Prostate cancer/prostate cancer: symptoms, treatment
Prostate cancer is quite common, mainly among older men. As a rule, the average age of patients is 55 to 60 years, although occasionally you may have the appearance of tumor and the young. Symptoms prostate cancer does not always appear in the early stages of the disease, so to identify it in the beginning of the development is quite problematic.
Malignant tumor of the prostate was first described in the NINETEENTH century, but the disease is considered rare, however, in our days, the picture is quite different. About 3% of men worldwide are likely to die from prostate cancer, which is the most frequent neoplasm in the male population. Among the causes of death in recent years, the disease came among the leaders, and all types of malignant tumors takes the second place, even ahead of cancer of the stomach and lungs.
In the post-Soviet countries prostate cancer is quite often found in advanced stages. This is probably due to poor quality diagnostic work, the absence of clear screening programs designed for mass screening of individuals at risk, and we cannot exclude a negative role for the patients themselves, who often come to the doctor when the diagnosis is virtually certain.
Causes and risk factors
Among the risk factors of prostate cancer the most important are:
- Old age;
- Exposure to external carcinogens, work in harmful conditions;
- Prior to the presence of hyperplastic processes in the gland;
- Genetic predisposition;
- Age-related hormonal changes in men;
- Features power, race, way of life.
It is known that the disease most frequently affects older men aged 55-60 years. This fact can be explained not only by the high probability of precancerous processes in the prostate and age-related changes in hormonal levels, but also decrease the protective functions of the immune system, which very often accompany the aging process.
With the advent of modern diagnostic methods, development of cytogenetic studies it has become possible to search for specific mutations, leading to cancer. In particular, the mutated BRCA2 gene not only determines the probability of tumor growth, but also more aggressive. The risk of tumors is much higher in the presence of blood relatives (father, brother) with the disease, so men from these families should be especially careful to monitor their health and undergo regular tests for the presence of the tumor.
A special role among the risk factors play hyperplastic processes and benign tumors. Perhaps there are few people who have not heard about prostate cancer, even advertising in the media contains information.
Hyperplasia is a benign process in which there is an increase in glandular tissue and surrounding stroma (connective, blood vessels) in various ratios. Adenoma – a benign tumor originating from the epithelial duct cells of the prostate. Both processes are accompanied by excessive multiplication of cells, and, therefore, the risk of mutations and violations of division high. Especially dangerous is hyperplasia with atypia, which is considered a precancerous condition. Any proliferative processes is fraught with risk of malignant transformation, therefore, must be under the supervision of experts.
The effects of carcinogens coming from the outside, bad habits, work in adverse conditions can become the Foundation that will give rise to the emergence of a clone of cancer cells. Contact with cadmium, rubber, dyes are considered hazardous in terms of developing prostate cancer.
Great importance is given to age-related changes in hormonal levels in men. It is known that in prostate tissue accumulates a greater amount of dihydrotestosterone (the product of the exchange of the male sex hormone testosterone), which by means of other biochemical reactions has a stimulating effect on the epithelium that may cause and benign hyperplasia, and cancer.
Scientists have noticed that the Europeans and Americans suffer from prostate cancer significantly more often than the population of Asian countries, but the reason for this phenomenon accurately has not been established. May play a role in the diet, the lifestyle and cultural characteristics. Among vegetarians, the incidence is significantly lower among those who are interested in products of animal origin (meat, cheese, eggs) and whose high-calorie diet, the percentage of patients above. Sexual activity has no significant effect on the risk of malignant tumors.
The direct causes of prostate cancer can be considered to be hyperplastic and tumor-like changes in the parenchyma of the gland, and genetic mechanisms of carcinogenesis.
How is the tumor?
The prostate is a small organ located below the bladder, and a circular covering the initial division of the urethra. The main role it is to develop a fluid part of semen to support sperm function and participation in the ejaculation. In addition, there is a role in the regulation of urination.
Parenchyma (primary tissue) of the prostate submitted to the glandular structures, epithelial cells which produce the secret. The epithelium also becomes a source of cancer. Most tumors originate from the peripheral parts of the gland, and only a small part of the Central.
With age, under adverse factors changes in proliferative activity of epithelial cells, there are prerequisites to mutations and the emergence of cancer.
The version of the structure of prostate cancer is determined by the kind of cells forming the tumor. In the case where neoplasia is composed of glandular epithelium, adenocarcinoma talking about, however, if there is the squamous component of squamous cell carcinoma. Most frequently diagnosed in the prostate glandular cancers (about 95% of cases) is adenocarcinoma, tubular, alveolar variant. It is also possible the detection of undifferentiated and undifferentiated forms, characterized by aggressive course and poor prognosis.
Prostate cancer is characterized by relatively slow growth, in some cases for 10-15 years, but metastases can appear quite early, which adversely affects the outcome of therapy.
Today, for the classification of cancer among oncologists the most relevant system ТNМ describing the growth pattern of the tumor, its size and degree distribution in the body and beyond, as well as the presence or absence of diseased lymph nodes and distant metastases.
