidiousness - the symptoms have not even appeared yet, and the neoplasm is actively metastasizing. As a result, even a small primary focus within a short period of time can spread beyond the affected gland, making the prognosis unfavorable.

This feature a malignant tumor that has developed in the prostate gland, due to the natural active blood supply to the prostate. The spread of secondary foci is mainly carried out through the bloodstream. Through the large iliac arteries, the cells of the disease are quickly carried to the spine and pelvic bones, they can enter the adrenal glands, liver and lungs. Such distant metastases are not treated with surgery, therefore, in such a situation, it is impossible to completely eradicate the disease and avoid re-manifestation.

Signs of prostate cancer

As mentioned, prostate cancer is caused by natural changes in the human body and a number of provoking factors that have no specific signs. Any clinical manifestations, as practice shows, indicate a serious stage of the disease. All symptoms of a prostate tumor, typical for the stage of active growth, are divided into three groups depending on the principle of occurrence:

We remind you that a prostate tumor can appear in any man... It is extremely important, for life as well, not to miss the moment and to diagnose the disease as early as possible. The main method of early diagnosis and prevention of cancer localized in the prostate is annual urological screening for men over 45 years old. Any suspicious signs suggesting prostate cancer after this age should be a wake-up call! Contact a specialist immediately and get tested.

Oncological diseases pose a serious danger to the human body. Due to their rapid spread, it is highly recommended to study the symptoms, consequences and main features of such lesions.

There are many types of oncology. One of the most dangerous forms of cancer is prostate carcinoma.

Prostate carcinoma is a malignant tumor that forms from cells that form the prostate gland. This organ is present only in the male part of the population and is localized in the pelvic region below the bladder, while surrounding the urethra.

Most prostate cancer is diagnosed in men living in industrialized countries.

Causes

Doctors identify the following reasons that contribute to the formation of prostate cancer:

• Age factor. The older a man is, the higher the likelihood of a tumor.
• Race. A man of a Negroid race is susceptible to damage to the prostate to a greater extent than representatives of other groups. They also have cancer diagnosed at a later stage in the development of oncology.
• Genetic predisposition. The likelihood of developing prostate carcinoma is higher in the category of people whose close relatives have previously suffered from this type of cancer.
• Improper nutrition. Eating excessive amounts of fat increases the risk of prostate injury.
• Smoking. The harmful substances contained in tobacco smoke, penetrating into the cells, have a detrimental effect on the entire body and on the prostate gland, in particular.

Determining the exact risk factors is difficult due to the fact that prostate carcinoma often resolves without any symptoms. But it should be borne in mind that any bad habits, be it the use of alcohol, drugs, nicotine, fatty foods, contribute to the onset of cancer.

Metastases

Metastasis significantly complicates the treatment and disposal of cancer. In prostate cancer, metastases primarily penetrate into the seminal vesicles, rectum and bladder.

But as with any oncological disease, without therapeutic measures, tumor cells spread throughout the human body, affect the main structures: bone, muscle, liver, spleen, causing significant complications, which are very problematic to get rid of later.

Degrees and symptoms

Prostate carcinoma is divided into several stages, each of which has specific characteristics in diagnosis, treatment and consequences. In particular, there are four stages:

• Stage 1. The neoplasm cannot be detected by palpation or using ultrasound examination, since it is very small in size. It can only be detected by analyzing for PSA. Has no specific features.

Stage 2. A cancerous tumor gradually spreads through the prostate gland, but at the same time does not leave the borders of the organ. Its development is limited to the prostate capsule. When probing the affected area, the neoplasm is revealed as a dense knot. Can also be detected using ultrasonic waves.

As for the symptoms of carcinoma, the main symptom of the second stage is the appearance of problems with urination - this is due to the fact that the prostate is putting pressure on the urethra. Often, such violations force men to go to the toilet 3-4 times a night. There is also pain in the perineum.

Stage 3. Cancer spreads to surrounding tissues and organs. First of all, the tumor enters the seminal vesicles, rectum and bladder. The process of metastasis does not affect distant structures.

Oncology of the prostate in the third stage is characterized by problems with potency, pain in the lumbar region and pubis. Blood can be observed in the urine, and a strong burning sensation occurs when urinating.

Stage 4. The tumor of a malignant nature reaches a large size. Metastases affect distant tissues and organs: bones, lungs, liver and spleen, lymph nodes. Signs of general intoxication of the body appear: weakness in the body, rapid fatigue, loss of strength.

