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Invasion of the prostate tumor into the rectum

Prostate tumors (prostate cancer, adenoma, etc.)

Disease diagnosis

For the diagnosis of PROSTATE CANCER, a digital examination of the rectum, a blood test for the presence of a prostate-specific antigen (PSA), radionuclide scanning and radiography of the bone skeleton, ultrasound examination of the prostate through the rectum (TRUS), X-ray computed tomography (CT) are used , magnetic resonance imaging (MRI).

Statistics

The incidence of prostate cancer (PCa) is steadily increasing, especially in older men.

In a number of countries, in the structure of oncological diseases, this tumor comes in 2-3 place after lung and stomach cancer, and in the USA - in first place. Mortality from Prostate cancer among oncological diseases ranks second after lung cancer. In the late 80s, there was a sharp increase in the incidence of prostate cancer, which gradually decreased to normal levels, which is explained by the detection (screening) of a large number of asymptomatic forms of cancer in connection with the introduction of a tumor marker - prostate-specific antigen (PSA) into everyday practice. /p>

Up to 40% of men aged 60-70 have microscopic (latent) prostate cancer. Only in 10% of cases, the latent form becomes clinically manifested and leads to the death of only 3-5% of the male population. Due to the peculiarities of the clinical course, the tumor may not affect the patient's well-being for many years.

Factors affecting the development of prostate cancer

Age is the most important epidemiological factor. 70% of men over 80 have various forms of prostate cancer, including latent ones (which do not manifest clinical symptoms).

Food. A number of studies have found that the risk of developing the disease increases with the consumption of large amounts of animal fats. Obese men are more likely to be diagnosed with prostate cancer.

Vitamin D. Ultraviolet radiation may also affect the risk of developing prostate cancer. The further south, the lower the incidence. This is explained by the sufficient content of vitamin D3, a cell growth inhibitor.

Genetic factors. Approximately 9% of prostate cancer cases are due to genetic causes, although it is not known which gene is responsible for this. The risk of getting prostate cancer is 2-3 times higher in men whose next of kin got sick with prostate cancer at a relatively young age. The more relatives were sick, the higher the likelihood of developing the disease. If blood relatives are sick, the risk increases by 8 times.

Metastasis

Prostate cancer spreads by local invasive growth, through the flow of lymph (lymphogenic) and blood (hematogenous). Local invasion often precedes the appearance of metastases. The tumor most often invades the prostate capsule, involving the base of the bladder and seminal vesicles in the process. It is possible for prostate cancer to spread to the urethra and urethra. Germination in the rectum is quite rare due to the presence of an anatomical barrier between the prostate and the intestine in the form of a dense connective tissue septum of Denovillier's fascia.

Lymphogenic metastases most often affect the intrapelvic lymph nodes. The next most frequent metastases are the internal and external iliac lymph nodes.

Hematogenous metastases often affect the bone skeleton, mainly the spine, femurs and pelvic bones. Bone metastases are found in 80% of patients who die from prostate cancer. It is not uncommon for advanced cancer metastases to the lungs, liver, brain.

Clinical picture of prostate cancer

In the initial stages, prostate cancer is not clinically manifested, it is usually detected during an in-depth examination of patients with elevated levels of prostate-specific antigen (PSA).

The development of symptoms is associated with an increase in the size of the organ and the appearance of regional and distant metastases. An increase in the volume of the prostate gland leads to the development of symptoms of infravesical obstruction (difficulty urinating, a sluggish stream, the appearance of residual urine), irritative symptoms (frequent urination, imperative urge to urinate), impaired urodynamics of the upper urinary tract (impaired outflow of urine from the kidneys), which, in turn, turn, leads to the development of chronic renal failure.

Locally advanced prostate cancer can compress and grow into the rectum. In such cases, they complain of constipation, false urge to defecate, bleeding, mucus discharge from the rectum. The patient is forced to consult a doctor for pain that appears with bone metastases.Some patients complain of lymphostasis and swelling of the lower extremities caused by tumor transformation of the lymph nodes. As the tumor process progresses, the patient's condition worsens, cachexia, anemia, and bleeding from the bladder develop.

DIAGNOSIS OF PROSTATE CANCER

Digital examination of the rectum

Digital examination of the rectum is the easiest, cheapest and safest method for diagnosing prostate cancer. The characteristic signs of this disease are an increase in size, a change in consistency, the presence of dense nodes, asymmetries, impaired mobility. Palpable motionless tumor infiltrate or germination in the intestine speaks of a far advanced tumor process. Differential diagnosis is carried out with benign hyperplasia (BPH), prostate stones, prostatitis, tumors of the rectum. Only one-third of cases of palpable nodules in the prostate gland are subsequently diagnosed with cancer. The accuracy of diagnosing prostate cancer with a rectal digital examination is 30-50%.

