How I treated prostate carcinoma

Treatment of prostate adenocarcinoma: effective methods

Prostate adenocarcinoma is one of the most common types of malignant epithelial formation. It is classified as cancer. It occurs in 90% of cases among patients with Prostate cancer. Other types of cancer are diagnosed less frequently. Symptoms at an early stage are practically absent, which makes self-diagnosis of the disease difficult.

Acinar adenocarcinoma of the prostate

What is acinar adenocarcinoma of the prostate? This is a histological feature of prostate cancer, the most common being adenocarcinoma. It is divided into large-acinar, small-acinar.

Small acinar - the most common type of adenocarcinoma. It occurs in 95% of cases of prostate cancer. Large acinar adenocarcinoma has an atypical structure, as well as a high malignancy of the tumor. Forecasts with such a diagnosis are usually disappointing.

Acinar adenocarcinoma in most cases is diagnosed in men over 50 years of age. The disease first affects the acinar epithelium of the peripheral zone of the prostate. Usually reduces the patient's life expectancy by 10 years.

Treatment of acinar adenocarcinoma of the prostate in the third and fourth stages of the disease is hampered by the rapid growth of the tumor.

Causes, stages, symptoms of adenocarcinoma

Adenocarcinoma is preceded by the following conditions:

• atypical hyperplasia, in which tissue growth and changes in its structure are observed;
• Intraepithelial neoplasia, in which new pathological cells, tissues are formed.

Pathology stages

The first stage is difficult to diagnose, structural changes are minimal and are detected only during a biopsy. Analyzes at this stage are usually not informative.

In the second stage, some parts of the gland and membranes are affected. Detectable during research due to the appearance of tumor markers in the blood, urine.

The third stage is characterized by active tumor growth. Cancer cells affect the vesicles of the prostate gland and can affect neighboring organs.

Metastases spread to neighboring organs of the genitourinary and digestive systems, sometimes affecting almost all organs.

Causes of the disease

Many factors influence the development of adenocarcinoma. Most common:

• senile changes in the body;
• hereditary predisposition;
• chronic cadmium poisoning;
• overweight;
• XMRV virus;
• hormonal imbalance;
• chronic inflammatory diseases.

Symptoms

Pathology may indicate:

• frequent urge to urinate;
• discomfort, pain in the groin area;
• after urination, there is a feeling of incomplete emptying of the bladder;
• impeded urine outflow;
• blood in urine, semen;
• frequent urinary tract infection;
• prostate enlargement;
• urination is performed only after a strong tension of the abdominal muscles.

The last stages of the development of the disease are characterized by pain in the anus, legs while walking, a feeling of heaviness in the pelvis. This indicates the growth of the tumor outside the prostate. Due to the spread of metastases, the lymph nodes in the groin may swell, and severe pain will be felt in the bones.

Prostate adenocarcinoma: treatment

Early stages allow you to cure the disease without surgery. In later cases, medical and surgical treatment is usually used. Commonly used treatments for adenocarcinoma:

• prostatectomy - a method of removing a tumor;
• endoscopic prostatectomy;
• radiotherapy;
• cryotherapy;
• chemotherapy;
• hormone therapy.

Prostatectomy

This is a surgical intervention with the complete removal of the prostate gland. The operation is performed under general anesthesia, preoperative preparation, as well as postoperative support, and a rehabilitation period are necessary. The most successful stages for the operation are the first, second and third stages without metastasis outside the prostate gland.

• intolerance to anesthesia due to diseases of the heart, blood vessels;
• blood clotting disorder.

During the operation, the gland, its capsule, adjacent tissues, and lymph nodes are removed.

Laparoscopic prostatectomy

Laparoscopic prostatectomy using endoscopic techniques is considered one of the modern methods. Also, surgical intervention is carried out using the Da Vinci operating complex.

During the operation, the surgeon makes three small incisions in the anterior abdominal wall, injects a gas mixture and an endoscope with a video camera and manipulators that display the image on the monitor.

This operation is less invasive and less traumatic than open surgery. Laparoscopy allows you to save the nerve bundles that control urination and urinary retention, sexual arousal, erection.

After an open prostatectomy, the patient must stay in the hospital for 2-3 weeks. After the laparoscopic method - 10 days. In the first days after the operation, urination occurs through a urinary catheter. The patient is also prescribed antibiotics to prevent infectious complications and a diet aimed at unloading the intestines, preventing constipation, gas formation.

