Surgery for prostate cancer metastases

Metastasis in prostate cancer, where metastases most often go

Metastases in prostate cancer are the result of the process of the spread of a malignant tumor to distant organs. There are several ways of metastasis:

Where does a prostate tumor metastasize? At the beginning of the tumor process, metastases enter the testes with the blood flow and through the lymphatic vessels to the lymph nodes of the bladder neck. This is typical for cancer of the third degree. Later, metastases in Prostate cancer are found in the liver and bones. Less commonly, prostate cancer metastasizes to other organs.

Bone metastases

These are the most commonly detected metastases. Detection of bone metastases can occur in one-half to two-thirds of all metastases. Metastasizing cancer is always a tumor already in the third or fourth stage. A little more than half of the cases are lesions of the spine in the lumbar and thoracic regions, less often lesions are found in the bones of the pelvis or thigh.

In this case, intense pain appears, which patients often take for osteochondrosis and treat themselves with anti-inflammatory drugs. Pain in prostate cancer is intense, not relieved by analgesics.

For diagnosis, it is necessary to start with an X-ray examination of the spine and bones. If the diagnosis is difficult, additionally conduct a tomography. On the pictures you can see the rarefaction of bone tissue and foci of metastases.

Prostate cancer often metastasizes to the bone. With metastases to the femur or pelvic bones, they are destroyed, the patient's gait changes, and because of pain, movement becomes almost impossible. The destruction of bone tissue leads to impaired sensation and movement in the legs. The patient can move only with assistance or crutches. Pain in metastatic prostate cancer often occurs at night.

With the destruction of bone tissue in the blood, the level of calcium rises. In this case, there are violations of the cardiovascular system. Various rhythm and conduction disturbances may occur. Due to excess calcium, dyspepsia and constipation often appear.

Metastases in the liver and other organs

After bone metastases, liver lesions are the second most common. In this case, both single and multiple lesions can be detected

Rarely, prostate cancer can metastasize to the rectum, adrenal glands, lungs, and brain. With foci in the intestines, the stool is disturbed, constipation appears, there may be blood in the stool. A tumor in the lungs is manifested by shortness of breath and hemoptysis, the appearance of changes during a fluorographic examination.

Formations in the brain are manifested by violations of brain functions, there may be changes in the organs of hearing and vision, the appearance of unsteady gait or memory impairment. On examination, brain symptoms with focal symptoms are detected, pathological reflexes are detected.

In the first place in the treatment of prostate tumors, as well as cancer of any localization, is surgery. If the prostate tumor can be removed, a radical prostatectomy is performed with complete removal of the organ, regional lymph nodes and fatty tissue. This greatly increases the patient's chances of recovery.

Unfortunately, symptomatic treatment becomes the main therapy in detecting distant metastases, since cancer of the advanced third or fourth stage is already observed. Treatment of a metastatic tumor is often ineffective. In this case, hormonal therapy is well effective. With a tumor of the prostate gland, the level of androgens in the blood increases. The use of hormones helps to suppress their activity.

In the absence of the effect of hormonal treatment, surgical castration is sometimes performed - strangulation of the testicles. Often this treatment is used in older people when other treatments have failed. Hormonal treatment is used as an additional method, it is never the only therapy. With lesions in the brain, hormones help to reduce the focus and prevent the development of cerebral edema.

Radiotherapy will help reduce the size of the tumor. It is used to irradiate the underlying tumor before surgery or as the only method if the tumor is not operable. Radiation therapy can also be used to irradiate metastases. Small metastases can thus be completely removed. However, radiation therapy has many side effects and is poorly tolerated by patients. Often such treatment is prescribed for patients with brain metastases. After using it, the patient may experience memory impairment, unsteady gait and other brain symptoms.

Single liver metastases can be removed surgically if they are located on the edge of the liver away from the main vessels and bile duct. With massive metastases, Surgical treatment is not used.Of the modern methods of surgical treatment, neurosurgical or radiosurgical intervention is used.