Prostate Specific Antigen (PSA)

PSA is a protein isolated in 1979 from human prostate tissue. And already in 1980, a serological test was created to determine PSA in blood serum. The half-life of PSA is 2.2-3.2 days. Therefore, it may take several weeks for PSA to normalize after prostate manipulation or radical surgery.

Biopsy and transurethral resection necessarily lead to an increase in serum PSA, on average, by 5.9-7.9 ng / ml. After 15-17 days, the level returns to normal. With cystoscopy, transrectal ultrasound and digital examination of the prostate gland, PSA practically does not increase.

In acute and chronic prostatitis, when the cells of the prostate epithelium are destroyed and physiological barriers are violated, which normally do not allow PSA to penetrate beyond the ducts of the prostate gland, its increase is also noted.

PSA detection allows you to detect early and local forms of prostate cancer. But the sensitivity of the method is insufficient to detect latent, microscopic prostate cancer: in 20-40% of cases, there is a normal concentration of PSA in the blood serum. And in the third and fourth stages of cancer, PSA is positive in almost 100% of cases. With a normal size and consistency of the gland, established by digital examination, an increase in the PSA level above 20 ng / ml indicates in favor of a malignant process and requires a biopsy.

The greatest difficulties arise when interpreting PSA values in the range from 4 ng/ml to 10 ng/ml. To address the issue of the need for prostate biopsy in these patients, such indicators as PSA density, PSA growth rate, age norms, and the ratio of various serum PSA fractions were proposed.

PSA density

PSA density is the ratio of PSA concentration to the volume of the prostate gland, determined using TRUS - ultrasound examination of the prostate through the rectum. Considering the higher concentrations of PSA in cancer patients compared with adenoma with the same volume of the gland, this indicator can be used to determine the probability of the presence of adenocarcinoma in a normal gland on a digital examination at PSA values of 4-10 ng / ml, and, accordingly, to decide on indications for a biopsy. Some authors believe that with normal digital examination data and a PSA density of 0.15). With a PSA in the range of 2-10 ng/mL, using this ratio helps to avoid unnecessary biopsy. Clinically significant prostate cancer can be detected by using this ratio even at a lower PSA range.

The described methods of diagnosis in the future require mandatory morphological confirmation of the disease. For this purpose, a puncture biopsy is performed, which is most reliable when performed under ultrasound control.

Staging

Traditionally, the stage of prostate cancer is determined by digital rectal examination. Despite subjectivity, prostate palpation data are taken into account in most classifications. Low cost and ease of implementation are undeniable advantages of the method.

PSA

PSA is of great importance in assessing the prevalence of prostate cancer, correlating with the stage of the disease. In patients with stage 1-2 with PSA>10 ng/ml, capsule germination is noted in 46%, invasion into the seminal vesicles - in 13%, and metastases to the pelvic lymph nodes - in 11% of patients. A PSA level of more than 50 ng/ml indicates spread beyond the gland capsule in 80% of cases and damage to regional lymph nodes in 66% of patients. A PSA concentration of more than 100 ng/ml is associated with the presence of regional or distant metastases in 100% of cases.

However, in each individual patient, it is impossible to accurately determine the prevalence of the tumor process only by the PSA value. The combination of PSA data with the results of digital rectal examination and the degree of tumor differentiation according to biopsy data (Gleason sum) significantly increases the importance of PSA in staging the disease.

Radionucleide skeletal scan

Until recently, this method was mandatory in determining the stage of prostate cancer. Skeletal scintigraphy is highly sensitive in the diagnosis of bone metastases, significantly superior to radiography, clinical examination, and alkaline phosphatase. Due to the high sensitivity, false-positive results are often noted in patients with bone fractures and arthropathies. Recently, radionuclide scanning to establish the stage of the process has been abandoned, since at PSA levels below 10 ng / ml, the probability of the presence of bone metastases is almost zero. However, in newly diagnosed patients with prostate cancer with PSA>10, the presence of bone pain or high alkaline phosphatase, a radionuclide study of the bone skeleton is mandatory.

Bone radiography is required to confirm the presence of metastases in case of ambiguous interpretation of radionuclide scanning. The method determines the characteristic changes in the bones of the pelvis and lumbar spine.

Lung X-ray detects metastases in 6% of patients with prostate cancer at the time of diagnosis and should be performed in all cases.

