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How does prostate cancer happen

Why does prostate cancer occur, its symptoms, treatment, stages

The prostate gland is a small organ located under the bladder that surrounds the urethra. The function of the prostate is difficult to overestimate, because it is the juice of the prostate gland that supports the vital activity of spermatozoa outside the testicles. In this article, we will look at such an oncological disease as prostate cancer, the symptoms, treatment and causes of this disease.

Disease statistics

Prostate cancer is a tumor localized in the prostate gland, which is malignant in nature and poses a serious threat not only to sexual function, but also to the life of a man. Another name for cancer is carcinoma.

In Europe, this is one of the most serious diseases of the male part of the population, which occurs in 214 people out of 1000 studied. It should be noted that the incidence of Prostate cancer in different regions varies. For example, in Sweden, the disease in question accounts for 37 percent of all cancer cases.

Prostate cancer is a disease that has a close relationship with genetics and human age. More often among patients there are men whose age exceeds 40 years.

Some patterns, causes of prostate cancer

Currently, the causes of prostate cancer are an open question. Scientists have established an unambiguous relationship between the occurrence of prostate cancer and two factors:

Over the years, hormonal changes occur in the body of a man. Next, there are changes in the prostate gland that can lead to cancer. It was found that prostate cancer directly depends on the level of testosterone in the blood. Therefore, men of middle and advanced age are susceptible to the disease. In young people, cancer is extremely rare and only in the case of a hereditary predisposition or under the influence of serious mutagenic factors.

The risk of the disease doubles if a man has prostate cancer patients among his close relatives. If relatives of the first or more degrees of kinship were sick, the risk is reduced, but there is a place to be. Hereditary prostate cancer differs from other etiological types of the disease only by an earlier date of occurrence (with a difference of 6-7 years).

Other factors by which a person can be classified as a risk group are currently established, but not proven, but they exist:

Lifestyle significantly affects the possibility of developing a cancerous process in the prostate gland. The presence of bad habits significantly increases (in unproven proportions) the risk of a tumor: a tendency to drink alcohol, smoke, drugs. The above substances have a powerful mutagenic effect and are able to activate the process of malignant degeneration of an existing prostate tumor.

Red meat and animal fats can provoke oncology. There is no clear link between diet and cancer. But doctors recommend avoiding eating these foods if there are prerequisites for oncology.

Classification

There are 2 classifications of prostate cancer. The first refers to the standard nomenclature of all cancerous tumors, and the second, more acceptable in the case of prostate cancer, is based on the aggressiveness of the tumor. Aggressiveness is determined by the Gleason index after examining a biopsy of a cancerous tumor. The score (index) is set from 1 to 10, which means, respectively, less and more aggressive tumor.

Prostate cancer symptoms

There are too many manifestations of prostate cancer to accurately establish the diagnosis only by the patient's history and palpation.

Pain and burning during and after urination Intermittent urination Frequent urge to urinate Pain in the groin area Pain during rectal palpation of the prostate Hematuria Impotence, etc. In general, the symptoms of prostate cancer can be grouped into three large groups:

• Functional disorders of urine outflow;
• Signs associated with tumor metastases extending beyond the prostate;
• Symptoms of extensive metastasis of cancer cells far beyond the prostate.

The first group of signs is associated with the fact that the cancerous tumor begins to mechanically compress the urethra passing through the prostate. As a result, urination becomes painful, problematic, and irregular. This leads to stagnation of urine in the bladder, nervousness, swelling, stress.

When the tumor penetrates beyond the prostate gland, it causes additional pain to the man. In addition, erectile dysfunction, hematuria and hematospermia can be observed.

With deep and extensive metastases, cancer spreads throughout the pelvic region, affecting the bones, spinal cord, and nearby organs.In this case, the main symptoms of prostate cancer will be as follows:

• Pain in the pelvis and lower back of bone origin
• Anemia (see iron supplements for anemia)
• Swelling of the body and limbs
• Paralysis

Prostate cancer stages

The staging of the disease is classified according to the forms of cancer. There are 2 main nomenclatures:

TNM - Within the framework of this classification, the degree of growth of a cancerous tumor is considered:

• T - the tumor is located in the prostate gland or slightly extends beyond the boundaries of its capsule.
• N - cancer cells grow into regional lymph nodes located below the bifurcation of the iliac artery.
• M - in this paragraph we are talking about distant metastases, in which non-regional lymph nodes, bones and other organs are affected.

Juit-Whitemore system - This classification divides the pathological process into stages A, B, C, D. The first 2 stages are curable, the last 2 carry more sad prospects.

The earliest stage is A, in which the patient may not experience any discomfort, and cancer cells can be single or massively localized in the prostate parenchyma.

