Prostate cancer - first signs and symptoms, stages, diagnosis and treatment of the tumor

Prostate cancer is a malignant neoplasm of the prostate gland. This disease is one of the most common malignant processes among male patients. According to statistics, prostate cancer competes only with tumors of the lung and stomach in terms of incidence.

Prostate cancer is currently considered a very big problem, since the disease can most often be diagnosed already at an advanced stage 3 or 4. Therefore, men over 55 years of age, especially with a history of prostatitis and benign hyperplasia, need to be regularly observed by an andrologist for timely diagnosis of a cancerous tumor.

What is prostate cancer

The prostate gland (prostate) is an endocrine gland that belongs to the male reproductive system, performs the functions of producing seminal fluid and is involved in ejaculation. The prostate is located under the bladder near the colon; it looks like a nut encircling the urethra. The gland directly affects the ability to retain urine. This organ is very susceptible to age-related changes, including oncology.

Prostate cancer is a malignant tumor that develops from glandular epithelial tissue. Like other cancerous tumors, prostate carcinoma tends to spread metastases to other organs, but the progression of the disease is slow; it can take 10-15 years from the appearance of microscopic signs of the tumor to the critical stage. Even a small tumor of the prostate gland can spread metastases, mainly to the skeletal system, liver, lymph nodes, lungs, and adrenal glands.

This is where the greatest insidiousness of the disease lies: if before metastasis the tumor can be surgically removed without any problems and the disease will recede, then when the metastasis grows, no doctor will be able to cope with the problem. In this case, the prognosis will be very sad, even death. Therefore, it is so important to promptly detect prostate cancer in men, and to do this, listen to your body and regularly visit a urologist, especially after 50 years.

Causes

The main causes of prostate cancer are not completely known. Oncologists tend to assume that hereditary predisposition and age-related changes play a dominant role in the formation - more than 2/3 of all cases of prostate cancer are diagnosed in elderly men. According to statistics from the World Health Organization, indigenous people and African Americans are more susceptible to the disease. The smallest number of patients was recorded among Asians.

There are many types of prostate cancer. The main types of tumors are shown in the figure below.

The following provoking factors or secondary causes of prostate cancer are identified:

• age-related hormonal changes;
• the predominance of animal foods in the diet - red meat, solid fats;
• deficiency in the diet of foods containing vitamin A and other antioxidants;
• carriage of retroviruses;
• intoxication of the body with cadmium, asbestos, and other chemicals;
• long-term regular exposure to ultraviolet and other types of radiation on the body.

Bad habits also increase the risk of cancer: smoking, alcoholism, and physical inactivity. Obesity can also affect the likelihood of developing a malignant tumor in the prostate gland. None of the reasons mentioned is dominant.

For a tumor to form, a combination of several unfavorable factors is necessary.

How long do you live with prostate cancer?

Statistical studies show that every seventh man aged fifty years or older has prostate cancer. This disease is a common cause of death among older men. Survival rate is, as a rule, high: 5 years are taken as the estimated value, it all depends on the stage of the disease and the purpose of adequate treatment:

• At the first stage, people live with a tumor for a long time, the survival rate is one hundred percent, provided that the doctor’s prescriptions are followed. However, the disease is very insidious and in the early stages there are no symptoms, so it is not always possible to identify it and start treatment on time.
• Stage two – survival rate is 85% of patients with proper treatment with positive results.
• The third stage is characterized by the growth of the tumor beyond the organ, and the survival prognosis is 50%.
• The fourth stage is characterized by a critical course, metastasis to organs, therefore, with aggressive treatment, patients live no more than three years. No more than 20% of patients are able to live for five years. The main problem with prostate cancer is late detection, since men are very careless about their health, avoiding examination for various reasons.

How quickly does prostatic cancer develop?

The growth of prostate cancer does not have a specific dynamics. For many years it may not manifest itself in any way, so a man does not need to go to a urologist for examination. Some live like this all their lives and die from completely different reasons. And in some cases, the tumor behaves very aggressively and develops quickly.

The rate of cancer growth depends on the activity of tumor cells. The main characteristic is the doubling time of the tumor volume. Special systems have been developed to predict the progression of prostate cancer, for example, DAmico. Calculation of the probability and rate of tumor growth from the initial stage to clinical symptoms is made based on a number of factors (they will be discussed in more detail below):

• Classification according to TNM (the most interesting indicator here is T - clinical stage);
• Gleason Sum;
• PSA level.

Risk groups of patients according to DAmico
Risk calculations based on Alan Partin’s nomogram are also used:

You need to use the tables as follows: for example, PSA 3.1, Gleason 3 + 4 = 7, stage T2. In the second table you need to find the range of PSA 2.6-4, Gleason 7. At the intersection of the lines the probability of progression will be described.

Symptoms

The main signs of prostate carcinoma in men are very similar to the signs of adenoma (benign tumor) of the prostate. In the later stages of the disease, symptoms are as follows:

• pain;
• difficult painful urination;
• erectile dysfunction leading to impotence;
• blood in the urine (hematuria);
• frequent need to get up at night to urinate;
• a feeling of bladder fullness and a strong desire to go to the toilet;
• the stream of urine is weak, intermittent, there is a need to strain4
• feeling of a not completely empty bladder.

When, in advanced stages of cancer, metastases penetrate into nearby and distant organs and tissues, this causes constant pain and discomfort of various types:

• pain and non-union of fractures in metastatic areas of bones;
• frequent colds, viral diseases due to decreased immunity;
• pain in other metastatic organs;
• constipation;
• bowel movements mixed with blood and mucus;
• apathy and fatigue;
• hematuria;
• cough with bloody sputum;
• pyelonephritis, pain in the lumbar region;
• sudden weight loss;
• the skin becomes pale earthy in color.

Early symptoms

The sluggish course of the disease with the absence of visible symptoms at an early stage only increases its danger. Symptoms of prostate carcinoma at an early stage are almost impossible to notice, so men after 45 years of age must undergo an examination and tests. Early detection and treatment of the disease increases the patient's chances. Perhaps nothing serious will be discovered, but you need to make sure of this after the examination. You should be wary and consult a doctor if:

• at night you often have to get up to go to the toilet;
• the jet pressure is weak;
• emptying occurs strained with painful burning sensations.