TRUS

Modern transrectal ultrasound sensors provide very high image quality and allow you to visualize in detail the structure of the prostate, its surrounding organs and tissues, as well as take a targeted biopsy from the altered area of the gland.

Ultrasound tomography reveals infiltration of the prostate capsule, seminal vesicles, bladder, rectal wall, lymph nodes, which, of course, allows you to clarify the stage of the disease. Unfortunately, about half of prostate cancer nodules larger than 1 cm are not visible on TRUS. The sensitivity of the method in the assessment of the stage is 66%, the specificity is 46%.

X-ray computed tomography (RCT)

RCT poorly visualizes the architectonics of the prostate gland, does not allow to reliably distinguish the second stage from the third, has low accuracy in assessing the state of the lymph nodes and, in general, has no advantages over TRUS.

Magnetic resonance imaging (MRI)

The information obtained from MRI corresponds to that obtained from TRUS. The tomograms also show the structure of the prostate gland, tumor nodes, their size, the degree of germination of the capsule, infiltration of the bladder, seminal vesicles, surrounding tissue. Given the high cost, MRI has no advantage over TRUS. The sensitivity of the method in assessing the stage of prostate cancer is 77%, the specificity is 57%.

Excretory urography assesses renal function and upper urinary tract urodynamics. Cystoscopy is an auxiliary diagnostic method. Cystoscopy reveals an asymmetric deformity of the bladder neck. At the same time, it is difficult to decide whether the tumor grows from the prostate gland into the bladder or vice versa.

Pelvic lymphadenectomy

Despite the use of all modern methods for diagnosing prostate cancer, underestimation of the stage is noted in a large percentage of cases. The most reliable information about the status of the iliac lymph nodes comes from the removal of lymph nodes (lymphadenectomy), performed either during radical prostatectomy or as an independent (laparoscopic) intervention in patients who are planned for radical surgery or radiation treatment. With the advent of PSA, the diagnostic value of pelvic lymphadenectomy has somewhat decreased, because serum PSA levels, Gleason scores, and stage are fairly predictive of the presence of lymph node metastases. In this regard, the implementation of lymphadenectomy in patients with prostate cancer with stages I and II, PSA 7 and PSA>10 reduces the risk of local recurrence and improves disease-free survival.

Adjuvant (prophylactic) hormone therapy

The benefits of early maximal androgen blockade after radical prostatectomy in patients with lymph node metastases have now been proven.

Antiandrogen monotherapy (Casodex 150 mg/day) as an adjuvant treatment after prostatectomy and radiation therapy significantly reduces the risk of disease progression with a follow-up period of up to 3 years.

Radiation therapy

Radiation therapy is indicated for patients with local forms of prostate cancer of the first and second clinical stages, who wish to avoid Surgical treatment or who have a high operational and anesthetic risk, as well as patients with the third clinical stage. In recent years, conformal irradiation has been widely used, which makes it possible to choose the most rational conditions for radiation exposure in three projections with minimal effect on surrounding tissues, while a large total focal dose of up to 81 Gy can be delivered. With traditional radiation therapy, the total focal dose is 60-70 Gy.

In patients with a high risk of lymph node involvement (PSA>10 ng/ml, Gleason score >7), pelvic lymphadenectomy is desirable, and the results of radiotherapy for metastases are unsatisfactory. The question of the advisability of using radiation therapy in patients with metastases in the lymph nodes (N+) remains controversial. A number of studies have shown a significant increase in relapse-free survival, improvement in local control, but there is no increase in overall survival (compared to the use of delayed hormonal treatment).

Direct local radiation reactions of varying severity from the lower urinary tract and rectosigmoid colon are observed in a significant proportion of patients. Most of them stop within the next 4 months. Impotence develops in more than half (55-63%) of patients in the long term after the end of radiation therapy. Other possible immediate and long-term complications of radiation treatment include diarrhea (1.4-7.7%), rectal bleeding (2.6-14.9%), blood in the urine (2.6-10.8%), strictures (narrowing) of the urethra (4, 1-11%), urinary incontinence (0.4-1.4%).

The data of recent years indicate the advantage of combined hormone-radiation treatment in patients with local prostate cancer with an unfavorable prognosis, as well as patients with the third clinical stage.

The follow-up of patients who have undergone radiation therapy is no different from that after surgical treatment: regular PSA determination and digital rectal examination. In case of tumor recurrence after radiation treatment, radical prostatectomy is associated with a large number of complications (vesicourethral anastomosis stricture, urinary incontinence) and is therefore rarely performed.