Stage B characterizes the growth of the tumor inside the prostate to a palpable size. At the moment, cancer can be detected by a moderate increase in the concentration of the PSA protein.

The next step, C, denotes the exit of cancer cells beyond the capsule of the prostate gland. The tumor reaches the seminal vesicles, other organs, can block the lumen of the urethra and bladder. At this stage, cancer becomes an incurable disease.

Stage D is the final stage of cancer development. It is characterized by an increase in the number of metastases and tumor growth towards the regional lymph nodes and beyond. Also referred to as stage D and recurrent metastases after surgical treatment of prostate cancer.

It must be remembered that the stages of prostate cancer, the symptoms of which can vary greatly, are highlighted conditionally. There are no clear criteria by which a tumor can be attributed to one stage or another.

Diagnosis

The following methods apply:

The first 3 methods are used as monitoring for prostate cancer. PSA is a great and easy way to monitor your prostate on a regular basis.

Before the appearance of PSA, advanced prostate cancer was detected in 30% of cases, now, with regular monitoring of this blood test and examination by a urologist, only 6% of cases reveal advanced prostate cancer, which improves the prognosis and allows timely radical treatment.

Normally, the PSA content should be less than 4 ng / ml, above 10 indicates a high risk of cancer. However, there are exceptions:

• Rarely, cases are recorded when the PSA test remains within the normal range in prostate cancer.
• Medications that cause a low PSA (false negative) in the presence of prostate cancer may be used in the treatment of the prostate.
• BPH and prostatitis can affect the PSA value, increasing its value in the absence of signs and symptoms of prostate cancer.

Prostate cancer treatment

Very important and relevant today is the question of the treatment of prostate cancer. The decision on treatment is made based on the age of the patient.

If a man is 65 years or older and the cancer does not spread beyond the prostate gland, then there is no point in taking action. To date, mortality at this age is quite high and by no means from prostate cancer.

If the process has gone beyond the prostate gland, then the patient has no more than three years to live without treatment. All currently known methods of treatment can be represented as follows:

• Targeted therapy and chemotherapy
• Hormone therapy
• Brachytherapy, radiation techniques
• Surgical interventions

Now the treatment of prostate cancer is as painless as possible.

Targeted treatment and chemotherapy

The action of medicinal substances is aimed at inhibiting the growth of cancer cells. But this action is not specific enough, therefore, it affects healthy cells and harms the body.

As an alternative to chemotherapy, scientists have developed targeted tumor treatment. In this case, cancer cells are attacked by highly specific monoclonal antibodies. This practice minimizes the side effect and greatly facilitates the treatment of prostate cancer.

The use of a certain set of hormones can stop or seriously slow down the division of cancer cells. This type of treatment is often used as an accompaniment to surgery or radiation therapy, but can also be used independently.

Beam methods

Exposure to x-rays and other radioactive radiation has always caused fear among patients and many side effects. This is due to the fact that with extensive metastases, it is necessary to irradiate not only the tumor, but also nearby tissues and organs. In the case of a tumor localized in the prostate, this technique is less dangerous, but not advisable.

Modern medicine has developed less risky treatments:

It involves the insertion of a special needle through the rectum, through which an isotope of iodine will be injected into the prostate. The localization of the injection is calculated exactly. The action of the radioactive substance extends only to cancer cells, without causing systemic harm, as in the case of irradiation by old methods.

This is a point effect of ultrasound on tumor cells. It has been proven that cancer cells are completely destroyed by high frequencies.

Modern methods of treatment significantly reduce the risk of side effects, and their effectiveness, on the contrary, becomes higher.

Surgical manipulations

Surgery is the easiest and most effective way to destroy the tumor in the first stages (A and B according to the Jewitt-Whitemore classification). As long as the tumor has not begun to grow beyond the prostate, it is really better to remove it. There are two types of operations:

In the case of a prostaectomy, the entire prostate gland is removed through an incision. This is the most traumatic type of surgical treatment for prostate cancer.

Transurethral resection involves partial removal of the prostate through the urethra. Indications for this kind of procedure are the impossibility of complete removal of the prostate or intolerance to operations. It is performed by the endoscopic method.

The special da Vinci robot is widely used abroad. Surgical intervention is reduced to small punctures, all manipulations are performed by a robot controlled by a doctor. On the one hand, this is a non-contact method of treatment for the doctor, on the other hand, it is minimally invasive for the patient.

Most frequently asked questions from patients

No, this kind of observation means that the tumor is slow growing and may not even manifest itself. With dynamic observation, a digital rectal examination and PSA are indicated 2 times a year. Such regular monitoring without treatment allows timely detection of tumor progression and transition from observation to intensive therapy.