For foci in the intestine, you can apply surgical treatment or use chemotherapy. Chemotherapy for prostate cancer is used more often as an addition to surgical treatment, and if it is impossible to radically remove the tumor, as the main therapy. Treatment of bone metastases is carried out using radiofrequency ablation and cementoplasty of the affected bone.

Prevention

The detection of distant metastases often indicates neglect and inoperability of the tumor. To avoid their appearance, it is necessary to identify the tumor at an early stage, when it is possible to completely remove it and radically cure the disease.

In order to prevent a severe stage of the disease, it is necessary to visit the surgeon annually, examine the prostate through the rectum, periodically donate blood for the prostate cancer marker PSA and, if indicated, do an ultrasound examination of the prostate gland. These, albeit unpleasant, procedures must be performed by men over 40 years old every year.

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Metastases in prostate cancer

This type of tumor is one of the most dangerous, as it often tends to produce metastases already in the early stages of the disease. Moreover, this process manifests itself already at a late stage, when treatment is very difficult, if not impossible. In this regard, timely diagnosis comes to the fore, the basis of which is a regular examination by a specialist. This is especially true for older men, because with age, the risk of such a pathology increases greatly.

Metastases are called secondary foci of the tumor that have arisen during the spread of cancer cells of the primary - maternal tumor throughout the body. Such metastases can occur in any corner of the body and in the later stages they can be even larger than the main tumor, but for all that, this is not another tumor, but a metastasis, since its cells have exactly the same nature as in the main tumor .

Prostate cancer develops secretly for a very long time and quite often it turns out that its metastasis is first detected, for example, in the lung and, only with a detailed examination, the main tumor that gave rise to it is revealed.

Metastasis pathways

Metastasis occurs when a cancer cell, separated from the main tumor and migrating throughout the body, attaches to the tissues of an organ and begins to divide - grow. There are several ways of such distribution:

• Local growth. In this case, the tumor, while growing, gradually penetrates into adjacent tissues and thus grows in the area of the main focus;
• Intravasia - the spread of a tumor through the lymphatic channels;
• Delay - cancer cells lingering in the capillaries begin to divide, gradually hitting their walls, penetrating outward and infecting neighboring healthy tissues;
• Angiogenesis - the emergence of new blood vessels, an atypical structure, which serve to supply blood to a growing tumor. In fact, such vessels can be considered local metastases;
• Circulatory - the transfer of cancer cells over considerable distances from the mother's tumor. This mainly occurs through the circulatory system and lymph. This process is the most dangerous because it can give rise to metastasis at any distance from the tumor and in any organ.

Another method is noted - proliferation, when new atypical cells are taken for micrometastases, which are formed during the division of existing ones, however, these micrometastases surround the tumor focus directly, so they can only be called metastases conditionally.

Appearance and spread of metastases

Prostate cancer is characterized by the fact that it produces metastases already in the early stages, and they are very small for a long time and behave secretly, without showing themselves in any way, and at the time of their discovery, it is most often necessary to fix the 3rd stage of the disease.

The first metastases appear in the seminal vesicles and the neck of the bladder, and the testes are affected by cancer cells brought with the blood stream, and the neck of the bladder through the lymphatic channels. Further spread occurs in the region of the organs and tissues of the pelvis, after which the liver and bone tissues most often suffer.

Metastases in the lymph nodes. These organs suffer from metastases in the first place. First, the lymph nodes located near the prostate gland suffer, which are very quickly affected by the cancer cells of the main tumor, and after a while, metastases are already detected in distant corners of the body.

Metastases in the bones. Bone metastases first occur in the pelvic bones, after which in the spinal column and femurs, and sometimes even the ribs are affected by metastases.With such a development of the disease, the patient experiences severe pain, which is difficult to relieve with analgesics, so it is necessary to use potent narcotic painkillers.

In addition to severe pain, metastases in the bones lead to a change in their normal shape and high instability - they become very fragile and brittle, and metastases in the spine first of all cause severe back pain.