Brachytherapy

An alternative method of radiation exposure in the first and second stages is brachytherapy or interstitial radiation therapy. Brachytherapy injection of radioactive I 125 granules into the prostate gland under ultrasound control. The dose of irradiation of prostate tissue when using I 125 monotherapy reaches 140-160 Gy, when combined with external beam therapy 120 Gy. Unlike external beam radiation therapy, the surrounding tissues are practically not affected during brachytherapy. The procedure for the introduction of capsules takes about an hour and is carried out on an outpatient basis, which distinguishes it from other types of radiation treatment.

The results of brachytherapy in the initial stages of prostate cancer are not inferior to external beam radiation therapy. Possible complications: acute urinary retention, urethritis, urethral stricture, urinary incontinence, rectal ulcers with possible bleeding, urethrorectal fistula formation. However, the incidence of these complications is low. In patients with the third clinical stage, brachytherapy should be combined with external radiation.

Delayed treatment

Only observation without cancer treatment is justified in patients with serious concomitant diseases, such as severe forms of diabetes mellitus, coronary artery disease, renal, hepatic, pulmonary insufficiency, etc. Prostate cancer practically does not affect their life expectancy. Patients with highly differentiated adenocarcinoma - benign along the course - are subject to observation without treatment. In stage 2, well- or moderately differentiated tumors, age, life expectancy, comorbidities, and the patient's opinion should be taken into account when considering possible follow-up. The basis of monitoring is the regular determination of PSA and the performance of a digital rectal examination. If signs of progression appear, you can return to consider other treatment options or start hormone therapy.

Local prostate cancer poses a real threat to life and can ultimately lead to the death of the patient. Determining the level of PSA in the blood serum allows diagnosing the disease 5-7 years earlier, which gives a chance for a cure. Radical prostatectomy is one of the most effective treatments for local prostate cancer, which gives a low complication rate and high 10- and 15-year survival rates.

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Invasion of the prostate tumor into the rectum

12.4.Prostate (prostate) cancer

Etiology. It is assumed that prostate cancer is caused by violations of the endocrine regulation of the sexual sphere, characteristics of sexual life, nutrition, chronic inflammatory diseases (various forms of prostatitis).

Pathological anatomy. Almost all prostate cancers are adenocarcinomas (95%), which originate from the epithelium of the ducts and acini of the prostate glands. In 5% of cases, prostate tumors originate from the stroma, neuroendocrine glands, or are secondary cancer.

Classification of prostate cancer by origin

1. Bladder cancer directly growing into the prostate

2. Direct germination of rectal cancer into the prostate

3. Metastases in the prostate of melanoma or lung cancer

Most prostate tumors (80%) occur in the peripheral zone, 15% of cancers occur in the perineal and central (5%) zones of the prostate.

G Hematogenous metastasis by this route occurs more frequently. After the frequency of metastasis, the bones (spine, pelvis, hips, ribs) are in the first place, then the liver and lungs.

G Lymphogenic prostate cancer can metastasize to regional lymph nodes, which include the pelvic lymph nodes located below the bifurcation of the common iliac arteries.

Classification of prostate cancers

(ICD code O C61) for the TNM system (5th edition, 1997).

The classification applies only to adenocarcinomas. Transitional cell carcinoma of the prostate is classified under tumors of the urinary tract. Histological confirmation of the diagnosis is required. Category N does not depend on the location of regional metastases.

TNM Clinical classification

Tx insufficient data to evaluate primary tumor

T1 clinically asymptomatic tumor that is neither palpable nor visualized

T1a tumor detected by chance during histological examination; it occupies no more than 5% of the resected tissue

T1b tumor detected incidentally on histological examination; it occupies 5% of the resected tissue

T1c tumor detected by needle biopsy (for example, due to an increased level of PSA prostate-specific antigen)

T2 tumor limited to the prostate

T2a tumor affects one lobe

T3 tumor extends beyond the prostate capsule

T3a extracapsular spread (unilateral or bilateral)

T3b tumor extends to seminal vesicles

T4 Tumor is immobile or extends to adjacent structures other than the seminal vesicles: bladder neck, external sphincter, rectum, levator muscle, and/or pelvic wall

1. Tumor detected in one or both lobes by needle biopsy, but not palpable and invisible to imaging methods, is classified as T1c

2. Invasion into the apex of the prostate or into the capsule of the prostate (but not beyond its borders), is classified not as T3, but as T2

N Regional lymph nodes.

