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Prostate cancer is one of the most common male malignant neoplasms in Poland. In terms of the incidence among men, prostate cancer is in second place - only lung cancer is more common. The number of diagnoses of prostate cancer has increased with the spread of the PSA test - a cancer marker useful in the diagnosis of this cancer. Thanks to it, prostate cancer is more and more often detected in the early stages of its advancement. Find out what the symptoms of prostate cancer are, what diagnostic tests are important to diagnose prostate cancer, what is the staging of prostate cancer, and how is prostate cancer treated?

Prostate cancer( prostate cancer ) is a malignant tumor that results from the conversion of normal prostate cells into neoplastic cells. Such cells undergo continuous, uncontrolled proliferation that leads to an enlarged prostate. A characteristic feature of cancer cells is their spread to other organs. Initially, the prostate cancer infiltrates nearby organs - the bladder, ureters, and rectum. Cancer cells can also spread to nearby lymph nodes. Over time, prostate cancer may metastasize to distant organs. The location of such metastases typical of prostate cancer is in the bones, in particular in the vertebrae of the lumbar spine. Much less often, prostate cancer has metastasized to the lungs, liver or brain. It is worth knowing that in many cases prostate cancer grows slowly and does not spread beyond the prostate gland for a long time.

The prostate gland, commonly known as the prostate, is a small organ of the male genitourinary system. The prostate is in the pelvis, below the bladder. The urethra runs through the center of the prostate, while the rectum adjoins it on the posterior side. The prostate's main function is to produce mucus, which is one of the main components of sperm. The anatomy of the prostate plays a large role in the diagnosis of diseases of this gland.

Enlarged prostate can cause difficulty urinating due to pressure on the urethra. The close proximity of the rectum allows for a transrectal examination of the prostate (per rectal examination and the so-called ultrasound scan)transrectal).

The most common prostate disease is benign prostatic hyperplasia. Benign prostatic hyperplasia is an enlargement of the prostate, which may result in urination disorders (increased urge to urinate, the need to urinate at night, and in extreme cases - complete urinary retention). Benign prostatic hyperplasia is a very common non-malignant disease and always requires differentiation from prostate cancer.

Finding prostate cancer in the early stages of development gives you the best chance of a full cancer recovery.

Prostate cancer - symptoms

Early stage prostate cancer may not cause any discomfort. Currently, prostate cancer is often detected as asymptomatic (due to, among others, the widespread PSA test). Symptoms commonly associated with prostate dysfunction are problems with urination.

The feeling of incomplete emptying of the bladder, a reduction in the strength of the urine stream, the need to urinate more often than before are indeed symptoms that may result from prostate diseases. Such symptoms should always be consulted with a doctor. However, it is worth remembering that their most common cause is benign prostatic hyperplasia.

Enlargement of the prostate causing pressure on the urethra is much less often due to the presence of cancer, although of course it should be excluded in all cases. Erectile dysfunction can also be the first symptom of prostate cancer, as well as blood in the urine or blood in the semen.

The more advanced prostate cancer becomes, the more ailments it causes. A tumor spreading in the pelvis puts pressure on adjacent organs, which can result in urinary retention, constipation and recurrent lower abdominal pain. Late symptoms of prostate cancer result from the presence of metastases to distant organs. The most characteristic metastases of prostate cancer are bones.

In rare cases, the first symptom of prostate cancer may be bone pain and the so-called pathological fractures, resulting from the weakening of the internal bone structure. Many years of advanced neoplastic process lead to gradual destruction of the body. Late symptoms of prostate cancer include weight loss, loss of appetite, and chronic weakness.

Prostate cancer - who has it?

The exact causes of prostate cancer remain unknown. The most important risk factors for the development of prostate cancer are, of course, male gender and age. Prostate cancer is rare in men under 50 years of age. The risk of developing prostate cancer increases with age.The vast majority of prostate cancer cases occur in patients over 65 years of age.

Interestingly, postmortem studies have shown that the frequency of prostate cancer in men over the age of 80 may be as high as 50%. Prostate cancer is in many cases a low aggressiveness cancer that does not cause any clinical symptoms. Outbreaks of this tumor have been found frequently in elderly patients who died from other diseases, not related to prostate cancer.

Regulation of prostate function is mediated by male sex hormones, mainly testosterone and its derivatives. Prostate cancer is considered a hormone-dependent cancer - male sex hormones can stimulate the growth of cancer cells.

This relationship is used, among others, by in the treatment of advanced prostate cancer. Hormone therapy, which consists in inhibiting the production of male sex hormones, is one of the basic methods of treating patients who cannot undergo radical treatment.