As for the characteristic manifestations: when urinating, significant difficulties appear, which are accompanied by severe pain. Often, the patient cannot empty the bladder on his own, so the use of a catheter is necessary.

Diagnostics

Modern diagnostic methods make it possible to establish the main indicators of the tumor, which helps to determine the most effective method of treatment. In particular, the following techniques are used:

• Rectal examination of the rectum. A small-sized special probe is inserted into the rectum. The size and structure of the prostate is determined using ultrasound waves.
• PSA analysis. Changes in the rate of prostate specific antigen upward make it possible to judge the presence of prostate carcinoma.
• Ultrasound. With the help of ultrasound examination, tumor size and localization can be determined.
• CT. Computed tomography allows you to compose a layer-by-layer image of a neoplasm, which helps in determining some of its indicators: size, structure, type.
• X-ray. The use of X-rays is the standard diagnostic method for many situations. In this case, it helps to establish the size and location of the tumor.

Treatment

Cancer treatment is selected by a doctor using an individual approach to each patient. In this case, it is necessary to take into account the following characteristics:

• The age of the patient.
• The stage of development of the neoplasm.
• Associated diseases.
• Patient preferences.

Not every patient can be shown any therapy. For example, men over 70 years old with serious diseases of the cardiovascular system are not always allowed to undergo medical procedures, since such events are quite life-threatening.

Therapy

Among the radical techniques are:

• Removal. Surgery is one of the most common methods for treating a tumor. This usually removes the entire prostate gland. To do this, a small incision is made in the lower abdomen and an organ is cut out, while the surrounding structures are excised.
• Monoclonal antibodies. Preparations with such antibodies help to stimulate the immune system of the human body to further resist cancer. It is rarely used in domestic practice.
• Virotherapy... The essence of this method of treatment lies in special artificial viruses that determine the location of cancer cells and destroy them, help to reduce the size of the tumor and restore the body's defenses.
• Brachytherapy. Radioactive preparations are injected directly into the neoplasm. Differs in greater efficiency and safety in comparison with radiation therapy.
• Radiotherapy. Due to irradiation of malignant structures, disturbances occur in the molecule of the affected cells, which contributes to a decrease in their ability to reproduce, as well as to complete death.
• Chemotherapy. Its principle of action is based on special preparations, which contain certain substances that have a detrimental effect on cancer cells. Their membrane and nucleus are destroyed, which allows getting rid of the tumor.
• Orchiectomy. This is a surgical operation in which one or two testicles are removed from a man if they have been affected by prostate cancer.

Medication

Drug treatment has a milder effect, but low efficiency:

• Antagonists of gonadotropin-releasing hormone. Drugs in this category lower the concentration of testosterone in the body. As a result, the development of the neoplasm slows down. Tumor cells become more differentiated, that is, healthy.
• Pituitary hormone analogs. The essence of the considered treatment method is based on "medical castration". The level of male hormones decreases several times - after 14-20 days, the testosterone concentration drops so much that it seems as if the man's testicles were removed. But this phenomenon is temporary.
• Antiandrogens. Drugs of this spectrum interfere with the interaction of cancer cells with adrenal hormones. It is used in combination with analogs of the pituitary hormone, which provides maximum blockade and the best efficacy in drug treatment

Prevention

Even with the current level of medicine, it is impossible to completely eliminate the risk of prostate carcinoma. But if you take into account the following points, then the likelihood of a tumor is significantly reduced:

• Balanced diet. Limit yourself in eating fatty foods. Diversify the diet with vegetables and fruits.
• Lack of carcinogens. Such substances contribute to cell mutation. Therefore, interaction with them must be avoided. They are found in tobacco smoke, various food additives, in industrial production.
• Active activity. Take some time to exercise every day, as one of the risk factors is a sedentary lifestyle.
• Exclusion of stagnation in the prostate. Sex and exercise allow you to avoid inflammatory processes through the outflow of prostatic juice.
• Healthy sleep. During sleep, a special hormone, melatonin, is produced, which prevents the development of cancer.
• Periodic examination. The frequency of doctor visits should be increased with age. This also applies to genetically predisposed patients who have a higher risk of developing carcinoma. This category of people is recommended to be examined at least 3-4 times a year - this will avoid removing the prostate gland.

a - healthy tissue, b - affected tissue

Forecast

The characteristic of the prognosis of prostate carcinoma largely depends on the stage at which the diseases were diagnosed:

• Nearly 100% chance of being cured, if a man went to a doctor and underwent treatment at the first stage.
• A less rosy prognosis awaits patients with the second and third stages. The success of treatment is determined by the individual characteristics of the patient. Life expectancy in the second stage - no more than 15 years, on the third - no more than 10 years.
• As for men with prostate cancer in the fourth stage, treatment is practically ineffective. Rarely does anyone survive up to 3 years. With combined therapeutic measures, it is possible to extend the life span up to 5 years.