Nx insufficient data to assess the status of regional lymph nodes

N0 no signs of involvement of regional lymph nodes

N1 has metastases in regional lymph nodes

M Distant metastases

Mx insufficient data to determine distant metastases

M0 distant metastases are not detected

M1 has distant metastases

M1a non-regional lymph node(s)

Clinic. Prostate cancer is asymptomatic for a long time. The appearance of clinical manifestations of the disease most often indicates the neglect of the process. The main symptoms are dysuria, urinary retention or incontinence, hematuria, polakiuria. At the time of primary diagnosis, digital rectal examination reveals a focus of prostate compaction (observed in more than 50% of patients).

Diagnosis. Diagnosis of early lesions of the prostate remains difficult. During the initial treatment, 50-70% of patients are diagnosed with stage III-IV of the disease. Often, prostate cancer is detected during clinical and radiographic examination of patients with -lumbar sciatica- (metastases in the spine).

G Digital rectal examination is the main method for diagnosing prostate cancer. The method is simple, cheap and quite effective (method sensitivity reaches 80%, with specificity up to 50%). Signs of prostate cancer are areas of stony density in the tissue of the gland, its asymmetry, tuberosity, immobility of the rectal mucosa over the gland. Only 10% of prostate tumors detected by digital examination are quite limited and can be effectively treated.

G Ultrasonography An important diagnostic method is transrectal ultrasound of the prostate, which can detect tumors up to 1 cm in diameter. With the help of ultrasound, the prevalence of the tumor process, germination into the capsule, the relationship with the bladder and rectum are assessed.The special value of the method is the possibility of visual control of the advancement of the needle when performing a puncture biopsy.

G Puncture biopsy of the prostate, performed through the rectum, with further cytological or histological examination of the material, allows an accurate diagnosis.

G Histological examination of tissues removed during adenomectomy reveals initial malignant growth only in 10% of cases.

U In cases where a cancerous tumor invades the prostate capsule, an increased activity of acid phosphatase in the blood serum is found. In patients with distant metastases, this indicator is increased in more than 80% of cases.

U As a diagnostic marker, the level of prostate specific antigen (PSA) is determined in the blood serum. With an increase in its level of more than 6 ng / ml, a third of men are diagnosed with prostate cancer, but pseudo-positive results are possible.

G X-ray examinations are used to confirm the diagnosis, detect metastases, and evaluate the function and morphological changes of the upper urinary tract (excretory urography). Radiography, CT scan of the pelvic bones and / or retroperitoneal organs, radioisotope scanning of the bones of the skeleton allow us to establish the prevalence of the tumor process and detect metastases in various organs.

Treatment. In the treatment of prostate cancer, almost all special methods that are used in oncology are currently used - surgical, radiation, hormonal, chemotherapeutic, thermal.

Determination of the stage of the disease is a decisive step in the study and selection of rational treatment for prostate cancer.

G Tumors of stage T0-1, asymptomatic, are detected at autopsy or during examination of prostate tissue removed for a suspected adenoma. Stage A1 (well-differentiated tumors) has a better prognosis than stage A2 (poorly differentiated tumors).

G Tumors of stage T2 grow within the boundaries of the gland, are detected by digital examination of the prostate in the form of characteristic nodes; can be removed surgically. Unfortunately, in fact, only 10% of prostate cancers can be treated with radical surgery. In many cases, metastases are present in the pelvic lymph nodes that are not detected during rectal examination.

G Stage T3 tumors are cancers that extend beyond the capsule of the gland (eg, to the seminal vesicles, bladder neck), but not to other pelvic structures. Such tumors account for 40% of all newly diagnosed cancers and are not subject to radical surgical treatment.

G Stage T4 tumors are cancers that invade the pelvic bones, lymph nodes, or beyond. About 50% of newly diagnosed tumors are stage T4.

Early stage cancer (T1-T2) requires radical prostatectomy, external gamma-ray therapy, or interstitial irradiation.

G Surgical treatment radical prostatectomy with preservation of the nerve plexus around the gland is indicated for patients with small tumors. Shown in patients aged less than 70 years and provides 10 15-year survival; in 40-60% of cases, normal sexual function is maintained, but 5-15% of patients develop urinary incontinence.

G Radiation therapy is indicated for elderly patients with significant spread of cancer or other diseases of the internal organs that do not allow surgery. Irradiation is also used in individuals who wish to maintain sexual activity. Cases of impotence with interstitial isotope implantation are less common than with remote gamma therapy.

Locally advanced prostate cancer (T3) in the treatment of preference is given to radiation methods in combination with hormone therapy.