Metastases in the lungs. Such localization of prostate cancer metastases occurs mainly at the terminal stage of the process, and only in a fifth of such cases, pronounced symptoms appear. These include:

• Chronic cough;
• Difficulty breathing - shortness of breath;
• Heaviness and stiffness in the chest;
• Increased body temperature.

With the development of metastases, severe chest pains appear, cough is accompanied by bloody expectoration, body weight decreases sharply and the patient quickly loses strength.

Metastases in the liver. This development of prostate cancer is observed in approximately one in three patients. At the beginning of growth, metastasis makes itself felt very weakly, or even develops asymptomatically, but with development there are:

• Discomfort in the right hypochondrium;
• Abdominal pain;
• Nausea and aversion to fatty foods;
• Yellowness of the skin and sclera of the eyes.

As a rule, several metastases occur at once in the liver, which grow rapidly and lead to dysfunction of the organ, and this is very dangerous - if the liver fails, death can occur almost instantly.

Metastases in the spine. In the spine, prostate cancer metastases appear after they have established a network in the pelvic area. With development, they can pinch the active areas of stem cells and lead to disturbances in the motor apparatus, up to complete paralysis of the limbs.

This condition is signaled by severe back pain with radiation to the lumbar region and sternum, depending on the area affected by the metastasis.

Metastases in the brain. The appearance in the brain of secondary cancerous foci occurs relatively rarely and, as a rule, in the late stages of prostate cancer. First, metastases affect the bone tissue and only then appear in the brain. The localization of such foci, as a rule, is limited to areas between the white matter of the brain and gray matter. Due to the peculiarities of this organ, the symptoms can be very different, but more often it is:

• Increasing headaches, protracted, pulling character;
• Nausea turning into vomiting;
• Decrease in hearing, vision, memory, etc.

As you grow, more severe manifestations may occur - partial or complete paralysis of the limbs, paresis, seizures of an epileptic nature, and even mental disorders, up to a complete loss of self-consciousness.

Prostate cancer survival predictions

Prostate cancer does not belong to tumors that are easily and reliably cured. The reason for this is the early production of metastases and the very secretive development of the disease, which leads to the detection of pathology, usually already in the late, advanced stages - in the third, or even in the fourth. In addition, prostate cancer very often leads to the occurrence of metastases in bone tissues, and this causes severe, intractable consequences.

In view of this, the forecasts are mostly disappointing. They depend on the stage of tumor development, the number and localization of its metastases, and to a large extent on the patient's general health, including psychological - if there is a strong desire to recover, the chances increase significantly.

If we take general statistics, then a tumor detected at the beginning of development, with timely and complete treatment, is completely cured in 8 out of 10 patients. But then, it all depends on the specific situation.

If stage 3 prostate cancer is detected, but without an extensive system of metastases, with the possibility of surgical removal of the tumor, followed by fixing chemotherapy and hormonal treatment, the prognosis can be quite favorable - a complete cure is hardly guaranteed, but the time of remission of the disease can be greatly postponed.< /p>

Surgical treatment is used very rarely due to its ineffectiveness. In this case, palliative therapy is carried out, aimed at slowing down the development of the cancer process as much as possible.

Symptoms of metastases in prostate cancer and effective treatment

The main difference between a benign tumor (adenoma) and a malignant one is the presence of metastases in the latter. These are cancer cells that have the same structure and type as the main tumor. Metastases in prostate cancer spread throughout the body, affecting the blood vessels, bladder, bones and other organs. As part of the article, we will tell you what symptoms accompany the pathology, how to treat the condition, what is the prognosis.

Mechanism for the development and distribution of metastases

4 degrees of prostate cancer are isolated. On the first and second tumor he grows, but the body metastasis does not occur. The first metastases appear, starting at 3 stages of the disease.

Initially, the cancer tumor simply squeezes the organs adjacent to the prostate gland. At this stage, the patient feels severe pain in the crotch area, usually stopping at the reception of analgesics. Next, the malignant neoplasm increases, cell division occurs, some of which blood and lymph is separated by the body. First of all, organs located near the prostate gland are affected:

• bladder and urethra;
• kidney;
• Tsemenniki;
• intestines.