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Degrees and stages of prostate cancer

The grade or stage of prostate cancer is determined based on the size of the tumor and its spread to nearby organs. Another important factor is the presence of metastases. This is the name given to secondary tumors that appeared due to the fact that blood and lymph carried malignant cells to distant organs. In order to determine the stage of prostate cancer, an examination is necessary. For this, different diagnostic methods .

1. Determination of the level of prostate specific antigen (PSA) in the blood.
2. Digital examination : the doctor examines the gland through the anus. This way you can determine the increase in its size, elasticity, and the appearance of compactions.
3. Ultrasound examination of the prostate with a rectal probe, which is inserted into the rectum. With its help, the doctor can identify compactions, nodes and tumors, their size and location.
4. A prostate biopsy is needed when there are tumors and elevated prostate antigen. In this case, the doctor determines whether the tumor is benign or cancerous. The study is carried out under ultrasound control. Using a special needle, several pieces of fabric are taken from different areas. In the laboratory, samples are stained and cell features are examined under a microscope.
5. Computed tomography and magnetic resonance imaging are needed when a biopsy confirms the presence of cancer. These studies help determine the size of the tumor and identify metastases.

Stages of prostate cancer After examination, the doctor makes a diagnosis and determines the stage of prostate cancer .

Stage I – the tumor is microscopic in size. It cannot be felt or seen with ultrasound. It is indicated only by an elevated level of prostate specific antigen (PSA). At this stage, the patient does not notice any signs of the disease. Stage II – the tumor grows, but does not go beyond the boundaries of the organ. It is limited to the prostate capsule. Second-degree cancer can be palpated by digital examination in the form of dense nodes and detected on ultrasound. With prostate cancer of the second stage, urination problems may occur, which are associated with the fact that the prostate compresses the urethra. In this case, the stream of urine becomes sluggish, pain and pain appear in the perineum. The need to go to the toilet makes a man wake up 3-4 times at night. Stage III – the cancer tumor extends beyond the prostate and grows into neighboring organs. The first to be affected are the seminal vesicles, bladder and rectum. Tumor metastases do not penetrate to distant organs. Prostate cancer of the third stage is manifested by impaired potency, pain in the pubis and lower back. There is blood in the urine and a strong burning sensation when emptying the bladder. Stage IV – the malignant tumor increases in size. Metastases form in distant organs: bones, liver, lungs and lymph nodes. With cancer of the fourth degree, severe intoxication, weakness, and loss of strength appear. When emptying the bladder and bowels, difficulties and severe pain occur. Often a man cannot urinate on his own and has to have a catheter inserted.

Causes

The incidence rate of prostate cancer varies depending on geographical areas. For example, in South and East Asia, according to some studies, the incidence of the disease is much lower than in the European region. Science has not yet been able to determine the true causes of malignancy, but the main risk groups are known:

1. Heredity. According to the results of a study of twins, 40% of all prostate cancer diseases occurred in men whose ancestors also suffered from this pathology.
2. Impact of carcinogenic factors on the body.
3. Eating style. Fatty, high-calorie foods and a lack of vegetables in the diet increase the risk of cancer.
4. Progression of prostate adenoma.
5. Age after 45 years.
6. Race. African peoples are more susceptible to cancer.
7. Sedentary lifestyle.

Diagnostics

Prostate cancer is often prediagnosed during a digital rectal examination. The malignant tumor is hard to the touch, fused with the surrounding tissues. In the absence of symptoms, cancer is detected in this way in 0.1-4% of cases.

It should be taken into account that after digital diagnosis, the PSA level will increase (considered a tumor marker, but in fact it is an organ-specific marker that changes depending on the volume of the prostate and the structure of its cells). This indicator is determined by blood serum and has important diagnostic value.

Stages

The generally accepted classification of carcinomas, which is used in European urology clinics, uses the Gleason scoring system: in it, stages are assessed according to the degree of malignancy. Low-aggressive cancer is scored 1 point, and highly aggressive cancer is scored 5 points. As a rule, if several foci occur in carcinoma, then histological material is taken from at least two large tumors and the research results are summarized to obtain a Gleason score. So, the minimum index is 2 points, the maximum is 10 points.

The next classification method is the Jewitt-Whitemore system, which serves to differentiate a tumor by size, damage to lymph nodes, and the presence of metastases. Degree of tumor spread:

1. First stage A. Malignant cells practically do not differ from normal ones, the tumor is encapsulated, the course of the disease is asymptomatic.
2. Second stage B. The tumor is encapsulated, is located within the organ, is not palpable rectally, tumor growth is observed, the PSA level is elevated, the course is asymptomatic.
3. Third stage C. The tumor begins to extend beyond the gland, spreading to nearby lymph nodes, the tumor penetrates the bladder and urethra, making it difficult for urine to pass out.
4. Stage four D. Metastatic tumor, elevated PSA level, extensive metastatic damage to regional lymph nodes, tissues, organs, there is a high probability of relapses after treatment.

Preventative measures to prevent the formation of prostate cancer

Currently, medicine does not know clear preventive methods to avoid encountering such a disease in urology as prostate cancer. However, like all cancers, prostate cancer has its own factors, including:

• poor nutrition;
• consumption of products with carcinogens;
• Unhealthy Lifestyle;
• irregular sleep patterns;
• untimely examination;
• lack of a full sex life.

Diagnostics

Do not panic at the first problems with urination. Maybe it’s a slight inflammation or an adenoma, but you definitely need to see a doctor to establish an accurate picture of the problem. Diagnostics consists of:

1. Rectal palpation (palpable in later stages).
2. Analysis for PSA (prostate-specific antigen) level. If a man has prostate cancer, his PSA level increases.
3. Clarifying examination methods include ultrasound with a rectal probe (TRUS), computed tomography, biopsy (sampling a piece of gland using a special needle).

Biopsy is a histological examination of tissue to definitively confirm or refute the diagnosis. To obtain objective results, it will be necessary to examine about ten or more samples of prostate glandular tissue taken from different parts of the gland. However, this diagnostic method has side effects such as the appearance of blood in stool, semen and urine. Although these complications normally go away after two days, there is a possibility of developing an inflammatory process in the prostate gland at the site where the tissue fragment was removed, and prolonged bleeding.