Walking is allowed on the second day after the operation. After 3-6 months, endurance and former activity gradually return.

In order to strengthen the muscles of the pelvic floor, to restore the general condition, the patient should do therapeutic exercises. With the permission of a doctor, you can do Kegel exercises.

Cryotherapy

During cryotherapy, alternating exposure to low and high temperatures occurs on the affected prostate tissues, leading to their death. When frozen, the cell membrane is pierced by ice crystals, damaging the blood supply, the supply of tissue with oxygen, and nutrients.

The procedure is performed under local anesthesia, as well as general anesthesia. Cryoprobes are inserted into the prostate and are monitored by transrectal ultrasound. Through them high and low temperatures are supplied. The procedure is controlled using a computer with a monitor.

It is often impossible to exclude the nerves that are responsible for erection from the freezing area during cryotherapy, which leads to erectile dysfunction. Six months after the procedure, 80% of men suffer from a lack of potency, after 2 years the percentage drops to 76%. In 5% of cases, cryotherapy can lead to urinary incontinence.

Hormonal therapy

Treatment involves taking drugs that suppress hormone levels in the body or block their effect on cancer cells. It is also possible to remove organs that normally synthesize such hormones (orchidectomy): 90% of testosterone is synthesized by the testicles. But usually men prefer drug therapy.

Therapy is divided into:

• adjuvant - antihormonal drugs are prescribed in the postoperative period to prevent the recurrence of the disease;
• neoadjuvant - hormonal drugs are given before surgery to reduce the size of the tumor.

In case of adenocarcinoma, hormonal therapy is connected in the later stages as a background during irradiation.

The prospect of recovery depends on the stage of the adenocarcinoma. The appearance of the slightest alarming signs is a reason for an urgent consultation with a doctor. The first two stages respond well to treatment, and there is also a high probability of maintaining labor qualities and erectile function. Advanced stages with signs of damage to internal organs can lead to death.

Treatment of adenocarcinoma of the prostate

Prostate cancer is the most common malignant neoplasm in men. Almost always it is adenocarcinoma (cancer) of the prostate gland, which has developed from its glands. Other, much rarer forms of prostate cancer are neuroendocrine, squamous, urothelial carcinomas, and lymphomas.

Causes of prostate adenocarcinoma

The causes of this type of cancer have not yet been fully determined. Symptoms of a prostate tumor after the first, mostly asymptomatic, phase are most often problems with urination: a weak stream, subsequent dripping, excessive urge - especially at night - and, finally, incontinence. In the progressive stage, there are pains in the prostate area, blood in the urine and seminal fluid.

Methods of diagnosis and treatment of adenocarcinoma

To prescribe the correct treatment for this disease, it is important to determine the differentiation of its malignant cells. The lower this value, also called the Gleason score, the faster and more aggressive the tumor develops. In total, pathologists distinguish 5 stages of differentiation. Unfortunately, in recent years there has been a tendency not only to an increase in the number of malignant tumors affecting the prostate gland, but also to a disproportionately rapid growth of their aggressive forms.

Poorly differentiated adenocarcinoma

This disease requires active therapy.In general, the treatment regimen for a prostate tumor should be developed each time individually based on its full characteristics: whether adenocarcinoma is poorly differentiated or highly differentiated (how many points), how affected are the surrounding tissues (there are four stages of development in total), what is the size of the tumor, taking into account the spread of metastases, how it is classified according to the modern integrated TNM system. True, more than 95% of prostate adenocarcinomas are acinar, that is, typical, without unexpected typological crosshairs.

If at the earliest and non-aggressive stage of development of acinar adenocarcinoma of the prostate gland, such a method of therapy as active observation (that is, constant monitoring by a doctor with repeated examinations) is usually sufficient, then at later stages and with a rapidly progressing disease, surgical intervention is often necessary. As a rule, treatment is required in the form of a radical prostatectomy, that is, the complete removal of the prostate gland.

Acinar adenocarcinoma is divided into large and small acinar. Small acinar is the most common.

In addition to being poorly differentiated, adenocarcinoma can be highly differentiated. It is also subdivided into such types as papillary, mucinous, cribrous, endometrioid, mucus-forming, glandular-cystic, solid trabecular adenocarcinoma.