With blood current oncological cells are recorded in the bone. This is the most common location of metastasis in patients with men. First of all, pelvic bones are affected, then the spine, ribs.

Bone tissue is updated throughout the human life. For this, there are two types of cells in its composition: one regulates the groove of the bone, others - its destruction. In the absence of pathology, the number of these cells is approximately the same. But as soon as the bone tissue includes metastases from the prostate gland, the balance is broken. Bone tissue changes, becomes fragile. At this stage, men suffer from injuries associated with fractures.

Lymph current Cancer cells fall into the lymphatic system adjacent to the prize. First of all, lymph nodes are affected at the mouth of the bladder neck. It is possible to develop pathology in other places of the body, in particular - in the thigh area.

Lastly, metastases penetrate into the lungs and brain. This picture is not often found in the practice of oncologist. The fact is that before the appearance of cancer cells in the lungs and brain, kidneys are affected: the patient dies from renal failure.

In accordance with the international classification of cancer, for describing the localization of metastasis and cancer stages, the TNM index is used. The last letter denotes the degree of metastasis of the body. The value is decrypted as follows:

• M-0 - metastases are missing;
• M-1 - available in the bones;
• M-2 - bones and other organs are affected;
• MX - the probability of metastasis is not excluded.

According to the international classification of diseases in the latest edition of the ICD-10, prostate cancer with metastases is assigned Code C-61.

Symptoms in prostate cancer metastasis

If we talk about general symptoms, they are identical with the signs of benign prostatic hyperplasia and with prostatitis. First of all, we are talking about urination problems:

• frequent urge;
• feeling of a filled bladder;
• sluggish urine jet;
• Please send a low need difficult.

During metastases, pain symptoms are characterized, especially in the area of the perineum, the waist, the head of the penis.

As for specific features, on which it is possible to understand the propagation of cancer cells in the body, it depends on the localization of metastasis.

The severity of the signs depends on the startingness of the process. So, at 4 stages of prostate cancer, if metastases penetrated the bone, paralysis of the lower extremities is possible.

Diagnostics with cancer with metastases

If a man late turned to a doctor with characteristic manifestations, then a full examination is necessary. We found out that prostate cancer has similar signs with prostate adenoma and prostatitis. To eliminate these diseases and confirm the presence of malignant neoplasms, the following tests and instrumental examinations are carried out:

• Common and biochemical blood test;
• test serum on PSA (prostatitic specific antigen);
• ultrasound of the prostate gland (with the possibility of underpants);
• MRI (magnetic resonance imaging) - this method allows you to determine not only the localization of the tumor, but also the distribution and degree of damage to the organs by metastases;
• puncture biopsy;
• x-ray.

When cancer is detected based on the results obtained, the disease is assigned the TNM index and appropriate treatment is selected.

Note that screening tests do not have 100% accuracy. Moreover, in some cases, the mental health of the patient is disturbed. It is believed that screening with prostate cancer allows you to identify cancer at an early stage, but often gives a false diagnosis. As a result, the patient is directed to taking biopsy, and this is not always appropriate.

Prostate cancer treatment methods for metastases

1 and 2 stages of prostate cancer metastases in the body do not apply.Therefore, for the treatment of the described problem, complex therapy is used, which is characteristic of the fight against the disease of stages 3 and 4. Note that at the last stage of oncology, all means are only supportive in nature and do not eliminate the malignant neoplasm. Hormones, chemotherapy, radiation exposure are used.

What hormones are prescribed

The relationship between the level of testosterone in the body and the occurrence of prostate cancer has been established. Therefore, hormone therapy is aimed at suppressing the synthesis of testosterone, or at changing the ratio between it and estrogen.

The following drugs are used:

• degarelix;
• leuprorelin;
• goserelin;
• buserelin;
• triptorelin;
• flutamide;
• bicalutamide;
• hexestrol;
• progestins (megastrols).

The effect of the female sex hormone on cancer cells is currently being studied. There is an assumption that an increase in the level of estrogen in the body in a man triggers the reverse process of the development of oncology, that is, the number of metastases decreases.