Studies in the United States found that men without prostate cancer and patients with a slowly growing tumor (with dynamic observation for 15 years) had the same mortality. To determine to whom dynamic observation is indicated, the patient's age and concomitant diseases are taken into account.

Dynamic observation is carried out in elderly people with an estimated life expectancy of not more than 10 years, in the absence of signs of tumor progression. This is considered more appropriate, since tumor growth is slow, and oncology treatment can worsen the patient's somatic status, having a number of side effects.

However, the choice always remains with the patient, not everyone can take a wait-and-see approach, since this is a serious psychological test that leads to depression and a deterioration in the quality of life. There is also a risk that the tumor will progress faster than expected and then more aggressive treatment will be needed, and the effectiveness of therapy in the later stages is lower.

The reasons for the lack of effect of treatment today are not well understood, but certain facts may contribute to the development of relapse:

• before preparing for treatment or surgery, the stage of the oncological process was determined incorrectly due to imperfect examination methods;
• during dynamic observation, the growth of the tumor was more rapid, as a result, the neoplasm went beyond the prostate capsule;
• before treatment, cancer cells had already penetrated into nearby tissues, today there are no methods that determine the spread of single pathological cells throughout the body;
• when tumor cells are insensitive to standard doses of radiation, in a situation where parts of the prostate gland cannot enter the irradiation zone, or when the tumor has penetrated beyond the irradiation limits.

It depends on how aggressive the primary tumor was, well-differentiated tumors relapse more slowly, low-grade tumors relapse faster, usually relapse in the first 5 years, but there are cases of relapse after treatment after 15 years.

At first (in the first years) relapse may be asymptomatic, it was previously believed that difficulties with urination, bone pain, swollen lymph nodes indicate a relapse, but this already indicates multiple metastases. Today, the onset of a relapse can be recognized by the rise in PSA.If there are no other manifestations of cancer, and PSA increases, then they speak of a biochemical relapse, and only after a few years, such a patient begins to show signs of tumor growth. Therefore, an important condition after the course of therapy is PSA control, biopsy, digital rectal examination, MRI, CT, bone scintigraphy.

In prostate cancer, metastases can be local (regional lymph nodes) and distant, these are any organs, most often these are the femurs and humerus, spine, lungs, liver, brain.

There are no grounds for such fears, a biopsy does not affect tumor growth, moreover, it is the most important component of diagnosis, an easy and safe procedure, a reliable method that rejects or confirms the presence of prostate cancer.

Surgery cannot be a method of prevention, since this is a serious intervention with a possible complex of complications, such as impotence and urinary incontinence. In addition, prostate cancer progresses rather slowly and in many patients it does not cause death or a sharp deterioration in health, since other diseases can cause death during this time.

Today, there is not a single folk or alternative medicine method that can cure this disease. Moreover, it is dangerous to use only any other methods of treatment and delay effective therapy offered by specialists. Delaying treatment may increase the risk of tumor progression and metastases.

In countries where there is a traditionally high consumption of refined foods and excess animal fats, such as European countries, Canada, the United States, the risk of oncology is much higher than in countries whose population eats soy, rice and seafood. An association between an increased risk of prostate cancer in men and obesity has also been found, while the risk of not only oncology, but also hypertension, atherosclerosis of the cerebral vessels, and diabetes mellitus in men increases.

It should be remembered that timely diagnosis of prostate cancer is the key to a successful recovery! Therefore, with any discomfort, do not delay the trip to a urologist.

Prostate cancer: symptoms and treatment

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

What is prostate cancer and where does it occur

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 back surface during examination). The initial part of the urethra passes through the prostate gland, where the excretory ducts of the gland open. The inferior vesical artery, which branches off from the internal iliac artery, supplies blood to the prostate and bladder. On both sides of The prostate gland is located along the neurovascular bundle, part of the lower hypogastric (pelvic) plexus. The prostatic plexus is essential for erectile function.

Prostate cancer occurs when prostate cells 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 the occurrence of metastases. Most cancers (95%) of the prostate are adenocarcinoma - a tumor that arises from the glandular epithelium. In much rarer cases (only 4% of total tumors), prostate cancer arises from the urothelium, the tissue that lines the urethra. 1% of diagnosed tumors is squamous cell carcinoma. Least of all (there are literally a few episodes) prostate cancer develops from neuroendocrine stem cells that are present in the prostate gland.