How to identify prostate cancer yourself

It is unlikely that you will be able to feel the prostate on your own for the presence of dense nodules, so you just have to pay attention to external signs :

• Changes in the process of urination: urge without urine separation, difficult outflow, frequent urge at night;
• Blood in the urine;
• Pain during ejaculation;
• Signs of metastasis: causeless nausea, vomiting, confusion, pain in the pelvic bones, spine, swelling of the extremities, enlarged lymph nodes.

The signs before metastasis are similar to prostatitis, but the latter is characterized by constant and quite noticeable diffuse pain in the groin, lower back, and pelvic area (go to the article, which describes in detail the symptoms of prostatitis). Urinary problems occur with benign hyperplasia (adenoma), but it is impossible to independently distinguish it from cancer.

Treatment

Depending on the examination data obtained, taking into account the patient’s age, stage of the disease, and the presence of metastases, treatment is prescribed. There are the following ways to combat prostate carcinoma:

1. The operative (surgical method) is the complete excision of the prostate gland (prostatectomy).
2. Medication – hormone therapy. Side effects are rare and do not require treatment.
3. Radiation therapy, brachytherapy - radioactive irradiation.
4. Focused high-intensity ultrasound ablation of the prostate (HIFU) - exposure to ultrasound waves.
5. Antiandrogen monotherapy – medical castration.
6. Removal using laser.

Operation

The tumor removal procedure can be performed in three ways: open abdominal surgery, laparoscopy, and robotic prostatectomy. Traditional abdominal surgery is extremely traumatic and fraught with complications (urinary incontinence, impotence). The latter method allows you to minimize blood loss, maintain erectile function and normal functioning of the bladder. The effectiveness of the operation is high only in the absence of metastases. A successful and timely operation is a guaranteed complete relief from the disease.

Removal of tumors

Abdominal surgery to remove a prostate tumor is performed under general or local anesthesia. During the operation, a small incision is made in the lower abdomen, the gland is separated from the bladder, urethra and excised along with the seminal vesicles. In this case, whenever possible, the nerves (Nerve Sparing) responsible for erectile function are preserved, if they are not involved in the cancer process. The urethral stump is then connected to the bladder through a catheter, which is removed two weeks after surgery.

The laparoscopic method of tumor removal is preferable for both the doctor and the patient. It is less traumatic, there is less blood loss, recovery is faster, and the stitches are almost invisible. During the first stage of the operation, small incisions 1 cm wide, five in number, are made in the peritoneum. Optical instruments are inserted into the holes, with the help of which the organ, seminal vesicles and regional lymph nodes are removed. Laparascopic prostatectomy is indicated for encapsulated tumors without metastasis.

An innovative technique for removing adenocarcinoma is the da Vinci robotic prostectomy. In European countries this method is being used more and more often. The operation is performed remotely using a robot. The “tentacles” of the robot are inserted into the abdominal cavity through small holes, which transmits an image of the operated organ to the computer monitor. The surgeon transmits commands to the robot about what movements to perform through a special apparatus, making movements with special joysticks.

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Chemotherapy

Chemotherapy is used to treat tumors with metastases in advanced stages. In addition, indications include insensitivity of the tumor to hormone therapy, relapse after prostatectomy, and locally advanced prostate tumor. Chemotherapy is the blocking of cancer cell growth and metastasis with toxic substances. In fact, chemotherapy drugs are poison for cancer cells. Once in the bloodstream, the medicine spreads throughout the body and finds the most distant metastases.

However, the drugs have a similar effect on normal cells. A medicine with a selective effect has not yet been invented, so the consequences of chemotherapy can manifest themselves in the form of symptoms of intoxication:

• nausea with vomiting;
• diarrhea;
• weakness;
• anemia;
• lack of appetite;
• hair loss;
• dizziness;
• fatigue.

Radiotherapy

To reduce the rate of tumor division and block the appearance of metastases, radiation therapy or radiotherapy - radioactive irradiation - is used. However, radiotherapy for prostate cancer does not guarantee complete victory over the malignant disease. Typically, radiation is combined with drug therapy to enhance the effectiveness of prostate cancer treatment.

An alternative high-intensity radiation method in the early stages of the disease is brachytherapy. The method is based on the injection of radioactive iodine into the prostate gland. The procedure is carried out under the control of an ultrasound machine. Thanks to this localized effect, the level of radiation in the affected area increases, and nearby tissues do not experience strong harmful effects. Brachytherapy can be performed on an outpatient basis and takes about an hour.

Treatment with medications

The growth of prostate cancer is stimulated by testosterone (male sex hormone). Drug treatment is the use of hormones that reduce testosterone synthesis. Treatment of prostate cancer with medications, such as GnRH, only inhibits tumor growth and the spread of metastases, reduces symptoms, improves the well-being of patients, but does not cure the disease.

Treatment with folk remedies

To overcome cancer, many factors must come together: timely early detection, successful treatment, strong immunity, etc. This is a complex and long process. There is no guarantee that treating prostate cancer with folk remedies will help in any way. In any case, you should not hesitate, look for the easy way, or treat yourself with herbs, roots and other drugs. Consult a doctor, and let folk remedies be an addition to the main treatment. It is quite possible that they will alleviate the patient’s condition, strengthen the immune system, and remove toxins from the body.

For prostate cancer, healers recommend the following herbs and infusions:

1. Lungwort.
2. Collection: chamomile, wormwood, currant leaves, birch leaves, celandine, oats, mistletoe branches, wheatgrass, yarrow.
3. A collection of rosehip, wheatgrass, calamus root, burdock, black poplar.
4. A collection of barberry leaves, rose hips, lingonberry and strawberry leaves, elder flowers, primroses, and calendula.
5. Collection: barberry, buckthorn bark, maple leaves, birch leaves, periwinkle, calamus, red clover flowers.
6. Infusion of hop cones with alcohol.
7. Alcohol infusion of fresh willow catkins.
8. Ivan tea decoction.
9. A water or alcohol infusion of young thuja shoots covered with leaves. (Caution! Thuja is poisonous in large quantities).
10. Rectal suppositories and propolis baths.

How to treat prostate cancer in men

To treat prostate cancer, there are medical, surgical, and radiotherapeutic methods. The choice depends on the nature of the tumor and the patient's condition.

