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Prostate cancer is prostate cancer

Prostate cancer (prostate): all symptoms, diagnosis, treatment, survival

The prostate itself is one of the most important organs in a strong half of our population. It surrounds the urethra and is located under the bladder. But what is it for? The gland itself secretes a certain fluid in which spermatozoa outside the testicles can live and function for some time. Consider an unpleasant disease - Prostate cancer.

Statistics on cases

Prostate cancer in men is a malignant neoplasm of the prostate gland, which develops and grows rapidly, and then metastasizes to other organs. Despite the fact that the processes in the tissues of the prostate develop for a long time (when compared with other oncological tumors), cancer still has a strong danger to the life of the patient.

In general, according to statistics, the majority of patients with this disease are blacks. This is rather strange, since they do not get cancer as often as whites.

As a rule, prostate adenoma cancer has a characteristic severity in older patients. And usually after 50 years, the risk of getting sick in men with this disease is higher than in young people. Of course, genetics also influences - so if the father had such a disease, then the son has a 2-3 times higher chance of getting sick than the other. There is also a minus that, like any cancer, the first signs of prostate cancer do not appear in any way.

Causes

There are several approximate factors that influence the occurrence of "male cancer". Like any other cancer, unfortunately, scientists and doctors do not have exact data on what exactly causes a mutation in the prostate gland. Consider all the causes of prostate cancer:

• The age of the man. Both women and men experience hormonal changes in their bodies as they age. Because of what the male hormone becomes less, the organs work a little differently than in young people. As a result, the gland itself can mutate and produce tumor cells. Statistics show that cancer is extremely rare in young people. Usually the chance of getting sick increases after 40-50 years.
• Heredity and genes. If a man had a family with this disease, then he also has an increased risk of getting sick. It is clear that the further a sick relative is by generation, the lower the risk, but it still remains. In this case, as practice shows, by inheritance, cancer appears more often. There are two genes BRCA 1 and BRCA2 that influence the heredity of predisposition to prostate cancer.
• Bad habits. Alcohol, tobacco and smoking, as well as drugs, have a large number of chemicals and mutagens that affect the occurrence of all cancers, including prostate cancer (PCa). To this can be added reduced activity, sedentary work, etc. Men who play sports are less likely to get this disease.
• Food. Doctors advise patients at risk for this disease not to eat red meat and animal fats.
• Ecology. This risk factor affects many diseases. And with a bad environmental situation in your city, as well as with chemical pollution, the chance of getting sick increases greatly.
• Hormonal failure. In this case, there may be a sharp increase in the level of male hormones testosterone, dihydrotestosterone and androstenedione. After that, the gland itself greatly increases and cells appear inside it, which begin to grow very quickly, they can later develop and mutate into cancer.
• Prostate adenoma - is it cancer or not? No, this is a benign neoplasm of fast-growing cells that can also turn into cancer. The mutation comes from the glandular epithelium.
• Prostatitis. The usual inflammation, as a result of which there is a violation of blood circulation inside the gland and a lack of oxygen to some tissues and cells.
• Sexual infections. Usually, diseases are very unpleasant and affect the entire male genital organ. As a result of the vital activity of the infection, poor-quality cells may occur.

Zero stage or precancerous condition

Like any other tumor, prostate cancer has several precancerous conditions that may not turn into cancer, but the chance of getting sick is greatly increased.

NOTE! These two factors do not always lead to the onset of cancer itself. Usually this is influenced by a huge number of factors: from smoking and alcohol, to nutrition and the environment.

Like other cancers, this type of tumor behaves covertly and quietly in the early stages. At the same time, a specific prostatic antigen, or PSA for short, begins to be released into the blood. But in order to identify it, it is necessary to donate blood for this oncomarker.Most often, a man understands that he is sick only when the tumor itself begins to spread to nearby organs: the intestines, the bladder. Consider all the symptoms of prostate cancer:

All of the above signs of prostate cancer may suggest other diseases. So if at least some symptoms appear, you will need to see a doctor to take general blood tests, biochemical analysis and blood for tumor markers.

Diagnosis

First, you need to identify the disease itself, which is quite difficult to do at the initial stages of tumor development. Later, you need to find out the degree of damage, the stage and size of the tumor itself. Well, the most important thing is to determine whether malignant cells metastasize or not yet, and how much time is available for treatment. How to identify prostate cancer?

Survey methods

• Blood tests. Usually the doctor begins to suspect something is wrong, after the usual clinical and biochemical analysis. After that, he directs the patient to take blood tests for PSA. Analyzes for antigens do not give accurate results and there are increases in performance. These proteins can also indicate other diseases.

• Finger study. Not a very pleasant procedure, but it makes it clear at what stage the cancer is. The doctor, using palpation, checks the gland for enlargement and compaction inside.
• Ultrasound. A sensor is inserted into the anus, which looks at the size of the tumor, its nature, as well as some seals.

• Biopsy of the prostate. If the prostate antigen is elevated and it is already clear that there is a neoplasm. It is necessary to find out a malignant tumor or benign. A special needle is inserted and a small piece of tissue is taken. Usually they take from several sites at once. Next, the cells themselves are studied under a microscope and look at the nature of the development of the disease itself.
• Magnetic resonance imaging (MRI), Computed tomography (CT). After the previous study, when confirming the malignancy of cancer tissues, it is necessary to determine the size of the tumor and how much it has affected nearby tissues, possibly organs.

Cancer stages

After all the studies that the doctor conducts, he makes the diagnosis itself, as well as the stage of the cancer itself, on which the nature of further treatment will depend. Consider the stages according to the Jewet-Whitemore system.

We can say that this is a precancerous condition, which we talked about a little earlier. Some doctors take it into account, and some don't.

A stage in which there are no certain external signs and even an increase in the gland itself. Even on ultrasound it is impossible to see the source of ignition. The only thing that can help is an analysis of PSA tumor markers.

The tumor grows, but does not go beyond the gland itself. It can already be detected by ultrasound and palpation. At the same time, some men have difficulty urinating due to squeezing the walls of the urethra.

Malignant cells penetrate into nearby organs: seminal vesicles, bladder and rectum. Also, due to the rapid growth, the tumor can damage the blood vessels and appear blood in the urine. Plus, pain when urinating, burning in the groin.

Metastases move to other distant organs. Due to a strong tumor, the urinary canal may completely overlap. There is a strong intoxication of the whole organism, headaches, a person quickly gets tired and tired. A more extensive development of this disease can lead to adenocarcinoma in the bladder or liver cancer. If malignant cells get on the testicles, then you will have to undergo an operation to remove the testicles.

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 on its own.

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 radiation zone, or when the tumor has penetrated beyond the radiation 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, radiation or hormone therapy is the cause of squamous cell carcinoma of the prostate.

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. Generally, the earlier prostate cancer is diagnosed, the easier it is to treat.

Surgical removal of the prostate (radical prostatectomy)

Surgical treatment is indicated for localized cancer in the absence of metastases; as a rule, it is prescribed 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.