The peripheral zone of the prostate gland is most prone to the appearance of cancer - cancer occurs there 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 to 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 cells that make up a cancerous tumor doubles in size) in prostate cancer is over 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

In favor of a genetic predisposition to prostate cancer is the fact that the frequency of its occurrence varies in different places on the globe, with the upper indicator being more than 50 times higher than the lower one! Most often, residents of North America, Australia and Northern 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 counterparts who remained in their historical homeland. This shows the importance of environmental factors, especially diet.

Sub-Saharan Africans are more likely to develop prostate cancer than whites and Asians, even if they share the same lifestyle. Although the death rate from prostate cancer continues to decline around the world, 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 here.

Family predisposition also plays a role; recent studies have shown that genes that predispose to the occurrence of prostate cancer are inherited. Heredity may be responsible for approximately 5-10% of prostate cancer cases; Men with a family history of prostate cancer may have cancer up to 6-7 years earlier and are more likely to develop cancer. Certain gene mutations can also increase the risk of developing prostate cancer. Also, some hereditary diseases, such as Lynch syndrome, contribute to the appearance of prostate cancer.

It is interesting that most often prostate cancer is found in men who 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.

The foods you eat may play a role in the development of prostate cancer. Although diet alone 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), however, in some cases, certain types of nutrition can reduce the likelihood of its occurrence. Or, in the opposite case, increase this chance.

One of the links that has been found between the occurrence of prostate cancer and diet 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 from prostate cancer less. Interestingly, with the spread of the Western diet in Japan (where they traditionally ate a low-fat diet), the number of cases of prostate cancer increased, and in its aggressive form.

There is also a correlation between eating red meat and prostate cancer. According to studies, prostate cancer in men who prefer to eat animal meat develops 2.64 times more often. The risk is even higher if the man likes meat 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 a marker of a general unhealthy lifestyle, rather than their danger as such.

However, if a man wants to reduce his chance of getting prostate cancer, it is advisable to eat less fried, fatty and red meat. For example, people who are accustomed to eating according to the Mediterranean type (an abundance of fruits, vegetables, cereals, 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.

Many studies have shown that obese people are more prone to developing prostate cancer than their thin counterparts, and cancer in such cases is more aggressive. True, the reason here may be that in obese people it is more difficult to diagnose prostate cancer in the early stages. Larger people have a larger prostate, making it more difficult for a doctor to determine with a biopsy whether there are cancer cells in it. Also, an enlarged prostate secretes an increased amount of antigen associated with prostate cancer, thereby making it difficult for a doctor to make a diagnosis.

It is believed that hormones influence the occurrence of prostate cancer. An indirect proof of this theory is that men who have undergone castration for some reason do not have prostate adenocarcinoma. According to studies, the risk of developing a tumor increases the level of luteinizing hormone and the testosterone / dihydrotestosterone ratio.

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

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

Prostate cancer symptoms

Now, prostate cancer is diagnosed in the early stages, when there are no symptoms of cancer. 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 examination of the rectum. In addition, prostate cancer can be detected by analysis of removed tissue in the treatment of benign prostatic hyperplasia.

Until the 1980s, when there was no information about the diagnostic importance of PSA, symptoms included complaints of difficulty urinating, back pain, blood in the urine.

With a progressive disease, the symptoms are already different:

Loss of weight and appetite.

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

Focal neurological deficit resulting from compression by tumors of the spinal cord.

Lower pain, swelling due to obstruction of the venous and lymphatic vessels (if prostate cancer has gone by nodal metastasis).

Uraemia 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 the doctor's gloved index finger is inserted through the anus into the rectum. Due to the position of the prostate, the back of the prostate can be easily felt through the wall of the rectum. 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 - cysts or stones do not differ from cancerous tumors to the touch.

The second main component of the diagnosis of suspected prostate cancer is the analysis of blood serum for the content of prostate specific antigen (PSA). The norm of its content in the 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 level has reached 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 gun and needles, and it is carried out under the control of transrectal ultrasound (TRUS). The needle enters the prostate through the wall of the rectum (therefore, before the biopsy, the patient will have to prepare - take a laxative and make a cleansing enema). Tissue is taken not only from suspicious areas, but also over the entire surface of the prostate (up to 24 points). Unfortunately, false-negative results often occur with biopsies, so multiple biopsies may be required to accurately identify prostate cancer. Complications can also occur with a biopsy: the patient may experience pain, have a fever, traces of blood may be found in the blood, and (in rare cases) it can reach sepsis. The risk of complications with repeated biopsies increases.

When the disease progresses, it is useful to examine the blood for creatinine and liver enzymes. Also, the patient will need to do a urine test to determine if there is blood in it or any infection. These data should be taken into account when planning treatment for prostate cancer.

