Prostate cancer: symptoms, degrees, stages and treatment
Prostate cancer is diagnosed by registering the proliferation of glandular cells of the prostate gland, the presence of which is characteristic only of men. Due to the significant contribution to the sex life of the body, the prostate is called the "heart" of the male principle - the release of androgens (male sex hormones) and the liquid part of the ejaculate necessary for transporting and feeding spermatozoa during fertilization depends on it.
Just like tumors of the mammary glands, ovaries and uterus in women, prostate carcinoma is the most common malignant neoplasm in men. At the same time, there is a special correlation by race: among Negroids it is about one and a half times more often than among Caucasians, and representatives of the Mongoloid race, in particular, the Japanese, are twice less likely.
It has been established that age is a determining risk factor for prostate cancer, since after 35 years it is found in only one in 10 thousand men, after 60 - already in every hundredth, and among those who have reached 75 years, every eighth man suffers from carcinoma. In connection with this situation, WHO experts recommend that all men who have reached the age of 50, pass all the necessary tests to prevent the worsening of the disease.
Content:
- What is prostate cancer?
- The reasons
- Prostate cancer symptoms
- Stages of prostate cancer
- Diagnostics
- Prostate cancer treatment
- Prostate cancer medications
- Forecast
- Prevention
What is prostate cancer?
Prostate cancer is a malignant neoplasm that develops from the cells of the prostate gland.
Anatomy of the prostate. The prostate is a gland of internal secretion, which is located in men in the pelvic area, its size is on average 3 × 4 cm. Due to the fact that the prostate is located around the urethra, its enlargement, provoked by a cancerous tumor, causes impaired urinary function.
The prostate gland is located inside a capsule of connective tissue, contains elastic septa that separate the prostatic glands. Consists of three parts - right, middle, left. In this gland, prostatic juice is produced, which is excreted during the contraction of smooth muscle muscles. The prostate participates in the processes of sperm production, increases their activity and vitality, is responsible for the quality of sperm and its excretion. Plays an important role in the implementation of male sexual function.
Functions of the prostate. For a more accurate understanding of the nature of the disease, it is necessary to understand in detail the main functions of the prostate gland. The main features of the functioning of the prostate are that it produces a certain part of the seminal fluid. According to experts, this is more than a third of the total. She is also responsible for participating in the process of semen eruption.
Another key function of the prostate is that it has a lot to do with the ability of any man to retain urine. That is why this gland is of great importance for the health of the male body.
How long do you live with prostate cancer?
In this, as in any other case related to oncology, it is very important to detect the disease as early as possible. However, the prognosis is most often unfavorable due to late detection and the occurrence of a significant number of metastases at an early stage. So, about 90% of cases of prostate cancer are detected at the third or fourth stage.
Therefore, answering the question of how long they live with prostate cancer, we can say that everything depends on the stage of the disease at which treatment was started. Radical prostatectomy, which was performed at an early stage of oncology in patients under the age of 70, is a guarantee of 10 or even 15-year survival. In general, after a timely treatment course, the five-year survival rate in the first or second stage is 85%, in the third -50%, in the fourth - no more than 20%.
Metastases of prostate cancer spread to distant areas, due to the spread of cancer cells through the blood and lymphatic vessels. Most often, pelvic pain, swelling of the legs in the ankle or foot area with prostate cancer means an increase in the number of metastases and the fact that the cancer has become aggressive.
The reasons
Modern research associates the causes of prostate cancer with chronic diseases and inflammatory processes that affect the prostate and provoke pathological changes in its tissues.
Common causes of prostate cancer include:
- Hormonal imbalance - since a prostate tumor is hormone-dependent, its occurrence and growth can be triggered by an increase in the level of dihydrotestosterone and androstenedione (male sex hormones).
- Prostatitis - inflammation of the prostate gland, as a result of which blood circulation and oxygen exchange in its tissues are disturbed;
- Prostate adenoma - benign neoplasms contribute to the appearance of cells that do not normally appear in the prostate gland, they are more prone to mutation and malignancy, which provokes the onset of the oncological process;
- Bacterial lesions of prostate cells and autoimmune processes damage the genetic apparatus of cells, contributing to their uncontrolled division and tumor formation.