Is there a cure for prostate cancer in men?

Prostate cancer can be treated quite successfully if it is detected at a stage when there are no metastases . In cases where the tumor begins to spread through the blood and lymph system, settling in the bones, lungs, and lymph nodes, the disease is considered incurable. All that remains is to control its development, periodically “catch” relapses and put them into remission. Some men manage to live like this for more than 5 years.

Observation

Sometimes clinically insignificant forms of cancer are discovered, the treatment of which may cause more harm to the patient than good. In such cases, doctors prefer dynamic observation. This is a kind of delayed treatment.

Indications:

• The predicted life expectancy is less than 10 years.
• High tumor differentiation. The survival rate for such forms is 87%, and for poorly differentiated forms it is only 34%.
• Localized tumor that does not grow beyond the capsule (T1a T2cN0M0).
• Severe concomitant pathologies.

Dynamic surveillance for cancer is important for older men after 70 years of age.

Hormonal therapy for prostate cancer

Hormonal therapy for prostate cancer is carried out as monotherapy for incurable tumors to maintain the patient's condition, and also as an addition to surgical and radiation methods.

If diagnostics during follow-up reveals signs of cancer progression, then hormonal therapy is prescribed. The tumor develops faster with high testosterone levels, so the oncologist’s task is to reduce it with the help of antiandrogen drugs.

Methods of hormonal therapy:

1. Treatment with LHRH agonists (luteinizing hormone releasing hormone). These are synthetic analogs of the hormone produced by the hypothalamus. They act on the receptors of releasing hormone and reduce their sensitivity to it, as a result of which a biochemical chain reaction is launched, during which the production of testosterone is reduced. Drugs: Goserelin, Triptorelin, Buserelin.
2. Treatment with LHRH antagonists. The substances competitively bind to LHRH receptors located in the pituitary gland, as a result, LHRH itself remains free, and testosterone levels drop. Drugs: Degarelix.

1. Castration (androgen deprivation). Read more about chemical castration methods.
2. Estrogen therapy (female sex hormones). Their task is to block luteinizing and follicle-stimulating hormones in order to reduce testosterone production. In addition, they directly inhibit testicular activity.
3. Androgen blockade with steroid (cyproterone) and non-steroidal (flutamide) drugs. the former block testosterone receptors in the prostate, and the latter competitively bind to them. As a result, the level of testosterone and its derivatives decreases.

The above methods can only control hormone-dependent prostate cancer. After 1.5-2 years of treatment with hormones, the tumor stops responding to them - a hormone-resistant phase begins. This is due to the constant mutation of cancer cells and changes in their genomes. A tumor that has stopped responding is called hormone-independent, or hormone-refractory (castration-refractory prostate cancer). In such cases, second-line hormones (abiraterone) or chemotherapy (docetaxel, cabazitaxel) are used. The use of another class of hormones is justified by the fact that the sensitivity of the tumor does not disappear to all, but mainly only to androgens. Changing therapy helps me last another six months .

Therapy for hormone-refractory cancer

Castration for prostate cancer

Removal of the testicles (orchiectomy) is performed to radically reduce testosterone levels so as not to provoke tumor growth .

Castration can be performed either by surgical removal or by medication using drugs that suppress testicular function. In the second case, the process is reversible, so surgical castration is usually used as the gold standard for radical hormonal therapy for prostate cancer.

Forecast

Which doctor can give a prognosis for prostate cancer depends on the stage of the newly diagnosed disease. Detection in the early stages increases the patient’s chances of completely defeating the disease. In Germany, for example, special attention is paid to this disease; men undergo regular examinations and only 18% are diagnosed with prostate cancer. In America, 80% of men who were given a similar diagnosis were successfully cured of cancer. A positive prognosis depends on how much attention you pay to your health.

FAQ

1. How do people die from prostate cancer? Differently. Some refuse to eat and drink due to constant pain and weakness. The body is no longer able to fight either the consequences of treatment or the tumor itself. Others die in intensive care due to intoxication from painkillers.
2. Disability group. Group 1 is assigned to stages 3 or 4, as well as after radical treatment methods. Group 2 – with a loss of 60 to 80% of working capacity. Group 3 is given for stage 1 or 2, as well as after chemotherapy.
3. Is it possible to go to the sauna if you have prostate cancer? In the initial stages it is possible, but then the patient himself will not want to because of dizziness and nausea.
4. Is it possible to have sex with prostate cancer? It is possible and necessary if the patient feels normal. Cancer is not contagious. The only condition is to wait a pause after brachytherapy.

Folk remedies for prostate cancer

Treatment of prostate cancer with folk remedies includes:

1. Immunotherapy with bee preparations Savin, which suppress cancer. It reboots the immune system to fight cancer. At the same time, mononuclear cells are activated, the number and activity of natural killer cells increases, the production of interferons, a number of necessary cytokines and nonspecific protective factors against the tumor are enhanced. The natural process of healing the body begins.
2. Use of pomegranate to reduce the effects of cisplastin toxins. Laboratory studies show that pomegranate is more effective than Taxol (cytostatic Paclitaxel). Pomegranate juice contains many substances that suppress cancer cells: flavonoids, anthocyanins, tannins (ellagic acid, quercetin, punicalagin). The most active antioxidant of pomegranate is punicalagin; it contains catechins, as in green tea.
3. Silymarin, which is contained in milk thistle, enhances the effect of chemotherapy and reduces its side effects.

It is important to know! Shiitake, Meitake, reishi, cordyceps and birch chaga mushrooms have anti-cancer properties. They renew the immune system and slow down tumor growth.

Shiitake, with the help of the lentinan polysaccharide, Cordyceps, tones, prolongs life, like ginseng, and exhibits anti-cancer activity. Reishi activates the immune system and increases its antibacterial, antiviral and antifungal properties.

Meitake mushrooms are able to suppress the growth of cancer cells and stimulate apoptosis (programmed death) of cells. A mushroom extract (D-fraction) with anticancer activity prevents the development of metastases. Meitake inhibits angiogenesis (vascular growth) by decreasing levels of the growth factor VEGF.