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

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

Prognosis for prostate cancer

As a general rule, the earlier prostate cancer is detected, the easier the treatment and the better the outcome. Subject to the correct diagnosis and qualified treatment, the working capacity of a man is restored to 100%. Unfortunately, the opposite is also true - the later prostate cancer is detected, the more likely it is to die.

The prognosis for prostate cancer depends on the following factors:

Prostate specific antigen level.

Gleason level. If the tumor is defined on a scale as 4 or 5 level (poorly differentiated forms of cancer), it is more aggressive, but at the same time, it responds better to chemotherapy and radiation therapy. Highly differentiated tumors of levels 1 and 2, although less prone to metastasis, respond worse to treatment.

Percentage of cancerous cells in a biopsy and tumor size.

The spread of the tumor and the presence of metastases. Despite the fact that the incidence of metastatic prostate cancer is declining 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.

Age of the patient. The older the patient, the more difficult the treatment and the more unfavorable the prognosis.

The type of anesthesia. According to studies, the prognosis for prostate cancer can even depend on the anesthesia used during the operation. The results of the study showed that the mortality rate in men undergoing surgery with general anesthesia was 30% higher than in men who were pain-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 probable prognosis of the disease. As a general rule, the earlier prostate cancer is diagnosed, the easier the treatment.

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 to younger patients. During 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 studies, 7% of patients died 15 years after the operation - mainly from squamous cell carcinoma of the seminal vesicles.

Both the prostate itself and the lymph nodes located nearby can be irradiated. There are several types of radiation therapy - remote, adjuvant, a combination of remote therapy and interstitial implantation of radioactive drugs (brachytherapy), and so on; Your doctor will help you choose the best treatment for your prostate cancer. Complications from radiation therapy may 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 likelihood of rectal cancer and bladder cancer.

In this method of treatment, the tumor is exposed to a powerful beam of ultrasonic waves. Ultrasound ablation is often used in the treatment of relapses that occurred after the removal of the prostate by surgery or radiation therapy.

Treatment of prostate cancer with hormones is one of the rarest methods, usually used if the cancer has recurred after the removal of the prostate or if the patient is old and other methods of treatment cannot be applied. Hormonal treatment for prostate cancer is 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 occur quite rarely.

Unfortunately, all treatment options are dangerous with side effects. If prostate cancer is detected at an early stage and the man is not bothered by symptoms, the doctor may suggest that he follow a wait-and-see policy - when intervention in the patient's body does not occur until the tumor is at risk of spreading. At the same time, 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 prostate tissue is exposed to low temperatures and destroyed) and the TOOKAD method (when a laser is applied to a tumor treated with a special drug). These operations are much less traumatic compared to traditional ones, they have a lower risk of complications, but how effective they are in the long term is still unknown.

Treatment in the advanced stages of the disease

In some cases, prostate cancer is diagnosed in the later stages, 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), to the extent possible, try to slow down the progression of the disease and thereby prolong the life of the patient.

Living with prostate cancer

Prostate cancer usually progresses very slowly; sometimes a person lives with him for decades, without experiencing inconvenience and without needing treatment. However, the mere fact of cancer (even if there are no symptoms) affects the quality of life primarily for psychological reasons. A person develops anxiety, depression may begin. The 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 food.It is recommended to avoid high-fat foods and meals; instead, preference should be given to fruits, vegetables, whole grain bread. Do not get carried away with supplements - not a single clinical study has shown that they can prevent cancer. Instead, choose foods rich in vitamins and minerals. According to some reports, drinking green tea may have a preventive effect; however, a large-scale clinical study of the anti-cancer properties of green tea has not yet been conducted.

Sport and active lifestyle. Regular exercise can improve health, help maintain normal weight and improve mood. There is evidence that non-athletic men have higher PSA levels. It is advisable to do exercises 3-4 times a week.

Weight control. If the patient's current weight is within the normal range, it is desirable 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; consultation with a nutritionist can help.

Regular examinations. When a man reaches the age of 45, it is wise to start checking PSA levels every year - this test will help to identify cancer (if it occurs at all) at an early stage, when the disease is easier to treat. It is recommended that people in one or another risk group undergo an examination by a proctologist and check for PSA every year.

Drugs and supplements for the prevention of prostate cancer

Cancer cannot be prevented by taking supplements, vitamins, or traditional medicines (or at least not until there is research to prove otherwise). Many substances that are considered beneficial - for example, vitamin E and vitamin D - do not help in the prevention of prostate disease; 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 the tumor does occur in the prostate gland, the cancer will progress faster.

Prostate cancer. Causes, symptoms, stages, treatment of the disease. Surgery for prostate cancer.