Precancerous conditions, which include atypical adenosis and prostatic hyperplasia, lead to the formation of a cancerous tumor. With atypical adenosis, nodular formations appear in the center of the gland, the cells of which quickly divide, and under the influence of mutagenic factors they can be reborn into malignant ones. Hyperplasia - active focal cell division followed by degeneration or malignancy; the risk of oncological tumor in this case increases significantly.
Risk factors for the development of prostate cancer are related to genetic predisposition and lifestyle. Thus, the increased content of animal fats in the diet, the intake of carcinogenic substances into the body in the composition of tobacco smoke and alcoholic beverages, the harmful production conditions of the textile, chemical industry, welding shops and printing houses can contribute to the development of oncogenic formations. Stagnation of prostatic juice due to a sedentary lifestyle and irregular sexual activity can be a predisposing factor for the development of pathology.
Other risk factors are sexually transmitted diseases, old age, infection with a retrovirus, cytomegalovirus and a depressed state of the immune system.
Prostate cancer symptoms
The first symptoms of prostate cancer (at an early stage of the disease) are absent, therefore, the presence of cancer can be determined only with a special examination - the diagnosis is carried out using a blood test for PSA (specific prostatic antigen).
The first symptoms of prostate cancer can be considered difficulty urinating, impaired sexual function, the presence of blood in urine and semen. The patient associates all these manifestations with other diseases, the occurrence of any of them does not mean the presence of cancer, but may be one of the symptoms.
Prostate cancer usually manifests itself when the tumor grows large and puts pressure on the walls of the bladder. As a result, a man may experience frequent urge to urinate - from 15-20 times a day and more than 2 times at night. In this case, urine comes out slowly, the stream is interrupted, there is a feeling of overflow of the bladder. The process becomes excruciatingly painful, there is a burning sensation, urine comes out in drops. The patient is forced to strain the press, since the tone of the bladder is weakened, in some cases it is necessary to insert a catheter.
- Urinary incontinence and groin pain can also be symptoms of prostate cancer;
- Swelling of the lower extremities, genitals, scrotum, provoked by metastases in the lymph nodes;
- Kidney stones, pain in the lumbar region - the ureter and renal pelvis expand due to the outflow of urine in the opposite direction, which can be triggered by a cancerous tumor;
- If an oncological neoplasm damages the vessels of the urethra or seminal vesicles, then there may be blood impurities in the urine and semen;
- Violation of potency occurs when the nerve endings are damaged by a cancerous tumor;
- A painful dry cough indicates metastasis of cancer to the lungs;
- Yellowness of the skin and heaviness in the right side are symptoms of the presence of secondary tumors in the liver;
- If a person experiences pain during bowel movements, then the tumor could have affected the intestines;
- In the later stages of cancer, bone pain may occur when the tumor metastasizes to bone tissue.
An increase in the intensity of all the above symptoms can be observed over several years, they appear gradually. Any of the above signs is a reason to see a doctor and be examined by a urologist.
Stages of prostate cancer
It is necessary to distinguish between such concepts as the stage and grade of prostate cancer. The degree of the presented form of cancer should be considered an indicator of the clinical type, which determines the degree of morphological fluctuations in the cells of the prostate gland. That is, a cell-type study is necessary, for example, a biopsy. It is she who makes it possible to determine the diagnosis literally at the first stage of the formation of the disease.
The stage of prostate cancer determines the increase in the size of the tumor formation and the further growth of the lesion focus. Identification of the stage is no less important than the degree of the disease, because it makes it possible to determine exactly what is happening with the tumor, and whether there are metastases.
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First stage
At the first stage, the tumor cannot be palpated, any modifications in the structure of the gland and its separately located cells can be established exclusively with the help of microscopic examination. |
Stage two
At the second stage, the increasing formation is noticeable on ultrasound, but its location remains limited only by the capsule of the gland and does not have any other foci of spread. |
Third stage
At the third stage, an invasive tumor spreads beyond the boundaries of the prostate, which are not directly related to the gland or are located next to it. |
Fourth stage
In addition to a significant proliferation of the tumor focus, metastases at stage 4 of prostate cancer grow into the liver, lymph nodes, lungs and bone tissue of the skeleton. |
Diagnostics
Even with the smallest problems with urine flow, it is advisable to see a specialist in urology as early as possible. It can be not only prostate cancer, but also an adenoma, as well as inflammation in the prostate area.