G Hormone therapy is used to reduce the concentration of endogenous testosterone as much as possible, the so-called androgen blockade. There are the following methods of androgen blockade:

1. Bilateral orchidectomy (castration).

2. Estrogen therapy (sinestrol, fosfestrol, chlortrianisene, microfollin).

3. Non-steroidal antiandrogens (flutamide, cosadex, anandrone).

4. Steroid antiandrogens (androkur).

5. Agonists (analogues) of LHRH (zoladex, decapeptyl, prostap).

6. Bilateral orchidectomy + antiandrogens.

7. Antiandrogens + estrogens.

8. Agonists (analogues) of LHRH + antiandrogens.

Earlier, castration in combination with estrogen therapy formed the basis of the treatment of prostate cancer in stage T3 T4. However, the use of estrogens is accompanied by a number of serious complications from the cardiovascular system. Currently, non-steroidal antiandrogens are widely used, which block androgen receptors directly in the prostate tissue and do not cause complications from the cardiovascular system.The method of choice is the use of a steroidal antiandrogenic drug -Androkur-, which has a direct antiandrogenic effect on the tumor process and metastases, affects hypothalamic receptors with the help of negative feedback, which leads to a decrease in the release of gonadotropins and inhibition of androgen production by the testicles. The drug can be used both in monotherapy and in combination with LHRH agonists or orchidectomy (castration). The average duration of the therapeutic effect of hormone therapy is 9-18 months.

G Chemotherapy for prostate cancer is of limited use, since tumors are insensitive to chemotherapy drugs

Forecast. Five-year survival of patients in the early stages after radical surgery is 80%, after radiation therapy 80%, hormone therapy 45-65%. In the later stages, the five-year survival of patients is 10-30%.

Prostate cancer metastases in the rectum

Metastases in prostate cancer

In local forms of cancer, when there are no metastases yet, prostate cancer responds well to treatment. Surgical treatment is possible only in the early stages. The prognosis is favorable.

Where do metastases go?

Metastases in prostate cancer appear already at the 3rd stage (in this case, the tumor passes beyond the prostate to the seminal vesicles). At the 4th stage, the tumor spreads to the bladder, rectum. The greatest danger of prostate cancer is the spread of metastases to the liver, adrenal glands and lungs. In this case, it is very difficult to get rid of them. Metastases in the internal organs have a serious negative impact on the state of the body and the quality of life of such a patient.

Metastases that spread by the lymphogenous route can occur in the pelvic and retroperitoneal lymph nodes. The first cancer outside the prostate affects the lymph nodes located on both sides of the bladder neck.

If metastases have spread beyond the prostate: to the internal organs or bones, then only symptomatic (palliative) treatment is carried out. The goal of such treatment is to stop the symptoms caused by the spread of the cancerous tumor.

Metastases of prostate cancer In the bones can be manifested by severe pain in the lower extremities and back. However, it is easily stopped by painkillers. Bone metastases in prostate cancer usually appear in the lumbosacral spine and pelvic bones.

Metastatic prostate cancer has such a feature that when it develops for a long time, there may not be any symptoms. In this case, it is possible to detect the presence of a cancerous tumor only with a regular examination of the prostate, which should be done by all men over 50 years old. CT and MRI, excretory urography, X-ray examination are used to detect metastases.

Methods of treatment

In the advanced stages of prostate cancer, the following treatments are used:

Chemotherapy; hormonal drugs; irradiation of the prostate and regional lymph nodes.

In the treatment of metastatic prostate cancer, sparing chemotherapy regimens and hormonal drugs are used. Medications and chemotherapeutic agents are aimed at curbing the recurrent process. However, chemotherapy causes many side effects, such as indigestion, hair loss, weakening of the immune system. Taking hormones blocks the effect of testosterone on prostate cells, which reduces the growth rate of a cancerous tumor and its metastases.

The main treatment for distant metastases is radiation therapy. Radiation destroys malignant cells, facilitating the patient's condition. Also, with bone metastases, it is necessary to maintain the necessary level of vitamin D and calcium in the body in order to strengthen bone tissue and avoid fractures. For the same purpose, bisphosphonates are used (they slow down calcium leaching from bones) and eoledronic acid.

Another method of treating bone metastases is the introduction of radioactive drugs into the vein, which are carried through the blood and deposited in metastases, while irradiating malignant cells.

Prostate cancer progresses rather slowly. Therefore, thanks to modern methods of treating prostate cancer, it is possible to achieve a long life span even in patients with the 3rd and 4th stages of cancer.

Metastases in prostate cancer and their localization in the body of a man

The human body works like a well-oiled mechanism. At the slightest disturbance in the system, a disease occurs. There can be several reasons leading to the appearance of prostate cancer:

Stress; depletion of the body; heredity; bad ecology; hormonal imbalance.