Is a malignant tumor of the prostate tissue. There are no specific symptoms, especially in the early stages. Possible disorders (sluggish intermittent urine stream, nocturia, constant urge to urinate, pain in the pelvic region, etc.) are associated with the presence of prostate adenoma or chronic prostatitis in the patient. In the diagnosis of prostate cancer, digital rectal examination of the prostate gland, PSA determination, ultrasound, and biopsy are used. Treatment may include radical approaches (prostatectomy), minimally invasive interventions (HiFu therapy, brachytherapy, cryoablation), external beam radiation therapy, hormone and chemotherapy.

General information

In a number of countries, in the structure of oncological diseases, prostate cancer in terms of frequency of occurrence in men is second only to lung cancer and stomach cancer. In modern oncourology, the disease is a serious medical problem, since it is often diagnosed only at stages III-IV. This is due to both long-term asymptomatic tumor development and inadequate implementation of measures for early diagnosis. Prostate cancer is more common among men over 60 years of age, but in recent years, there has been a tendency to "rejuvenate" the pathology.

Causes

Prostate cancer is a polietiologic disease with unexplained causes. The main risk factor is the age of the man. More than 2/3 of cases of malignant tumors of the prostate gland are over 65 years of age; in 7% of cases, the disease is diagnosed in men under 60 years of age. Race is another predisposing factor: the disease is most common in African Americans and least common in Asians.

Family history is of some importance in etiology. The presence of pathology in a father, brother or other men in the family increases the risk of prostate cancer by 2-10 times. There is an assumption that the likelihood of a neoplasm of this localization in a man increases if the family has relatives with breast cancer.

Other likely risk factors include dietary habits associated with the consumption of large amounts of animal fats, testosterone therapy, and lack of vitamin D. Some studies indicate an increased likelihood of tumors in men who have undergone vasectomy (sterilization). Reduces the potential risks of eating soy products rich in phytoestrogens and isoflavonoids; vitamin E, selenium, carotenoids, low fat diet.

Classification

Prostate cancer is represented by the following histological forms: adenocarcinoma (large-acinar, small-acinar, cribrous, solid), transitional cell, squamous cell and undifferentiated cancer. The most common glandular cancer is adenocarcinoma, which accounts for 90% of all detected prostate neoplasms.

The Gleason score is used to assess the grade of prostate cancer. According to her, the degree of cell differentiation in two samples of biopsy material is estimated from 1 to 5 points, the total is the index of prostate cancer:

• 2-6 points - highly differentiated, low aggressive, slow growing prostate cancer
• 7 points - a low-grade tumor of moderate aggressiveness
• 8-10 points - poorly differentiated, rapidly growing prostate cancer with a high risk of early metastasis.

According to the TNM system, several stages of prostate cancer are distinguished:

• T1 - the tumor does not manifest itself clinically, has a diameter of less than 2 cm, is detected by chance. At substage T1a less than 5% of the gland parenchyma is affected, at T1b - more than 5%. The T1c substage is selected if abnormal cells are found in the biopsy.
• T2 - a tumor 2-5 cm in size without germination of the capsule of the gland. T2a - less than half of the prostate lobe is affected, T2b - more than half of the lobe on one side, T2c - bilateral lesion.
• T3 - the tumor is more than 5 cm, the capsule of the gland grows. T3a - seminal vesicles are not affected, T3b - germination into seminal vesicles.
• T4 - the tumor grows beyond the capsule, spreads to the neck or sphincter of the bladder, rectum, levator muscle of the anus, pelvic wall.
• N1 - single lymph node metastases are found, N2 - multiple metastases are determined
• M1 - Distant metastases of prostate cancer in lymph nodes, bones and other organs are determined.

Prostate cancer symptoms

The neoplasm is characterized by a long latent period of development. There are no specific signs of prostate cancer. The existing symptoms, as a rule, with the presence of concomitant pathology in the man - prostatitis or prostate adenoma. There is an increased frequency of urination with difficulty starting miction; feeling of incomplete emptying of the bladder; intermittent and weak urine stream; frequent urge to urinate, problems with urinary retention.