Biopsy of the prostate tissue from different departments through histological examination is determined by the so-called Gleason score. The higher the number, the more malignant the tumor is available. There is also a parallel determination of the level of prostate specific antigen (PSA).
The combination of the characteristics of the tumor according to the TNM system, the Gleason sum and the level of prostate specific antigen selects the corresponding stage of the tumor. As you can see, this is a fairly complex process that requires detailed consideration not only the tumors, but also conduct additional laboratory tests.
The lower the degree of differentiation of tumor cells, the greater the likelihood of early metastasis and a worse prognosis. Small and undifferentiated tumors poorly respond to treatment and prone to relapse.
The spread of prostate cancer beyond it occurs most often lymphogenous way (with the lymph flow) and hematogenous (blood). Regional lymph nodes relative to the prostate are in the pelvis, they often find early metastasis. Think distant lymph nodes outside the pelvis (aortic, inguinal, femoral, etc.), and the detected secondary tumours of conglomerates is a sign of distant metastases.
Hematogenous route of the spread of tumor cells leads to the spread of metastases to bones, lungs, liver.
Manifestations of the disease
Signs of prostate cancer depending on the stage and the tumor size. Any symptoms, it indicates a malignancy, no. As a rule, in the initial stages symptoms are similar to those in the adenoma or hyperplasia of the gland, so not all patients, most of whom are already elderly, tend to quickly get to the doctor.
For localized forms of cancer include first and second stage, when the outside of the capsule the tumor does not extend, and metastases yet. In this case, the clinic will be scarce and nonspecific. With 3-4 degrees of proliferation neoplasia the clinical manifestations become more distinct and characteristic, as the tumor mass grows capsule body, extending beyond it, and can also be detected metastases.
All of the symptoms of prostate cancer can be divided into two groups:
Obstructive symptoms due to the fact that the affected neoplasia prostate squeezes and narrows the lumen of the initial division of the urethra, thereby disturbed the normal progress of urine. Such symptoms include:
- Frequent, difficult urination, which is manifested first by night and then by day;
- Frequent urination with feeling of incomplete evacuation of the bladder;
- Weak stream of urine;
- Prolonged emptying of the bladder;
- The need to natureline for proper urination;
- Urinary retention in advanced stages or when a significant compression of the urethra.
These symptoms are familiar to many older men owing to the prevalence of hyperplasia of prostate, but they should serve as a pretext for regular visits to the urologist.
The symptoms associated with the growth of a tumor node appear later, often in the II-III stages of tumor. The most characteristic pain is a result of germination of cancer cells through the capsule of the prostate, damage to nerves and blood vessels. In stage IV joins haematuria (blood in urine) associated with the spread of neoplasia in the bladder wall.
In some cases, cancer can grow in the rectum causing pain during bowel movements, diarrhea, and sometimes intestinal obstruction.
In the later stages of the disease join the common signs of the tumor and intoxication by products of exchange – weight loss, weakness, anemisation. When metastasis to bone characterized by pain in the spine, the limbs, particularly intense in pathological fractures.
Methods of detecting prostate cancer
Diagnosis of prostate cancer remains challenging. This is due to the fact that the small size of the tumor may not produce no symptoms, or symptoms are very similar to age-related hyperplastic changes. In addition, many men are quite sensitive to not only the presence of any pathology of the genital organs, but also the fact that the need for referral to a specialist with this problem, so the time can be lost.
Basic diagnostic measures in the case of prostate cancer are:
- Digital rectal examination;
- Determination of serum prostate specific antigen (PSA);
- Ultrasound examination through the rectum.
These affordable and simple tests should be carried out to men older than 50 years, especially in the case of any urological problems.
If you suspect the presence of a tumor, the diagnostic is complemented by low biopsy, under ultrasound control, as well as the possible involvement of other methods, CT, MRI, Doppler ultrasonography, urography, bone scan, etc. to clarify the nature of tumor growth and possible metastasis of the cancer.
Digital rectal examination is the simplest, most accessible and cheapest way to diagnose prostate cancer. Its implementation is already on primary reception at the doctor-the urologist or the surgeon. Many men try to avoid this manipulation in all ways, but its diagnostic significance is difficult to overestimate.
When digital examination the patient is in the knee-elbow position or on one side, and the doctor performs palpation of the prostate through the rectum, determining its consistency, size, local seals, movement. It should be noted that to detect cancer in this way is possible only with a fairly large size of the tumor, in other cases the changes will be similar to hyperplastic changes, so the majority of malignant neoplasms diagnosed by digital examination, are already in advanced stage.
Determination of PSA levels for prostate cancer has high diagnostic value. This tumor marker in the norm formed by cells of the prostate gland, and its concentration does not exceed serum 4нг/ml. malignancy the PSA level increases significantly. The definition of this figure is available in the conditions of clinics, and can appoint him to the urologist after inspection.