The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious physician. All drugs have contraindications. Expert advice needed

Prostate cancer (prostate carcinoma) is a malignant tumor that develops from prostate cells. This internal genital organ is only in the representatives of the stronger sex. He is deservedly called the second male heart for playing a big role in the sexual sphere. A malignant tumor of the prostate grows relatively slowly. It can remain small for years, but, like other types of cancer, it is dangerous and forms metastases.

Prostate cancer is the most common malignant tumor in men and has become more common in recent decades. But our compatriots are relatively lucky, because this disease often affects representatives of the Negroid race. But the Japanese and South Asians get sick several times less often than Europeans.

A neoplasm can occur after 35 years in 1 in 10,000, but with age, the risk of getting sick increases hundreds of times. Among men over 60 years old, one in a hundred is sick. And in Old age, after 75 years, prostate cancer is found in one in eight men. Therefore, after 50 years, you need to be especially attentive to your health and take special blood tests that will indicate that there are problems with the prostate.

Anatomy of the prostate

The prostate or prostate gland is the internal gonad in men. In shape, it resembles a chestnut, 4 by 3 cm in size. It consists of lobes of different sizes: right, left and middle.

The prostate gland is located in the small pelvis. It is located below the bladder, between the rectum and the pubis. The prostate surrounds the urethra (urethra) with a wide open ring. Therefore, its increase causes problems with urine excretion.

The prostate performs many functions that provide "male power":

Prostate structure

• Prostatic glands, there can be from 30 to 50 of them - this is the main part of the prostate. Their task is to produce prostatic juice, which makes up a third of the sperm.
• Smooth muscles contract and remove prostatic juice from the gland. Its congestion in the prostate can cause inflammation.
• A connective tissue capsule covers the outside of the gland. Inside, elastic partitions depart from it, between which the glands are located. The prostate can be felt through the rectum.It is located at a depth of 5 cm from the anus. Normally, the gland is resilient and elastic to the touch, without compacted areas and nodules.

Causes of prostate cancer

Scientists are still looking for an answer to the question of what causes prostate cancer. Some doctors argue that a malignant tumor develops only on the affected gland. Chronic diseases and other changes undermine the functioning of the body and cause disturbances in the structure of cells.

Most often, the appearance of a tumor is preceded by:

• Hormonal failure. The cause of the appearance of a cancerous tumor may be an increase in the concentration of male sex hormones: testosterone, dihydrotestosterone and androstenedione. They cause the growth of the gland and the multiplication of tumor cells. In connection with this feature, prostate cancer is called a hormone-dependent tumor.
• Prostate adenoma and other benign changes cause the growth of cells that should not be in the gland. They mutate more often than healthy cells of the glandular epithelium.
• Prostatitis. Chronic inflammation in the prostate causes poor circulation and lack of oxygen.

In addition, prostate cells attack bacteria and immune bodies. Under their onslaught, the genetic apparatus in the nucleus, which is responsible for cell reproduction, changes. Such conditions contribute to the appearance of a tumor.

Precancerous conditions

There are also precancerous conditions. They are more likely than others to lead to the appearance of a cancerous tumor. These changes may be congenital or develop in adulthood. These include:

• Atypical adenosis (atypical prostatic hyperplasia). Nodules appear in the central part of the gland, in which cells grow and multiply more actively than the surrounding ones. In addition, they change their structure. Their large nuclei indicate that the cells are in a borderline state between the norm and the tumor. It is considered an optional precancerous condition - this means that cancer can occur in its place if mutagenic factors act on the body.
• Hyperplasia with malignancy (intraepithelial neoplasia of the prostate gland). Cells in individual foci of the prostate begin to multiply actively. Gradually, they become less like typical cells of the prostate gland, and acquire the properties and signs of a malignant tumor. It is considered an obligate precancer - this means that the likelihood of a malignant tumor is very high.

But still, not every man has changes in the prostate that turn into cancer. This happens if the body is affected by factors that increase the risk of developing a malignant tumor.

Signs of prostate cancer

In the early stages, signs of prostate cancer will not be noticed. The tumor behaves secretly and does not cause any symptoms. Only an increase in the level of specific prostate antigen (PSA) in the blood can give it away.

So doctors discover prostate cancer by accident when a man is being examined for another disease. Symptoms of the disease appear when the tumor has affected neighboring organs: the bladder and intestines.

• I have to get up 2-3 times at night to empty my bladder (normally 1 time)
• urination during the day becomes more frequent up to 15-20 times
• there is a strong urge to urinate that is difficult to endure
• severe pain and burning during urination
• urinary incontinence
• pain in the perineum and pubis

• difficulty initiating urination
• Intermittent urine stream
• at the end of urination, urine does not flow, but is excreted in drops
• after going to the toilet, there is a feeling that the bladder is still full

All these symptoms do not appear at once, but gradually, and grow over several years. But none of these signs clearly indicates prostate cancer, and may be a manifestation of other diseases. But in any case, this is a reason to consult a urologist.