Burning or painful urination or ejaculation may occur; hematuria and hemospermia; pain in the perineum, above the pubis or pelvis; lower back pain caused by hydronephrosis; erectile disfunction. It is these complaints that often force the patient to seek medical help. Prostate cancer most often becomes an accidental find during an in-depth urological examination.

Continuous dull pain in the spine and ribs, as a rule, indicates bone metastases. In the late stages of prostate cancer, edema of the lower extremities caused by lymphostasis, weight loss, anemia, cachexia may develop.

Diagnostics

The scope of examination required for detecting prostate cancer includes digital examination of the gland, determination of PSA in the blood, ultrasound and USDG of the prostate, and prostate biopsy. With a digital examination of the prostate through the rectal wall, the density and size of the gland, the presence of palpable nodes and infiltrates, and the localization of changes (in one of both lobes) are determined. However, only with the help of palpation it is impossible to distinguish organ cancer from chronic prostatitis, tuberculosis, hyperplasia, prostate stones, therefore, additional verification studies are required:

• PSA study.A common screening test for suspected prostate cancer is blood PSA levels. Urology oncology specialists are guided by the following indicators: at a PSA level of 4-10 ng / ml, the probability of cancer is about 5%; 10-20 ng / ml - 20-30%; 20-30 ng / ml - 50-70%, above 30 ng / ml - 100%. It should be borne in mind that an increase in prostate-specific antigen values \u200b\u200bis also observed in prostatitis and benign prostatic hyperplasia.
• Ultrasound of the prostate. It can be performed from a transabdominal or transrectal approach: the latter allows even small tumor nodes to be detected.
• Transrectal biopsy of the prostate.It is performed under ultrasound control. The material is usually taken from 12 points (6 from each lobe of the gland). It is carried out through the rectum, usually under local anesthesia.
• Saturation biopsy.It is performed with a transverse approach under spinal anesthesia. During the procedure, more than 12 tissue samples are taken.
• Fusion prostate biopsy... A special computer program processes the MRI data of the prostate, which allows you to target tissue sampling from a suspicious area. It is done both through the perineum (spinal anesthesia) and transrectally (local anesthesia).

Additionally, testosterone levels can be determined, abdominal ultrasound, skeletal scintigraphy, lung radiography.

Prostate cancer treatment

Taking into account the stage of the tumor, surgical treatment, radiotherapy (remote or interstitial), chemotherapy can be undertaken. The use of different approaches is primarily due to the prevalence of prostate cancer.

• Minimally invasive methods... Includes HiFu therapy, prostate brachytherapy, cryoablation. They can be used in patients with low cancer risk or in those patients who cannot perform prostate removal for medical reasons. However, in the case of using these techniques, the likelihood of relapse is higher than with a radical approach.
• Radical prostatectomy. The main type of surgical intervention for a neoplasm of the prostate is radical prostatectomy, during which the gland, seminal vesicles, prostatic urethra and bladder neck are completely removed; lymphadenectomy is performed. Radical prostatectomy may be accompanied by subsequent urinary incontinence and impotence. Modern surgery is gradually moving away from open surgery. Laparoscopic and robotic-assisted prostatectomy is becoming increasingly common practice.
• Androgenic blockade... In order to induce androgenic blockade in prostate cancer, testicular enucleation (bilateral orchiectomy) can be performed. This operation leads to the cessation of the production of endogenous testosterone and a decrease in the rate of growth and dissemination of the tumor. In recent years, instead of surgical castration, drug suppression of testosterone production by LHRH hormone agonists (goserelin, buserelin, triptorelin) has been used more often.
• Drug therapy... Hormone and chemotherapy can be used after prostate removal and in patients who cannot be operated on

Forecast and prevention

The outlook for survival depends on the stage of the oncological process and tumor differentiation. A low degree of differentiation is accompanied by a worsening prognosis and a decrease in the survival rate. At stages T1-T2 NOM0, radical prostatectomy promotes 5-year survival in 74-84% of patients and 10-year survival in 55-56%. After radiation therapy, 72-80% of men have a favorable 5-year prognosis, and 48% have a 10-year prognosis. In patients after orchiectomy and undergoing hormone therapy, the 5-year survival rate does not exceed 55%.

It is not possible to completely exclude the development of prostate cancer. Men over 45 years of age need to undergo an annual examination by a urologist for early detection of neoplasms. Recommended screening for men includes rectal digital examination of the gland, TRUS of the prostate, determination of PSA in the blood.