In all cases of suspected malignant tumor of the prostate is mandatory to biopsy with subsequent histological examination. Sampling of fragments of the tissue generate a fine needle under ultrasound control of the six points, and if there are changes in the structure of each hearth.
Ultrasound examination of the prostate gives a great amount of information with relative ease and availability. It is carried out through the rectum for a more accurate and detailed visualization of the internal reproductive organs. At the same time determine size, shape of cancer, the presence of focal changes in parenchymal deposits of calcium salts (calcification), deformation of the circuit, compromising the integrity of the capsule, etc.
Prostate cancer treatment
Prostate cancer treatment is determined by stage at which detected a tumor, and patient age and presence of severe comorbidity.
The main stages of therapy are:
- Surgical removal of the tumor;
- Radiation therapy;
- The use of hormonal drugs;
Surgery – radical prostatectomy – gives a good effect in patients with I – II stage of the disease, and their 10-year survival rate is 90%. Complete removal of the prostate along with tumor is characterized by a virtually disease-free subsequent course of the disease. If necessary, this treatment can be supplemented by hormone therapy before surgery.
In the postoperative period, patients may have problems with potency and incontinence, but their likelihood depends on the method of operation and the experience and qualifications of the surgeon.
Radiation therapy gives good results in patients with II stage of the tumor and the survival rate is 70-80%. There are two ways to radiowaste: external beam radiation and brachytherapy.
Remote irradiation of the prostate leads to a decrease of the tumor size and cessation of growth, however, also observed radiation reaction on the part of other organs – rectum and bladder that can be manifested dysuric disorders and diarrhea.
Brachytherapy prostate cancer is the introduction into the body of a special capsule containing radioactive isotopes. With this method of treatment is the maximum radial load on the prostate tumor and nearby organs does not suffer. At high impact on the tumour, brachytherapy gives a minimum of side effects, so it would be more appropriate and modern method of treatment in the early stages of the disease.
Elderly patients often resort to radiation therapy, while the young men performed radical prostatectomy.
One of the non-invasive methods of prostate cancer treatment may be an ultrasonic ablation, which consists in the introduction into the rectum of equipment that produces high-intensity ultrasound. Due to the thermal effect and mechanical effect is destruction of cancer cells. This method is indicated for locally advanced forms of cancer or at relapse after surgery or radiation treatment.
Because prostate cancer is hormone-dependent, the effectiveness of therapy will depend on the level of testosterone in the body. To reduce possible total removal of the testes, which formed the main part of testosterone, and the appointment of hormonal drugs antiandrogens, estrogens, GnRH antagonists. Because estrogens as female hormones, give expression side effects of the cardiovascular system, liver, etc., their use is currently limited only to cases where there were metastases in the bones.
In some countries used special treatment – virotherapy, which consists in the introduction of viruses, with tropism for the tumor tissue and destroys its cells.
Patients with presence of metastases, III and IV stages of the disease surgery is not possible, therefore they conduct external beam radiation and hormone therapy. In severe cases, may only alleviate the condition of patients with hormone therapy, radiation and possible removal of the other symptoms (pain, urine retention).
Chemotherapy is not widely used, as most types of tumors of the prostate are not sensitive to anticancer drugs. It is possible to conduct only in tumors that are resistant to the effects of hormones or in severe cases in severe metastasis.
The use of folk remedies for prostate cancer not only appropriate, but also unacceptable, since the positive effect is impossible to achieve without qualified professional help.
Nutrition in prostate cancer has some peculiarities. American scientists have found that men taking low-calorie foods and avoiding large amounts of animal fats and calcium in the diet, the risk of disease is much lower. In addition, the diet restriction of these components contributes to slower tumor growth and lower the probability of its transition to an aggressive form of flow. In this regard, prostate cancer is recommended to reduce caloric content of food intake, give preference to the proteins of vegetable origin, fish and seafood. In the presence of disorders of urination is not necessary to load the body with excess fluid and salt.
Video: doctor about the treatment of prostate cancer
As you know, good treatment outcomes can only be achieved in the initial stages of the disease. In the first stage treatment is effective in 90% of cases, the lifetime of which may be another 10-15 years and even more. It should be noted that most patients are in old age, so death in this period may come from other causes.
For prostate cancer 2 degrees, the survival rate reaches 85%, in the third stage, only 50% of patients have a chance for a relatively favorable outcome, and in severe cases the success rate of treatment is not more than 20%.
Among the possible consequences of the disease can be called impotence, and incontinence, often occurs after a radical surgery to remove the prostate.
Unfortunately, in our days most of the identified cases of prostate cancer are patients with advanced forms, so the risk of an unfavourable outcome and mortality are quite large.
For effective prevention of men older than 40 years recommended every year to visit a urologist, to undergo a digital examination of the prostate, also tested for prostate specific antigen. Special attention should be paid to persons at risk of having relatives with this disease, as well as a variety of hyperplastic processes and benign tumors.
Healthy lifestyle, good nutrition and timely visits to specialists – the key to maintaining men’s health, and the effectiveness of treatment in case of detection of pathology.