Importance of early diagnosis of prostate cancer

The spread of modern methods of early diagnosis of malignant neoplasms in men more and more often makes it possible to determine the presence of a tumor at one of the initial stages, without perforation of the gland capsule and the formation of metastases, and resort to a sparing form of tumor treatment while preserving the prostate gland and all important nerve endings, responsible for both erectile and urinary functions. It should be recognized that in the advanced stages of cancer, the operation can maintain its effectiveness only for a certain time, after which, sooner or later, a relapse is possible.

Although prostatectomy is in many cases the main method of removing a prostate tumor, which has proven itself for many years and often leads to a complete cure, other methods of treating adenocarcinoma can be used, especially in the early stages. These methods include brachytherapy, radiation therapy, hormonal therapy, as well as various alternative methods.

The average age of prostate cancer diagnosis is 69 years. Unfortunately, there are still too few men who have resorted to early methods of detecting the disease, which allows to detect and defeat cancer at the very beginning, and recommended for regular passage from the age of 45. But over the past 30 years, oncology has made progressive strides in the treatment of adenocarcinoma, and mortality from the removal of prostate cancer by surgery has decreased by at least 20%.

Prostate cancer

Carcinoma (cancer) of the prostate gland is a malignant tumor that develops in the prostate gland. The gland is located in the pelvis in men, just below the bladder to the front of the rectum and surrounds the urethra.

Prostate cancer is statistically one of the most common diseases affecting the male population of different ages. Prostate cancer or prostate carcinoma ranks third in the list in terms of global indicators, second only to colon cancer and lung cancer.

Among 100 patients who develop prostate cancer, up to 3 people are doomed after treatment. To reduce the mortality rate, it is important to diagnose prostate cancer at an early stage of prostate cancer and apply prompt surgical treatment for prostate cancer.

Malignant carcinoma of the prostate

The difference between carcinoma and adenocarcinoma

Malignant adenocarcinoma of the prostate or glandular cancer is a consequence of prostate adenoma - a benign tumor.

Prostate adenocarcinoma grows towards neighboring organs in accordance with the direction of blood and lymph flow and disrupts their work. When growing in a limited space, the tumor moves up to the bladder, manifesting symptoms of cystitis.

Prostate carcinoma - what is it? A tumor that develops from the epithelium of the ducts (tissue) of the prostate is called carcinoma.

Like cancer, prostate carcinoma is diagnosed as a result of an increase in the level of PSA tumor markers in the blood plasma. Histological examination shows that the cells in the bulk of the tumor are atypical and not endowed with normal features. Carcinoma is considered an oncological tumor that affects any internal organ and epithelial cells of the skin.Any tissue structure containing epithelial cells can become a site of carcinoma localization.

This means that different types of carcinomas can develop in the internal organs. The place where it appears determines the nature of the cells that make up the carcinoma. For example, it can develop from flat cells in the cervix, the mammary gland in women, in the lungs and prostate in men, in the colon in any person.

Carcinoma can appear on the skin and looks like a separate nodule with a smooth surface: red or pinkish. It is characterized by a translucent pearl belt. Crusts and ulcerations later appear in the center.

In squamous cell carcinoma, the cells are composed of many layers of squamous epithelium. It grows rapidly and metastasizes. Tumor cells are connected by desmosomes, they have keratinization. They develop under the influence of the external environment with carcinogenic factors, solar radiation. The structure of carcinomas is also different, which depends on the structural features of the epithelial tissue from which it develops. If the epithelium is not changed and there is no precancerous disease, then the carcinoma does not suddenly appear. Some type of precancer does not give symptoms at all, then a cancerous tumor is diagnosed, bypassing precancerous precursors.

Again, when the epithelium of glandular tissues (Prostate, thyroid gland, bronchi) is captured by a cancerous process, the disease is referred to as adenocarcinoma, since the subtleties of diagnosis cause controversy among oncologists, as well as cancer treatment.

Causes

Natural changes in the hormonal level in the blood, starting at 40 years of age and older, affect the manifestation of benign and oncological formations in the prostate gland. It has been proven that the progressive growth of neoplasms is directly related to a high level of testosterone in the blood. That is, due to male sex hormones, the tumor focus grows with a decrease in the level of immunity.

In some cases, prostate cancer occurs in the presence of a heredity gene. With a mutation within the HOXB13 gene, the risk of developing an oncological tumor increases tenfold.