The primary diagnostic method is digital, rectal examination of the rectum. This method is the simplest and makes it possible to suspect oncology. However, in the case when it is already possible to probe the formation, this indicates that the disease is at one of the final stages. In this connection, even in the case when the formation cannot be probed, the patient is prescribed an additional study: a blood test for the presence of prostate-specific antigen (PSA).
To make a more accurate diagnosis, a man may also be prescribed an ultrasound of the prostate, computed tomography, X-ray and radioisotope examinations.
The final diagnosis can be made after a biopsy of the prostate gland - with a specific needle through the perineum or rectum, a specialist takes a small part of the gland in order to conduct a study.
What is the PSA level in prostate cancer?
A cancer tumor limited to the area of the borders of the prostate gland is often asymptomatic and does not manifest itself in any way. Therefore, for early and timely detection of an emerging aggressive disease, men are recommended to regularly undergo a test that determines the level of prostate specific antigen (PSA) in the blood.
Prostate specific antigen (PSA) in the blood is a protein synthesized in the prostate gland, the normal level of which is shown in the following table:
| Male age (years) | Serum PSA norm |
| 40-49 | <2.5 (μg / l) |
| 50-59 | <3.5 (μg / l) |
| 60-69 | <4.5 (μg / l) |
| 70-79 | <6.5 (μg / l) |
The test must be taken by men from the age of fifty. And if there were cancer patients in the family, then it is recommended to start this procedure earlier.
Determining the level of specific antigen of the prostate gland correlates with its size. In the presence of a large gland, the PSA level in the blood is high, but this is not essential. A tumor can also form with a low antigen count. The antigen can be found in the blood in both free and bound forms.
There is an inverse relationship between free PSA and cancer. The lower the concentration of antigen in the serum, the higher the likelihood that the increased level is caused by the presence of a cancer in the prostate gland.
This relationship is shown in the following table:
| Free PSA concentration (%) | Cancer probability as a percentage (%) |
| 0-10 | 56% |
| 10-15 | 28% |
| 15-20 | 20% |
| 20-25 | sixteen% |
| more than 25 | eight% |
Prostate cancer treatment
The type of treatment for prostate cancer depends on the patient's age, state of health, stage of oncology and his wishes. Elderly men with pathologies of the lungs, heart, blood vessels and severe chronic diseases are recommended expectant tactics, since surgery can do more harm to the body than a cancerous growth. In this case, it is necessary to do an ultrasound of the prostate gland and an analysis for PSA every six months in order to prevent the intensification of tumor growth.
Operative treatment
Surgical treatment of prostate cancer is carried out by the method of radical prostatectomy - the patient under general anesthesia or with epidural anesthesia is subjected to excision of the prostate gland and surrounding tissues if the tumor has spread beyond the prostate. Sometimes excision of lymph nodes is required, removal of part of the tumor in nearby organs, then the prognosis for recovery is less favorable, chemotherapy is additionally performed. Almost one hundred percent chances of recovery in patients whose tumor has not gone beyond the connective tissue capsule.
The duration of the operation is from 2 to 4 hours, it is prescribed for patients under 65 years of age because of the possible risks and complications. An incision is made in the groin or abdomen. Modern surgical treatment of prostate cancer is carried out using a Da Vinci robot controlled by a doctor. The operation is performed without incisions through small punctures, which speeds up the healing process of tissues and reduces the number of postoperative complications, minimizing the risk of impotence and other unpleasant consequences.
Orchiectomy
Another measure to combat prostate cancer is orchiectomy - removal of either one or two testicles.
The presented surgical intervention leads to a stop in the production of endogenous testosterone and a decrease in the growth rate and further development of malignant tumors. The intervention is advisable to be carried out solely on the basis of the diagnosis after the biopsy of the gland.
The intervention can be carried out not only on an outpatient basis, under local anesthesia, but also under complete anesthesia. During the operation, a technique is used in which changes in the visual character remain unnoticed (cord reservation, introduction of artificial testicles).
Orchiectomy makes sense in the following cases:
- the process of treatment with hormonal drugs is impossible as a result of satellite diseases, which are in no way associated with malignant formation;
- in the absence of the possibility of taking prescribed hormonal drugs or injections every day.
Chemotherapy
Chemotherapy involves the use of drugs with toxins that target rapidly dividing cells. Due to the fact that tumor cells are characterized by rapid growth and division, chemotherapy allows you to selectively affect their membrane and nucleus, causing destruction. Such treatment is prescribed at the third and fourth stages of cancer, when the tumor gives metastases - toxic substances are carried throughout the body, destroying pathological cells. In the earlier stages of prostate cancer, this treatment is impractical, as it has many side effects, the most common of which are nausea, hair loss, fatigue and weakness.