Stress manifests itself as a specific reaction of the individual to everyday affairs, circumstances. As a result, all the resources of the body are mobilized. Often, men experience a pathological stressful situation, and its chronic course contributes to the appearance of prostate cancer.

The rate of formation of an oncological disease depends on the state of the whole body of a man and the degree of magnitude of the accumulated problems. The older a man is, the more likely he is to get prostate cancer.

In the elderly, after examination, cancer cells are found in the tissues of the prostate gland. Prostate cancer is formed with metastases very slowly, for many years it does not show any signs. Most often, cancer metastases occur due to the patient's genetic predisposition to the onset of the disease. The disease appears due to the inheritance of the HPC1 gene, located in DNA. Testosterone, as a male hormone, promotes rapid tumor growth in prostate cancer.

Some infections of the genital tract create favorable conditions for the development of a malignant tumor in the prostate. The most powerful provocateurs of the oncological process are the herpes virus and papillomavirus. In case of cancer, it is necessary to pay attention to the products and the quality of the cooked food.

Fat, found in large quantities in meat and milk, contributes to the appearance of symptoms that indicate prostate cancer. A large number of fruits and vegetables protects the body from the degeneration of cells in the tissues of the gland. Vegetables do not contain fat, which promotes changes in cells, but there is lycopene, which has an anti-cancer effect. Vitamins and minerals act in two ways on the body.

Plant foods do not prevent prostate cancer. The risk of developing a tumor increases with the use of large amounts of calcium contained in foods.

Signs of a tumor in the prostate

The insidiousness of the disease lies in the complete absence of clinical symptoms for some time. With a significant growth of the tumor, it compresses the urethral canal. Urine begins to be excreted drop by drop, while the bladder itself is significantly enlarged in size. Thanks to modern diagnostic methods, the tumor is detected at an early stage. In more advanced cases, the patient appears:

Blood in the urine; anuria; intermittent urinary stream; increased urination; pain when passing urine.

With severe pain in the bones, a man may suspect cancer metastases. They appear in the spinal column, affect the pelvic bones, lumbar back, bones of the lower extremities. Symptoms of tumor metastasis are combined with weight loss, unmotivated weakness and fatigue.

Often, Prostate cancer with metastases causes a dangerous condition - acute urinary retention, requiring immediate medical attention.

Frequent urinary tract infections may indicate prostate cancer. With age, the likelihood of metastases to neighboring organs increases. In many cases, the disease does not give itself away, and metastases are detected during a routine urological examination.

Painful sensations during urination increase with the growth of a malignant tumor and metastasis of its cells in the tissues of neighboring organs.

The appearance of blood in the urine depends on the degree of the tumor process. Its constant presence in the analyzes indicates the neglect of the process and the presence of bone metastases. In the case of prostate cancer, hematuria may appear suddenly.

The process of metastasis to other organs in prostate cancer

Prostate cancer with metastases has a special clinical picture, which is characterized by the presence of changes in bone tissues. Doctors have found that cancer metastases can occur in two types: osteoblastic lesions and osteolytic changes in the bones.

With osteoblastic changes in the tissue, an increase in the amount of minerals occurs, during the osteolytic process they are washed out of the body, and the likelihood of fractures increases. The cells that form prostate cancer have a dual purpose: they can simultaneously destroy or stimulate the process of bone cell division.

The process of damage to organs by a tumor occurs due to the migration of cells through the blood and lymphatic channels, with further penetration into the tissues of many organs. Bone metastases affect the functional characteristics of organs in the human body.

During the growth of a malignant tumor, healthy cells are replaced by cancer cells, and tumor-like bone formations appear. The composition of the tissue changes completely, the amount of calcium, sodium, magnesium, and fluorine increases in it. Metastases affect the work of the red bone marrow: the total number of erythrocytes, platelets and leukocytes changes.More often than other organs, metastases in prostate tumors affect the lumbar spine, much less often - the femur or thoracic region.

Clinical manifestations of lesions by metastases of organs and tissues of the body

Very often, prostate cancer with metastases develops asymptomatically in the early stages of the malignant process. Most men suffering from prostate cancer note the appearance of pain of varying intensity in the lumbar region or in the bones, less often there is a dysfunction in the part of the body where the tissues penetrated by metastases are located.

The defeat of the spinal cord by a malignant tumor causes certain changes in the spine. The pain becomes unbearable during movements, loads, spread along the nerve trunks. A violation of sensitivity develops in the form of numbness; observed hypoesthesia in the abdomen. Pain in the lower third of the back is unbearable, aching, shooting.

The processes of urination are disturbed, and some patients develop symptoms corresponding to an increased content of calcium ions in the blood plasma. The patient has sharp symptoms of thirst, nausea increases, fatigue may occur and appetite disappears.