Traditional medicine in a comprehensive cancer treatment program

Treatment of prostate cancer with folk remedies has become part of complex therapy. The basis of traditional treatment is the correct diet with diuretic products at the head: vegetable soups with herbs, salads and juices from vegetables, fruits and berries, dairy products, weak coffee and tea, decoctions of herbs and rose hips. Vegetables and fruits are useful in fresh, boiled and baked form, berries - in any form.

There should be no fatty meat, eggs, wheat bread, animal fats, fried or spicy foods on the menu. It is better to boil meat, rabbit, chicken and add it to a side dish of vegetables or solid pasta, to buckwheat or rice porridge.

Note! With prostate cancer, it is important for men to control their own weight, especially with ductal and hormone-resistant forms of cancer.

Ductal prostate cancer is more common in overweight men. In an unhealthy diet that is low in fiber and high in fat and calcium, saturated fat increases testosterone synthesis. Testosterone is known to promote the growth of cancer cells, including high-grade ones. Then, out of 10 cases of ductal cancer, 9 diseases will be ductal adenocarcinoma or small acarcinoma. This type of cancer starts from a cell that lines the prostate duct. The rate of its growth and spread is much faster and more active than acinous adenocarcinoma. Cancer of this form is characterized by an aggressive course and is poorly sensitive to hormone therapy. Therefore, they perform prostate surgery and chemotherapy after it. Medicinal herbs are prescribed to prevent nausea and vomiting.

Hormone-resistant prostate cancer progresses indolently, without clinical manifestations for a long time. But it takes many lives, despite demonstrating good response to first-line antiandrogen hormone therapy. At the same time, the intensity of bone pain and blood PSA levels decrease, and regression of soft tissue metastases occurs. Unfortunately, the response to primary hormone therapy lasts 12-18 months.

In addition to surgical methods, the comprehensive program for hormone-resistant cancer includes treatment for bone pain, pathological fractures, obstruction of the urinary tract and ureters, spinal cord compression syndrome, disseminated intravascular coagulation syndrome, anemia and edema.

The comprehensive program includes the following treatment for prostate cancer:

• radiation, chemotherapy, hormone therapy;
• surgical stabilization;
• drugs of the group: taxanes, estramustines, mitoxantrones, Vinca alkaloids;
• standard therapy
• biosphosphonates, steroids, analgesics;
• DIC syndrome - Heparin, Epsilon-aminocaproic acid, red blood cell transfusion, FFP, etc.;
• iron supplements and vitamins;
• bone marrow stimulants for anemia;
• diuretics and decoctions and/or infusions of diuretic herbs for edema;
• aspen bark, lungwort, microenemas from decoctions of medicinal herbs: mantle, oregano, plantain and uterus, rectal suppositories.

Mushroom therapy is becoming increasingly popular due to the presence of anticancer components in some mushrooms, such as Golovach, Winter honey fungus, Birch chaga, Reishi, Meitake and Shiitake, and Cordyceps.

It is recommended for the prevention of prostate cancer daily:

• eat dried mushroom and chew it thoroughly;
• drink a drink - Koporye tea made from fireweed leaves after their fermentation.

Fireweed leaves have no toxic properties and a decoction or tincture of them can be taken long-term for adenoma and prostate cancer.

To get tea (infusion) from fireweed leaves, you need to slightly wither them, then twist them into flagella until the juice is released. They are covered with a damp cloth and placed in a warm place for fermentation for 6-8 hours. After this, each flagellum turns black and acquires the smell of fruit. They are cut, placed in the oven and dried at a temperature of 40-50ºC. This brew is stored in a container with a tight-fitting lid. Brew instead of tea and drink all day without setting dosages.

Stages of oncology

Carcinoma can develop in the prostate gland over many years without spreading beyond the organ. If therapy is not started in a timely manner, the tumor will constantly grow and extend beyond the prostate.

Malignant carcinoma cells can spread throughout the body in three ways:

• lymphogenous - tumor cells spread through the lymph through the lymphatic vessels, penetrating the lymph nodes;
• hematogenous - metastases spread through the bloodstream, affecting distant tissues and other organs;
• invasive - carcinoma infiltrates into nearby healthy tissue.

The prevalence of cancer depends on the current stage of development of the pathology.

Stages of development of prostate carcinoma:

1. The first is that the size of the tumor is small, which is why it cannot be determined by rectal examination. The presence of pathology can only be detected through microscopic examination of gland tissue.
2. The second is that with the help of ultrasound (ultrasound), the presence of carcinoma can be determined, but it is still located within the gland capsule.
3. Third, a malignant tumor extends beyond the boundaries of the prostate and spreads to nearby tissues.
4. Fourth (final) - the occurrence of metastases is observed and their spread throughout the body, lymph nodes, vital organs and bone tissue are affected.

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To determine the stage and type of tumor, it is necessary to carry out a number of diagnostic measures. Prognosis for patients may vary and depend on the extent of the cancer.

Symptomatic manifestations

In addition to natural causes, primarily associated with age-related changes, there are a number of others that provoke the occurrence of prostate cancer. Unfortunately, both groups of these disease-provoking factors do not manifest themselves with obvious and specific symptoms for a long time, and if they do arise, they are very similar to the manifestations of other, less dangerous diseases and do not cause due concern.

All this leads to the fact that the overwhelming number of men suffering from this disease find out about it at best at the 2nd stage of the disease, and often at the advanced stage - the third. The stage of active cell division of a malignant tumor is characterized by:

• Various disorders of the urinary system - from difficulty urinating to complete blockage of the ureter, which require immediate catheterization, otherwise the resulting stagnation will not only activate the disease, but can also complicate it with kidney problems. Sometimes the opposite picture is observed - partial and even complete incontinence;
• When a tumor grows through the capsule of the gland, the affected tissues and organs adjacent to it acquire atypical dysfunction, and trophic processes are disrupted. This is expressed by discomfort and pain, problems with erection and the appearance of blood in the ejaculate;
• The growth of the tumor and the occurrence of metastases also causes pain, usually in the lumbar and bone tissues, and their intensity is quite high, especially at night. Further development of the process leads to a sharp decrease in the concentration of hemoglobin in the blood, severe weight loss, swelling of the legs, and with compression (compressing the spinal cord) metastases in the spine, partial or complete paralysis is possible.