Degrees and stages of prostate cancer

The grade or stage of prostate cancer is determined based on the size of the tumor and its spread to neighboring organs. Another important factor is the presence of metastases. This is the name of secondary tumors that appeared due to the fact that blood and lymph carried malignant cells to distant organs.

In order to establish the stage of prostate cancer, you need to conduct an examination. To do this, use different diagnostic methods.

Staging of prostate cancerAfter the examination, the doctor makes a diagnosis and determines the stage of prostate cancer.

I stage - the tumor has a microscopic size. It cannot be felt or seen on ultrasound. It is indicated only by an elevated level of prostate specific antigen (PSA). At this stage, the patient does not notice any signs of the disease.

Stage II - the tumor grows, but does not go beyond the boundaries of the organ. It is limited to the prostate capsule.Cancer of the second degree can be patched with a finger study in the form of dense nodes and reveal on ultrasound. With The prostate cancer of the second degree, urine disorders may appear, which are related to the fact that the prostate squeezes the urethra. At the same time, the urine jet becomes sluggish, cuts and pain in the crotch. The need to go to the toilet causes a man to wake up at night 3-4 times.

III Stage - cancer tumor goes beyond the limits of the prostate and germinates into neighboring organs. The first are the seed bubbles, bladder and a straight intestine. Tumor metastases do not penetrate remote organs. The prostate cancer of the third degree is manifested by a potency violation, pain in the pubic and lower back. Blood appears in the urine and strong burning sensation during the empty of the bladder.

Iv Stage - malignant tumor increases in size. Metastases are formed in remote organs: bones, liver, lungs and lymph nodes.

In a fourth grade cancer, severe intoxication, weakness, decay of forces appear. With the empty of the bladder and intestines, difficulties and severe pain arise. Often, a man cannot silently overlook and have to put a catheter.

Prostate cancer treatment

Treatment of prostate cancer doctor selects individually for every man. Oncologist-urologist necessarily takes into account age, the stage of tumor, concomitant diseases and wishes of the patient.

Expectant tactic. Old age men (over 70 years old), severe chronic heart disease, vessels and lungs can become contraindications to the treatment of prostate cancer. It may be more dangerous for life than the disease itself. If the tumor is small, does not go beyond the borders of the gland and stopped the development, the doctor will propose to postpone treatment. In this case, you will have to do an ultrasound of prostate once every 6-12 months and take an analysis on the PSA.

Operation to remove the prostate gland (radical prostatectomy) is one of the main methods of treatment of the tumor. This is the most common method of combating cancer in men under 65 years.

At the bottom of the abdomen or in the crotch, the surgeon makes a small incision. Through it remove the gland completely. The doctor also exchering the surrounding tissue and, if necessary, lymphatic nodes. The operation lasts 2-4 hours. A man at this time is under general anesthesia. Sometimes they make regional anesthesia (epidural anesthesia), when there is no sensitivity below the belt.

If the tumor did not go beyond the connecting capsule, then it is possible to defeat the disease in 100% of cases. But if the tumor sprout into the neighboring organs, it can also be deleted, but the forecast for recovery is worse. May additionally need chemical or radiotherapy.

Modern clinics offer treatment with the help of a special robot surgeon "da Vinci". The doctor manages all the actions of a robotic system, which eliminates the body from a tumor with high precision. The operation is carried out through small punctures, which then quickly heal. New technologies allow the risk of complications to a minimum. It is possible to avoid such side effects as urinary incontinence and impotence.

Chemotherapy

Prostate cancer chemotherapy is the destruction of tumor cells with medications that contain special toxins. These substances lie cells that are quickly divided. This feature is distinguished by cancer cells from the rest. Chemotherapies destroy the kernels and shells of tumor cells, causing their death.

Chemotherapy uses instead of operation at III and IV stages when the tumor has grown, and metastases appeared. Toxins are separated by blood in the body, they find cancer cells and destroy them. Preparations are administered intravenously courses (paclitaxel), sometimes they are taken in the form of tablets. In total, treatment lasts half a year.

Prostate cancer is sensitive to chemotherapy, but in the early stages it is rarely prescribed. The reason is that chemotherapy products act on healthy cells and cause many side effects (baldness, weakness, nausea).

Radiotherapy

Radiotherapy This is the treatment of prostate cancer using X-rays, neural, gamma, beta or other radiation. The irradiation disrupts the DNA of the tumor cells. This leads to the fact that they cannot share, aging and die.