Depending on the location of the cancer, the patient's left or right leg becomes numb. Following the loss of sensitivity in the affected organ, pain quickly sets in. Bone metastases are found in the later stages of the disease.

Metastases from prostate cancer to the femur and pelvic bones

In 20% of patients with malignant tumors of the prostate, metastases affect the femurs or bones that form the large and small pelvis of a person. With such a lesion, significant destruction occurs. The patient hardly moves without assistance, any load on the affected leg causes severe pain. Movement becomes possible only with the help of a cane or walker. Due to his insolvency, the patient develops social phobia.

The pelvic complex is affected by metastases much less frequently than the bones of the limbs. Alien cancer cells destroy bone tissue, causing its mineralization, the balance of phosphorus, copper, calcium changes. The patient's legs become sensitive to cold, in the places where the tumor is formed, the skin is pale, dry to the touch, then there is pain in the legs or cramps in the muscles appear.

The pain is very severe, occurs some time after the start of walking, does not go away after rest. Often, pathological fractures may appear in the region of the shoulder region of the upper extremities. Their presence indicates the presence of bone metastases. Prostate cancer with metastases in the bones of the upper extremities forms an ever-increasing pain that becomes unbearable at night.

Increasing hypercalcemia creeps up imperceptibly: there are already changes in the bones, but much later there is a violation in the work of neighboring organs. In a patient with prostate cancer, metastases contribute to the occurrence of:

Modern methods for diagnosing metastases in the spine and bones

Prostate cancer is called the "invisible enemy" for a reason. It develops over a long period, and against its background, the processes of deformation and destruction of bone tissue are accelerated. With his problems, a man turns to an oncologist. The timely adoption of measures for the diagnosis and treatment of prostate cancer with bone metastases depends on this specialist. The disease "ripens" for a long time.

Bone pain may appear after 10 years of illness. Diagnosis of the disease begins with an x-ray examination and radioisotope therapy. At the same time, the specialist uses screening tests to identify individuals with risk factors for developing prostate cancer with bone metastases.

In men with prostate cancer, tests can detect some form of the tumor. One of the effective methods for diagnosing cancer with metastases is a biopsy. For it, small pieces of tissue are taken to confirm the presence or absence of a tumor in the prostate. With a transrectal examination, the doctor determines the location of the proposed biopsy.

Research is not very accurate because it does not provide a direct answer to the question of the nature of the tumor. prostate cancer with metastases is determined using a prostate-specific antigen, the rate of which indicates the size of the malignant tumor. At an antigen level of up to 20 ng/ml, metastases did not form in bone tissue or other organs. The presence of an antigen over 40 ng/ml indicates massive metastasis of a cancerous tumor.

Fluctuations in the level of antibodies indicate the effectiveness of therapy or a recurrence of the disease. Having found an antigen above 20 ng / ml, the specialist prescribes a test for metastasis. After an X-ray examination, it is possible to determine whether the skeletal system is affected by the disease.

Treatment of prostate cancer after establishing its metastasis to other organs

Recent studies have shown that cancer treatment should be selected taking into account factors such as:

Complex treatment is carried out using expectant management or radiation therapy. With active monitoring, the specialist monitors the development of cancer, studies its progression, in order to accurately determine the start of treatment. Surgical intervention involves the removal of the prostate gland.

At the same time, nearby vessels and vas deferens are excised. This type of treatment greatly prolongs the life of the patient, reducing the likelihood of a recurrence of the disease. Surgery is contraindicated in the elderly.

In radiation therapy, the tumor is destroyed with the help of remotely directed beams. With hormonal treatment, the doctor surgically removes the testicles in order to stop the production of male sex hormones. The algorithm for the treatment of localized cancer involves:

Active observation; remote irradiation; brachytherapy; removal of the prostate.

Radical treatments are the most effective. They are carried out for men under 65 years of age at a prostate-specific antigen level of 10 ng / ml. All patients with prostate cancer and metastases are formed into 3 risk groups in terms of survival.

In high-risk men, the standard of living increases with the use of hormonal treatment, but the number of side effects increases. New treatments are being used in patients with localized prostate cancer. After removal of the tumor, the PSA antigen level drops to 0. Recurrence of a tumor with metastases is treated depending on comorbidities and study data. Assigned for treatment:

When treating prostate cancer, side effects may appear in the form of:

Prostate cancer has a good prognosis, and the chances of survival are maximum, within 91-95%.

Treatment of prostate cancer with metastases gives many patients a chance to increase life expectancy.

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