If the cancer tumor consists of cells of an undifferentiated nature, the described symptoms are extremely severe, and the survival prognosis is extremely negative.

In view of the above, early diagnosis of the disease is especially important, and it is impossible without regular examination by a specialist. Men who have reached the age of 35 should consult a specialist annually, and those who have crossed this milestone every six months. Understanding risk factors and preventing the disease is also of great importance, especially for people who are genetically predisposed.

Classification

First, let's say how prostate cancer is coded according to ICD-10. Why do people without medical education need to know this? Yes, simply because sometimes doctors have already made their diagnosis of a malignant neoplasm and written a code in the medical history. And the patient is given comforting false diagnoses. Therefore, if a patient sees that the medical documents contain code C 61, then this is prostate cancer.

TNM Features

For accurate diagnosis, which provides the key to treatment, it is necessary to correctly stage prostate cancer. A mistake can have fatal consequences. The staging is based on the clinical-morphological classification (TNM). It is used for all neoplasms where:

• T—description of the primary tumor;
• N - description of regional lymph nodes through which cancer cells primarily spread;
• M is the presence of metastases in prostate cancer.

If a urologist makes a diagnosis of T1, this means that the tumor cannot be determined in any way during a rectal examination, or it is very small. Such a tumor can be detected accidentally, for example, during transurethral resection of the prostate in the treatment of adenoma. After all, the tissue removed during resection is examined, and cancer can be accidentally found there. T1 - if the tumor does not occupy less than 5% of the removed tissue.

If the diagnosis is T2, this means that the tumor can be anything, but does not extend beyond the prostate gland. T3 indicates tumor growth beyond the capsule of this organ. If the diagnosis is T4, then this indicates that it has already grown far away, for example, into the rectum, into the pelvic muscles, or into the neck of the bladder.

The situation is similar with lymph nodes. N0 - the nearest lymph nodes are not affected, and there are no metastases. N1 is when there is at least one metastasis. In this case, we are talking about those pelvic lymph nodes that lie below the common iliac arteries.

As for the last category M, these are metastases further than the lymph nodes, which are called distant. For example, bone metastases from prostate cancer. M0 - no metastases (M will definitely be noted even with the most insignificant tumor), M1 - detected. In this case, it is also necessary to take into account whether the metastases have advanced beyond the lymph nodes or not. Thus, category M1A is metastases to distant lymph nodes that are further than regional ones, and M1B is metastases to bones, lungs, and brain.

Gleason score

There is another classification that indicates the aggressiveness of cancer tumors. It is called the Gleason scale, and has a gradation from 2 to 10. The higher the score, the less cell differentiation, the higher the malignancy and aggressiveness. Naturally, this requires a biopsy and a full histological examination. This scale is important, since zone 6-7 on this scale allows you to determine the type of radiation therapy.

Urologists have noticed that if the tumor volume is less than half a cubic centimeter, classification T1-2, and the tumor scores less than 6 on the Gleason scale, then most often such cancer will not progress, complications will not develop, and such tumors will never bother a person in his life. In other words, he will die from other causes. If the values ​​exceed those indicated, then clinically significant prostate cancer develops, and it is this that requires immediate treatment.

What are the symptoms of prostate cancer?

Signs of prostate cancer metastases to other organs

Skeleton

Prostate cancer most often metastasizes to the bones (50 to 70% of all metastases). And in half of the cases these are the lumbar and thoracic vertebrae, less often - the pelvic or hip bones; there may be multiple lesions of the skeleton.

It is severe back pain that usually forces a patient with stage 4 prostate cancer to see a doctor.

Pain with metastatic bone lesions gradually increases and intensifies at night. Conventional painkillers help little. If there are dropouts in the vertebrae, they become compressed, the nerve roots are compressed, and walking function is impaired. Such patients often suffer pathological fractures at the slightest awkward movement.

Vertebral deformities can cause spinal cord compression. Gradually, such patients stop walking without assistance, and pelvic function disorders may occur (control over urination and defecation is lost).

With the destruction of bones, the level of calcium in the blood increases, which can cause disturbances in the heart (blockade, arrhythmias), and from the gastrointestinal tract - constipation, abdominal pain, nausea, vomiting.

Liver

In second place in terms of the frequency of formation of tumor screenings.

Single lesions in this organ may not produce any symptoms. If multiple lesions occur, then the following are determined:

• Yellowness of the skin.
• Pain and heaviness in the right hypochondrium with liver enlargement.
• Dilated veins on the anterior abdominal wall.
• Enlarged abdomen (ascites).
• Bleeding (nasal, rectal, gastroesophageal).

Distribution or epidemiology

The problem of prostate cancer is indeed very acute. Unfortunately, this is a very common disease. If we take all cancer diseases in men, then prostate cancer ranks firmly third in the world.

In the USA it comes first because life expectancy there is quite high. Prostate cancer is mainly a disease of old age. In Western Europe, this is a solid second place, but in our country prostate cancer is in fourth place.

In 2019, more than 12,000 people died from this disease in our country. Why? Because of the long-suffering of Russians. That is why the percentage of cancer detected in the last stages, with the presence of metastases, is high. This is approximately 17.5% of all cases of newly diagnosed patients each year. The first place among Russian men is taken by lung cancer, the second by stomach cancer, and so on.

Surprisingly, in Japan and China, this disease is quite rarely recorded, despite the fact that there are a large number of elderly people there. Thus, in Japan, the prevalence of prostate cancer is 100 times less than in the United States.

Unfortunately, the number of cases increases every year. The so-called increase is 3% annually. In the Russian Federation, this figure is twice as high, and the growth in our country is explained by other reasons.

If in developed countries the average life expectancy is constantly increasing, and, accordingly, the corresponding diseases are increasing, then in our country there is no increase in average life expectancy, and especially an explosive one.

Here the matter may be about a significant deterioration of the environmental situation, about careless medical examination, which simply increases the chances of the development of malignant neoplasms. Failure to adhere to the principles of a healthy lifestyle (inactivity) and other factors are also important. So what are the causes of prostate cancer?

Symptoms

Regardless of the cause of prostate cancer, the symptoms of the disease are the same in most men.

There are no initial symptoms of the development of the disease. Therefore, without special diagnostics, it is impossible to suspect the presence of an oncological process in the genitourinary system.