The most common drugs used in chemotherapy treatment are:
- "Mitoxantrone" - is most often used in combination with prednisolone at the later stages of treatment of cancerous tumors, with the formation of metastases in bone tissue;
- "Doxorubicin" is recognized as one of the main components of chemotherapy, which is successfully used not only in the treatment of prostate cancer. The algorithm for the effect of a drug on any cells implies interaction with the DNA of cells. This is accompanied by blocking the production of protein in them, which, in turn, is almost the main building material;
- "Paclitaxel" - it slows down the activity of cancers, affecting their skeleton, which consists of a large number of microscopic tubes. Due to this, they acquire great flexibility, and this provokes the fact that the cells can no longer divide in a normal way and die off soon enough;
- "Extramustine phosphate" - is a link between two strands of DNA, which makes the algorithm of its copying invalid. The result is the impossibility of the development of a cancer cell, which eventually dies.
The course of taking chemotherapy drugs is six months, they are available in the form of tablets or solutions for injection (Paclitaxel).
Radiotherapy
Radiation therapy involves exposing cancer cells to X-rays, damaging their DNA and impairing their ability to divide. It is carried out using a linear accelerator that spreads neural, gamma and beta radiation to the tumor area and, in some cases, the lymph node area to stop its growth and the spread of pathological cells throughout the body.
External beam radiation therapy is applied five days a week for two months. The procedure itself is painless and takes only fifteen minutes, after which the person is recommended to rest for two hours. It is prescribed only for large tumors with metastases, since radiation can affect healthy cells, provoking a number of side effects.
Brachiotherapy is distinguished by fewer side effects due to its selective action - radioactive substances (iridium, iodine) are introduced into the prostate and act directly on the tumor, practically without affecting healthy cells and tissues. This increases the effectiveness of the procedure and minimizes side effects. The needles with the irradiating agent are inserted under anesthesia and removed either immediately or during the day.
HIFU therapy is another modern method of radiotherapy that is used to selectively destroy a tumor without damaging healthy tissue. It consists in ultrasonic action on an oncogenic neoplasm, which destroys the structural proteins of pathological cells.
Brachytherapy
An alternative method of radiation exposure to the presented gland in the initial stages of the formation of the disease is brachytherapy. The essence of the method lies in the fact that under the control of ultrasound, iodinated granules with a high degree of radioactivity are injected into the gland. Due to this, an increased radiation ratio is formed in the area of education, and the tissues located nearby are practically not affected.
The procedure for the introduction of capsules is given no more than an hour and it is carried out in an outpatient clinic. This is what distinguishes it from other types of radiation treatment.
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Prostate cancer medications
The growth of prostate cancer is affected by male sex hormones, the increased concentration of which leads to an increase in the size of the neoplasm. This is the reason for the effectiveness of drug therapy - with a decrease in the amount of androgens and a decrease in the susceptibility of tumor cells to their effects, its growth slows down significantly. The result of such treatment is more pronounced if it is applied at an early stage of the disease. But it is possible to slow down the growth of an oncological tumor and increase the patient's life expectancy with the help of drug treatment even at an advanced stage of cancer.
Hormone treatment
It is used in the fourth stage of cancer, when surgical treatment is ineffective and can only aggravate the patient's condition, it remains the only available treatment for cancer tumors in elderly people with chronic diseases.
Hormonal drugs for the medical treatment of prostate cancer:
- Analogues of pituitary hormones - after their use, the level of androgens in the blood of men drops to the state that occurs after surgical castration. But unlike the operation to remove the testicles, this phenomenon is reversible - at the end of the hormone intake, the testosterone level is restored. The drugs of this group - Lukrin, Dipherelin, Decapeptil, are used by injection.
- Antiandrogens - prevent the interaction of pathological cells with adrenal hormones, the combination of antiandrogens with pituitary hormones in medical practice is called maximum androgenic blockade and is one of the most effective methods of drug treatment for cancer. The drugs in this group include Flucin, Casodex, Anandron.
- Antagonists of gonadotropin-releasing hormone, which lower testosterone, slowing down the growth of oncogenic neoplasms, and in addition - stimulating cell differentiation, due to which they turn from pathological into typical cells for prostate tissue. The drugs of this group are Fosfestrol, Firmagon, Diethylstilbestrol.