Prostate carcinoma is characterized by a stable but slow malignant course. Even in the absence of symptoms in the early stages of development, prostate carcinoma grows and insidiously actively metastasizes. Metastases in prostate cancer in a short time from a small focus can spread outside the prostate, which makes life prognosis unfavorable.

The natural active blood supply to the prostate supports metastasis and the formation of secondary foci through the bloodstream and lymph flow. Cancer cells are carried by large iliac arteries to the spine and pelvic bones, to the adrenal glands, liver and lungs, to the LN.

Manifestations of carcinoma

Clinically, prostate carcinoma manifests itself depending on natural changes in the body associated with immunity and hormonal levels, as well as provoking factors that do not have specific signs. With any clinical manifestations, a serious stage of the disease can be suspected.

Symptoms of oncological tumors are divided into three groups:

Further invasive development of a malignant tumor manifests itself:

• pain in the bones, especially in the pelvic and lumbosacral region;
• significant weight loss, including cachexia;
• a decrease in the level of hemoglobin in the blood (anemia);
• restriction of leg movement, swelling;
• paralysis of the legs due to compression (squeezing) of the spinal cord.

It's important to know! When determining undifferentiated prostate cancer, the prognosis will be unfavorable. With the manifestation of any symptom of the third group, it indicates a late stage of the oncological tumor and an unfavorable diagnosis. Mortality is more common in representatives of black skin, as is the risk of development compared to the white population of the planet.

Carcinoma is 70% located in the peripheral zones of the prostate, 20% - in the transition zones and 10% - in the central region. Fibromuscular stroma is affected due to the germination of oncological tumors from other areas, for example, transitional ones.

With prostate hyperplasia and adenoma, the same manifestations occur as with carcinoma, therefore, with the slightest doubt regarding the health of the prostate gland, you should immediately consult a doctor and conduct an examination.

Diagnosis of prostate carcinoma

If there is a large tumor in the form of a dense node, it will be determined by a digital rectal examination. If the tumor is 0.5-1.0 cm in diameter, then a tumor marker and prostate biopsy will indicate it.

For elevated PSA levels or large tumors, ultrasound and ultrasound-guided biopsy are performed.

It's important to know! PSA is a prostate-specific antigen produced by cells of healthy pancreatic epithelium, as well as malignant cells.PSA belongs to a serine protease of the kallikrein family associated with semen fluid.

If the formations are identified, a biopsy is taken from them. If there are suspicious areas, then a biopsy is systematically taken in 6 directions. To obtain tissue columns, the biopsy is performed transrectally.

Bone scanning is performed with an elevated PSA diagnosis (more than 200 ng / ml) or with severe pain in the bones. The Gleason sum is calculated on two areas of the pancreas, assessing each on a 5-point scale. The sum of Gleason scores can be 2-10. Highly differentiated tumors have scores of 2,3,4. In moderately differentiated - 5.6.7. Poorly differentiated "evil" tumors have the highest scores - 8,9,10.

Prostate carcinoma treatment

When conducting complex therapy, they prescribe:

• Radical prostatectomy - an operation to remove the prostate gland, seminal vesicles with accesses: pertoneal or retropubic. At the same time, an anastomosis of the bladder and urethra is formed.
• Saving prostatectomy, as the final stage of treatment, for patients with little effect of radiation.
• Radiotherapy using an external source of radiation: protons and neutrons, linear accelerators, cobalt. Or direct injection of interstitial microcapsules containing gold - 198, iodine - 125 and iridium - 192.
• Endocrine therapy to reduce circulating testosterone, affect the prostate, and/or impair testosterone metabolism by epithelial cells. In this case, prostate cells atrophy and die, reducing the progression of the tumor.
• Luteinizing hormone-releasing hormone (RH/LH) analogs to reduce circulating LH levels and thereby impair testosterone secretion by the Leydig cells in the testis.
• Complete blockade of androgens to prevent testosterone production by the testicles: castration or the use of RGHL analogues. Or they stop the action of other circulating androgens, for example, those formed in the adrenal glands. An androgen such as Flutamide prevents the binding of dihydrotestosterone and a specific cytoplasmic receptor.
• nutrition for prostate cancer to replenish the body with microelements, vitamins, anticancer substances, resume normal metabolism and body peristalsis;
• Folk treatment for prostate cancer to maintain immunity and restore the protective functions of the body.

Only complex treatment of prostate carcinoma can provide a positive prognosis for the survival of patients among the male population.

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