The first signs of cancer development in men are mild. Many people don’t even pay special attention to them, so they don’t see a reason to contact a specialist. This period of the disease is usually accompanied by the appearance of blood impurities in the seminal fluid, sexual dysfunction and difficulty urinating. Similar symptoms may be characteristic of another pathology, so if they are detected, you should not stress yourself out. You just need to contact a specialist and get diagnosed.

Frequent urination is one of the warning signs of pathology

More obvious signs of prostate cancer appear when the malignant tumor grows to a certain size. It begins to compress the walls of the bladder, resulting in an increased urge to go to the toilet. A man can experience this need more than 15 times a day.

The cancer continues to develop, causing its symptoms to become even more severe. Early signs include painful urination and a constant feeling of a full bladder. Going to the toilet does not solve this problem.

There are other symptoms of cancer in men that affects prostate tissue:

1. Urinary incontinence.
2. Formation of kidney stones.
3. Pain in the lower abdomen, lumbar area and perineum.
4. Swelling of the lower extremities and genitals.
5. Sexual dysfunction.
6. Blood in urine and semen.

Men also experience other signs of cancer, such as a dry cough or painful bowel movements, if there are metastases to other parts and internal organs.

The increase in the severity of painful symptoms often takes several years. To prevent the disease from actively progressing, at the first suspicion of illness, you should contact a competent specialist.

Treatment of prostate carcinoma

When carrying out complex therapy the following is prescribed:

• Radical prostatectomy is an operation to remove the prostate gland and seminal vesicles using approaches: pertoneal or retropubic. In this case, an anastomosis of the bladder and urethra is formed.
• Rescue prostatectomy as the final stage of treatment for patients with little effect of radiation.
• Radiation therapy using an external radiation source: protons and neutrons, linear accelerators, cobalt. Or the direct introduction of interstitial microcapsules containing gold - 198, iodine - 125 and iridium - 192.
• Endocrine therapy to reduce circulating levels of testosterone that affects the prostate gland and/or interferes with testosterone metabolism by epithelial cells. In this case, prostate cells atrophy and die, reducing tumor progression.
• Analogues of luteinizing hormone releasing hormone (RH/LH) to reduce the level of circulating LH and, due to this, disrupt the secretion of testosterone by Leydig cells in the testes.
• Complete blockade of androgens to prevent the production of testosterone by the testicles: castration or the use of RH\LH analogues. Or they stop the action of other circulating androgens, for example, those produced in the adrenal glands. An androgen such as Flutamide prevents the binding of dihydrotestosterone and a specific cytoplasmic receptor.
• nutrition for prostate cancer to replenish the body with microelements, vitamins, anticancer substances, restore normal metabolism and peristalsis of the body;
• folk treatment of prostate cancer to maintain immunity and restore the body's protective functions.

Only comprehensive treatment of prostate carcinoma can provide a positive prognosis for patient survival among the male population.

Causes and risk factors

The cause of adenocarcinoma is the same as that of most cancers - the inability of antitumor immunity to cope with the emerging tumor cell. It is more correct to talk about risk factors for prostate adenocarcinoma as a separate type of tumor. These include:

1. Patient's age. This type of tumor is much more common in older men.
2. Heredity. There is a genetic predisposition to prostate adenocarcinoma. Persons whose relatives suffered from these diseases are at greater risk than those who did not have such a pathology in their family.
3. Hormonal background. Research is currently underway to better define which hormones are key in increasing the risk of prostate cancer. Today it is known that disruption (most often due to age) of the normal hormonal balance leads to an increased risk.
4. External factors. These include working in hazardous industries, infections, poor nutrition, and excessive sun exposure.

Separate mention should be made of precancerous diseases. These are atypical hyperplasia and intraepithelial neoplasia of the prostate. Atypical hyperplasia is an optional precancer of the prostate, i.e. its transition to cancer is possible, but not obligatory. Intraepithelial neoplasia is an obligate precancer that, without proper treatment, invariably leads to adenocarcinoma.

Prevention

Despite the advances of modern medicine, there is still no effective way to prevent the occurrence of cancerous tumors. However, it is possible to significantly reduce the risk of cancer. For this, doctors recommend:

1. Adhere to proper nutrition, which consists of a predominance of fresh vegetables and fruits in the diet while simultaneously reducing the amount of fat.
2. Avoid eating foods high in carcinogens that promote cell mutation. In addition to food, carcinogens are present in tobacco smoke and hazardous industries.
3. Play sports and lead an active lifestyle.

1. Get enough sleep.
2. Avoid stagnant processes in the pelvic area. This is facilitated by exercise and regular sex life.
3. Be regularly examined by a urologist.

Prostate cancer is a dangerous disease that requires long and complex treatment. However, unfortunately, it is not always possible to achieve a complete cure and save the patient’s life. Therefore, in order to avoid unpleasant consequences, doctors recommend an annual examination by a urologist and always respond to any changes in the genitourinary system.

Localization

To say that cancer forms “inside the prostate gland” is completely insufficient. There are 5 zones in the gland. These are the center zone, the periphery, the transition zone, the area surrounding the urethra and the so-called anterior fibromuscular stroma.

Interestingly, the central and peripheral zones together make up 95% of all glandular tissue. However, in the central part (20% of the gland’s volume), for some reason, cancer forms no more often than in 10% of cases.

But the peripheral zone (by the way, it is this zone that can be palpated through the anus) is the source of about 80% of all prostate adenocarcinomas. Of course, if there is no glandular tissue, then adenocarcinoma, that is, a tumor arising from the glandular epithelium, cannot develop at all. Therefore, cancer never forms in the fibromuscular stroma.

Many men ask the question. If they have a benign prostate adenoma removed (there is an article about BPH, or adenoma), then is this cancer prevention, and can we stop worrying? Unfortunately, this question must be answered in the negative. The fact is that cancer and adenoma arise from different parts of the gland. These are completely different diseases, and therefore removal of the adenoma does not in any way affect the risk of cancer.

For the development of cancer, it is not the adenoma that is important, but a condition called transitional, or precancerous. This is the so-called prostatic intraepithelial neoplasia. In this condition, cellular changes occur in the structures of the secretory epithelium, in the area of ​​the prostatic ducts.