Treatment is started with antiandrogens - in some cases, Casodex is enough to slow down tumor growth, while maintaining the male's sexual function.
Hormone therapy in patients under 60 years of age is carried out in combination with cryotherapy - tumor freezing. When abnormal cells freeze, ice crystals form, which destroy them. Hormones are also prescribed in combination with radiation therapy.
The radical method of treating prostate cancer in the framework of hormone therapy is the removal of the testicles, after which testosterone production is irreversibly reduced. It is rarely used due to the severe psychological trauma that most men experience after this operation.
Monoclonal antibodies
Monoclonal antibodies are classified as cancer immunotherapy methods that are rarely used in our country, and were approved in America in 2006. Vaccines are being developed based on these drugs that contain antibodies that the body's own immune system uses to fight cancer cells.
Virotherapy
One of the modern methods of treating prostate cancer involves the use of viruses that selectively destroy cancer cells, making it easier for the body to fight cancer. One of the most promising drugs in this group is ECHO 7 Rigvir, which allows you to stop tumor growth and activate the immune system to fight off pathological cells. It is prescribed in the early stages of cancer before and after surgical treatment.
At the fourth stage of cancer, a therapy is prescribed that does not destroy the tumor, but slows down its growth and the spread of cancer cells throughout the body, and also improves the patient's well-being by reducing pain. After surgical treatment, patients can live from fifteen years or more with successful therapy. Treatment of advanced prostate cancer is difficult due to the intensive growth and proliferation of tumor cells, but modern research in this direction will allow the disease to be overcome in the near future.
Forecast
The prognosis for patients with prostate cancer depends on the stage at which the treatment was carried out. Specialists have a concept of "five-year survival", which allows to assess the success of treatment. So, for patients who consulted a doctor at the first stage of cancer, the five-year survival rate is more than 90% - that is, more than 90% of people live 5 years or longer after treatment. For the second stage of cancer, this figure is 80%, for the third and fourth - 40 and 15%, respectively.
If a patient seeks medical help at the first stage of the disease, then as a result of therapy he is able to completely restore control over the function of the bladder, sexual function, remove the tumor and restore working capacity. After successful treatment, the negative manifestations of prostate cancer are eliminated, the disease does not reduce life expectancy.
At the second and third stages, the success of treatment largely depends on the professionalism of the doctor and the state of health of the patient, his age and general well-being. Therapy takes longer, treatment is more complicated, but the chances of success are quite high - the life expectancy of most patients after treatment is 15 years or more.
At the fourth stage of prostate cancer, the prognosis is poor - rarely any of the patients manage to live more than seven years after long-term combination therapy.
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Prevention
Today, medicine cannot offer a one hundred percent method of preventing cancer, but if you follow the general recommendations for maintaining a healthy lifestyle, the risk of cancer is minimized.
- Regular sleep is a prerequisite for maintaining the health of the whole body, it is during sleep that melatonin is produced, a hormone that prevents the onset and growth of tumors.
- Healthy Diet - Include more fruits and vegetables on your menu, crucifers, legumes, garlic, onions, citrus fruits, leafy greens and yellows are especially beneficial for supporting the body's antioxidant defenses. Eat lean meats, fish and seafood, give preference to vegetable fats and grains that are rich in dietary fiber, easily digestible protein, vitamin E and phytosterols.
- Avoid carcinogenic substances - carcinogens that provoke the development of tumors can enter the body with food, from polluted air or water; tobacco smoke, products with aromatic and flavoring additives contain carcinogenic substances, their concentration is increased in the chemical industry.
- Preventive examination by a specialist - over the age of 50, men are advised to screen the prostate gland for cancerous growths at least once every two years and once a year for men with adenoma, prostatitis and other pathologies. Screening includes an ultrasound scan of the prostate gland and a blood test for prostatic antigen.
- Physical activity avoids stagnation in the prostate, strengthens the walls of blood vessels and is the prevention of atherosclerosis and cardiovascular diseases. Gymnastics in the morning and an evening run or walk for forty minutes can help neutralize the harm done to the body by a sedentary and sedentary lifestyle.
- Regular sex life - prevents congestion and inflammation in the prostate gland, enhances pelvic circulation and metabolic processes in the tissues of the prostate.
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"