In the treatment of prostate cancer, irradiation is carried out with the help of special equipment - a linear accelerator. This method is called remote radiation therapy.

The doctor will advise remote irradiation if the neoplasm has large sizes, and metastases appeared in other organs. In this case, it is necessary to irradiate not only the tumor itself, but also lymphatic nodes. The course of treatment lasts about 2 months to 5 days a week. The irradiation lasts 15 minutes, and it is absolutely painless. After the procedure, it is necessary to rest1-2 hours and on the same day you can return home.

But more effectively will enter the particles of the radioactive substance directly in the prostate. The method was called - Brachytherapy.For this purpose, iridium or radioactive iodine is used. As a result of such exposure, the cancerous tumor dies off, and healthy tissues are irradiated minimally. This avoids serious side effects.

The procedure is performed under anesthesia. There are methods when radioactive granules remain in the gland. There are also those when needles with irradiating material are inserted for a while and removed on the same day.

Radiation therapy is used to treat cancer in the early stages, and in advanced cases, when surgery is no longer possible.

Fewer complications occur if prostate cancer is cauterized with a thin beam of high frequency ultrasound (HIFU therapy). Under its influence, the protein in cancer cells is destroyed, and they die

Medicine treatment

Treatment with hormones

For older men who cannot have surgery for health reasons and for those with stage 4 cancer, hormone therapy is the only treatment available.

To treat prostate cancer without surgery, use:

• Antagonists of gonadotropin-releasing hormone: Firmagon, Fosfestrol, Diethylstilbestrol. Drugs lower testosterone levels. They inhibit tumor growth, help its cells become more differentiated (similar to other prostate cells).
• Analogues of the pituitary hormone: Diphereline, Lucrin, Decapeptyl. Injections of these hormones provide "medicated castration". The level of male hormones after 2-3 weeks drops as much as if a man had his testicles removed. But this phenomenon is temporary, and gradually the concentration of testosterone in the blood rises again.
• Antiandrogens: Casodex, Flucinom, Anandron. These drugs prevent tumor cells from interacting with hormones that are secreted by the adrenal glands. They are used in conjunction with analogues of the pituitary hormone. This combination is called "maximum androgen blockade" and allows you to achieve the best result in the treatment of cancer.

In some cases, the doctor prescribes only one drug from the group of antiandrogens - Casodex. If this treatment is suitable for a man, then it is possible not only to stop the growth of the tumor, but also to maintain sexual desire and erection.

In men under 60, hormone treatment is combined with cryotherapy - freezing the tumor with low temperatures. Ice crystals that form in cancer cells destroy their membranes. The combined use of hormones and radiation therapy has a good effect.

If hormonal treatment does not work, the doctor will advise you to have an operation to remove the testicles. After it, testosterone levels fall and tumor growth stops. But men have a hard time undergoing surgical castration psychologically.

Monoclonal antibodies

Virotherapy

Among the new methods of treatment, virotherapy is considered the most promising. Viruses are specially developed that find and dissolve (lyse) cancer cells. ECHO 7 Rigvir proved to be the best. The drug reduces the tumor and stimulates the immune system so that it fights mutant cells on its own. It is prescribed in the early stages of the disease before and after surgery.

In the event that cancer is detected at stage 4, the doctor prescribes treatment that is aimed at relieving pain and improving the condition. In this case, the tumor is not removed, but they try to stop the spread of metastases.

An operation or the right treatment can help a man live 15 years or more. Research is ongoing in this area and new drugs are being tested. This gives hope that in a few years doctors will be able to cope with the disease in the later stages.

Prognosis for prostate cancer

The prognosis for prostate cancer is favorable if the man consulted a doctor on time and the disease was detected at stage I. Treatment allows you to completely get rid of the tumor, as well as maintain male strength and avoid problems with urinary incontinence. The man can continue to work. Life expectancy with successful treatment is unlimited.

At the diagnosis of "prostate cancer" stage II or III, more complex and lengthy treatment will be required. Its success depends not only on the skill of the doctor, but also on the age of the man and his state of health. Life expectancy in most patients with stage II is more than 15-20 years. Patients with stage III who have successfully completed a course of treatment can live 5-10 years.

It is believed that with stage IV prostate cancer, the prognosis for recovery is unfavorable. The average life expectancy is 3 years. But a combination of treatment and the will to live can work wonders. And some men manage to live longer than 5-7 years.

Doctors have a 5-year survival rate. He talks about what percentage of patients after treatment live five or more years. This allows you to judge what are the chances of a successful cure in patients with different stages of cancer.