There are several degrees of neoplasia: 1, 2 and 3. So, in patients, according to biopsy data, in whom grade 3 neoplasia has existed for several years, a repeat biopsy reveals reliable cancer in 40-90% of all cases.

What are the grades of prostate cancer, and how is it classified?

Preventive actions

In modern medicine, there are still no ways to prevent the appearance and development of malignant neoplasms of the prostate by 100%. But doctors have developed recommendations to help reduce the existing risk:

• Proper nutrition - limiting the consumption of fatty meats and including fresh fruits and vegetables in the diet;
• Exclusion of carcinogens - these substances cause cell mutation, predominate in food additives, cigarettes, and hazardous industries;
• Active lifestyle - morning exercises and walking to strengthen blood vessels, heart and boost immunity;
• Sound sleep - during sleep, the body secretes the hormone melatonin, which protects against the development and formation of tumors;
• To avoid congestion in the prostate, maintain regular sex life and exercise, especially for men with a sedentary lifestyle. These measures will help avoid inflammatory processes and ensure the outflow of prostate juice;
• Regular examination - after fifty years, once every 2 years it is necessary to take a PSA test, undergo prostate cancer screening and ultrasound of the prostate gland. It is recommended that those suffering from adenoma and prostatitis be examined annually.

Attentive attention to your health and timely visits to doctors at the first signs of illness will allow you to successfully overcome the disease and live for many years.

Symptoms

Prostate carcinoma may not show itself for a long time. The first serious symptom indicating prostate cancer is the presence of blood in the urine and semen. Blood getting into the urine is due to the fact that as carcinoma grows, it primarily affects blood vessels. In the later stages of development, blood impurities can be detected in the stool.

There are also other possible clinical manifestations indicating the appearance of a tumor:

• the presence of mucous discharge from the urethra;
• pain in the groin, perineum and lower back;
• burning and stinging sensation during urination;
• impaired urination, which may manifest as partial or complete incontinence;
• deterioration of erection.

Often, patients' symptoms manifest themselves individually. Without adequate treatment, as the tumor grows, an inflammatory process occurs in the regional lymph nodes. In the final stages of carcinoma development, patients experience paralysis of the lower extremities, as spreading metastases affect bone tissue and the spinal column.

Differences between adenocarcinoma and adenoma

In some cases, patients confuse two fundamentally different concepts - prostate adenocarcinoma and prostate adenoma. BPH is called benign prostatic hyperplasia, which also causes prostate growth and disruption of its function, but is not cancer. Symptoms may be similar, but treatment approaches and prognosis are different, so it is important not to confuse these two diseases. It should also be noted that an adenoma, although not cancer, can cause serious complications and can become malignant, and also requires attention and treatment from a specialized specialist.

Tumor treatment

The course of treatment for prostate cancer is prescribed individually and depends, first of all, on the patient’s age, concomitant pathologies, stage of the oncological process and the patient’s wishes.

There are also contraindications to treatment, which include: the patient’s advanced age, severe diseases of the heart, blood vessels and respiratory organs. Because in this case, therapy may turn out to be much more dangerous for them than the tumor. If the diagnosed tumor is located within the organ and is not growing, the doctor will recommend watchful waiting. In this case, the man needs to undergo examination several times during the year.

Treatment tactics for prostate cancer

Surgical treatment

One of the main treatment methods is surgical removal of prostate cancer. It is performed on most patients under 65 years of age.

During the operation, an incision is made in the lower abdomen through which the prostate is completely removed (prostatectomy). In addition, the doctor cuts off the tissue located around the gland and, if necessary, the lymph nodes. The duration of such an operation is from 2 to 4 hours. It is performed under general or epidural anesthesia.

Modern medicine offers the latest way to perform an operation using a robotic surgeon, whose actions are controlled by a doctor. Surgery is performed through small punctures. The doctor controls the robot from a working console, which may be located far from the operating table. Reviews show that this makes it possible to avoid many complications, among which impotence or urinary incontinence is common after removal of the prostate. The video shows robot-assisted nerve-sparing laparoscopic radical prostatectomy:

If the tumor is diagnosed within the prostate, then removing the prostate makes it possible to completely defeat prostate cancer. However, if it has managed to spread to neighboring organs, the prognosis worsens. In this case, the patient is additionally prescribed radiotherapy or chemotherapy.

Chemotherapy

Special drugs containing toxins help destroy tumor cells. These substances are destructive to actively dividing tumor cells, which distinguishes them from all others. The death of a tumor occurs due to the destruction of the membrane and nuclei of its cells.

Chemotherapy for prostate cancer is prescribed at stages 3 and 4 of the disease, when the tumor has grown significantly and has metastasized. Through the bloodstream, toxins spread throughout the patient’s body, recognizing and attacking cancer cells.

The drugs are generally administered intravenously, but sometimes they can be taken in tablet form. The average duration of treatment is 6 months.

Despite the fact that cancer cells in the prostate are very sensitive to such treatment, they are practically not used at stages 1 and 2 of the disease. This is due to the fact that they can cause various side effects, the most common of which are: general weakness of the body, hair loss, etc.

How to cure prostate adenoma without surgery? Read the detailed article.

Radiotherapy

This treatment method is based on the action of x-rays (beta, gamma, neural, etc.). Radiation acts in such a way that the DNA of tumor cells is disrupted, and this leads to the impossibility of their division and further death.

For this, a linear accelerator is used. This procedure is prescribed when the tumor has reached a significant size and has begun to metastasize. Not only the malignant tumor, but also the lymph nodes are exposed to irradiation. Therapy is carried out 5 times a week for 2 months. The procedure itself takes about 15 minutes and is absolutely painless.

Brachytherapy procedure

A type of radiotherapy is brachytherapy - the injection of a radioactive substance in small doses directly into the affected organ. For this purpose, radioactive iodine or iridium is used. After brachytherapy, the tumor dies. At the same time, healthy cells receive virtually no radiation, which makes it possible to avoid various complications and side effects.

To administer the substance, the patient is given general anesthesia. Some techniques are based on the introduction of radioactive granules into the prostate, which then remain there.

Radiation is prescribed both at the very beginning of the oncological process, which allows treatment of stage 2 prostate cancer without surgery, and when treatment of stage 4 prostate cancer is necessary.