How chemotherapy is performed

Unlike other treatments, chemotherapy affects the entire body of a man. At this stage, special drugs are prescribed, which are administered intravenously or orally and act on all neoplasms, including metastases and benign tumors. The drugs are taken in courses, between which they allow the body to "rest" and recover.

Most commonly used drugs:

• docetaxel;
• mitoxantrone;
• vinblastine;
• carboplatin;
• vinorelbine

It is known that chemotherapeutic agents actively destroy all types of cells that have the ability to rapidly divide. In addition to cancer cells, cells of the mucous membrane, hair follicles, and bone marrow are affected. After chemotherapy, the work of the intestines is disrupted, wounds and ulcers appear in the oral cavity, and hair falls out. Therefore, this method of dealing with metastases is prescribed only if other means do not give the proper therapeutic effect.

Peculiarities of radiation therapy for metastases

The essence of the method is the introduction of radioactive substances (isotopes of radium or cesium) into the tissues of the prostate gland. It has been established that under radioactive exposure, cancerous tumors stop growing, in some cases a decrease in size is observed. Another name for the method is brachytherapy.

In case of a malignant tumor of the prostate gland, substances are injected with a needle directly into the affected area of the organ. Depending on the severity of the disease, radiation sources can be permanently in the organ or removed after a certain time.

As for the use of brachytherapy for metastases, here we are talking more about prolonging the life of a sick man. The growth and division of cells directly in the tumor stops, new metastases do not appear.

Surgical treatment for metastases

If metastases have spread throughout the body, penetrated into the liver, lungs or bone tissue, then surgical treatment will not contribute to recovery. However, by removing the prostate gland, the vessels adjacent to it and the vas deferens, doctors manage to prolong the life of a sick man. In addition, the likelihood of repeated outbreaks is reduced. Due to possible risks, prostate surgery is not performed on older people or those with serious disorders from other organs.

Surgery with a laser or using classical techniques is radical and is considered the most effective method. The main indication for surgery is a PSA level above 10 ng/ml.

If a relapse occurs after the operation, the treatment method will be selected taking into account diagnostic data and the development of concomitant diseases.

Prognosis and life expectancy

The prognosis, duration and quality of life for a malignant neoplasm in the prostate with metastases depend on the degree of progression of the tumor, the number and location of cancer cells in the body.

For stage 3 carcinoma, the mortality after treatment is 30% during the first five years. This does not take into account data on mortality due to complications in other organs. Therefore, the level of damage to organs by metastases will affect the quality and duration of life.

With stage 4 adenocarcinoma, accompanied by multiple metastases, the average life expectancy is from one to three years. With proper treatment, the period increases by 1-2 years. As for the quality of life, men with severe pain due to metastases are assigned 1 disability group

If metastases have penetrated the bones, then the average life expectancy does not exceed 1 year.

Conclusion

In order to prevent such unfortunate consequences, it is necessary to undergo an examination in a timely manner. Men aged 40 years and older should definitely donate blood serum for PSA levels. This is one of the modern methods for diagnosing prostate cancer in the early stages, it is carried out every 6 months.

If the favorable moment for the timely detection of prostate carcinoma was missed, and the visit to the doctor occurred at the stage of metastasis, you must strictly adhere to the doctor's recommendations. Modern medicine knows methods by which you can increase life expectancy.

For example, hormone therapy can slow down the spread of metastases in prostate cancer. A long course of hormonal drugs (from 1.5 years and more) allows you to achieve health improvement in about 75% of sick men. True, we are not talking about increasing survival, which is impossible to achieve at the present stage of development of oncology. But it is possible to achieve a decrease in the intensity of symptoms and damage to various organs.

Remember that metastases in prostate cancer is the last, final phase of the development of the disease, which leads to death. Do not neglect your health, regularly take blood tests for PSA levels, lead a healthy lifestyle. Only with this approach can one cope with the disease at the stage of the onset of the pathological process and prevent such disastrous consequences.