Genetic factors play a role in the development of prostate cancer. Prostate cancer with a genetic burden can run in families. Prostate cancer in the closest relatives (father, brother) is associated with a several-fold increase in the risk of this cancer. In such situations, it is advisable to conduct preventive examinations earlier and more frequently.

One of the genetic factors associated with an increased risk of developing prostate cancer are mutations in the BRCA1 and BRCA2 genes, which are also an important risk factor for the development of breast cancer.

The risk of developing prostate cancer is also related to ethnicity - the incidence of prostate cancer is higher among black men.

Prostate cancer - diagnosis

In order to make a diagnosis of prostate cancer, it is necessary to undergo a series of diagnostic tests. The first step is a medical interview, the purpose of which is to gather information about the patient's ailments, his comorbidities and the presence of prostate cancer in the family.

Initial physical examination of the prostate is performed by inserting a finger into the rectum (examinationper rectum ). Due to the close proximity of the prostate to the rectum, such an examination makes it possible to assess the size of the prostate, its soreness and possible changes in its structure. Rectal examination provides valuable information that may be an indication for in-depth diagnosis.

It is worth knowing, however, that such a study is informative and does not allow to distinguish prostate cancer from benign changes. If abnormalities are found on the rectal examination,additional research is necessary.

  • Prostate cancer - tumor markers

The best-known marker used in the diagnosis of prostate diseases is PSA - a specific prostate antigen. PSA is a protein that is produced by prostate cells and then released into the bloodstream. A blood test for PSA is commonly referred to as prostate cancer screening.

It is worth knowing, however, that the PSA test has some limitations, and its interpretation should be performed by an experienced specialist. Simply put, an increased PSA concentration does not always mean prostate cancer, and normal PSA concentration does not always rule it out.

A result below 4 ng / ml is considered the norm of PSA concentration. Increasing PSA levels may be a symptom of prostate cancer, but an increase in levels of prostate cancer can also have many other causes (inflammation of the prostate, benign prostatic hyperplasia, pelvic surgery, bladder catheterization, recent ejaculation).

On the other hand, there are cases of prostate cancer in which PSA levels remain normal. PSA should therefore be considered a useful marker, but it does not allow for a certain exclusion or confirmation of prostate cancer.

Increased PSA concentration, as well as clinical data suspecting prostate cancer are indications for histopathological examination, which allows to obtain a reliable diagnosis.

  • Prostate cancer - imaging tests

Examinationper rectumdoes not allow for an accurate assessment of the volume and structure of the prostate. For this purpose, imaging tests are used, the most common of which is ultrasound examination (USG).

Prostate can be visualized in traditional transabdominal ultrasound, although the technique "dedicated" to this organ is transrectal ultrasound (TRUS). This examination involves inserting a small ultrasound probe into the rectum to obtain an accurate picture of the prostate. The advantages of ultrasonography are low cost, high availability and low invasiveness of the examination.

Unfortunately, not all prostate tumors are visible on ultrasound. Magnetic resonance imaging is used to visualize the prostate and the surrounding organs more precisely. This examination allows you to visualize all the structures of the abdominal cavity and pelvis, making it useful both in the detection of prostate cancer and the assessment of the extent of the neoplastic process.

In more advanced cases of prostate cancer, additional tests are performed to locate any tumor metastasis. Depending on the patient's indications and symptoms,usually computed tomography of the abdominal cavity, chest, and sometimes also a CT of the head.

Bone metastases typical of prostate cancer are most often detected by scintigraphy. Scintigraphy involves introducing a radioactive tracer into the body, which accumulates in the bone fragments affected by the neoplastic process.

  • Prostate cancer - histopathological examination

Testper rectum , PSA levels, and imaging tests may indicate suspected prostate cancer. A certain diagnosis of a neoplasm is possible only by performing a histopathological examination and visualizing neoplastic cells in a material taken from the prostate.

The material to be tested is obtained in a biopsy, i.e. a prostate puncture with a special needle. To increase the chance of detecting abnormal tissue, usually several (about 10) samples are taken from different zones of the gland.

Prostate biopsy is most often performed under transrectal ultrasound control, which allows you to control the location of the collected material. Histopathological examination allows for the diagnosis of prostate cancer, assesses the degree of malignancy of the neoplasm and provides preliminary information on the prognosis of a given patient.

  • Prostate cancer - grades and the Gleason scale

After diagnosis of prostate cancer, and before starting treatment, it is necessary to determine the severity of the disease. The Gleason scale is the tool used to assess the histological malignancy of prostate cancer.

The Gleason scale tells you how much the structure of the tumor differs from the normal structure of the prostate. The higher the Gleason score, the more abnormal the structure of the tumor - and the greater its malignancy.

Since prostate cancer may be characterized by a heterogeneous structure, the Gleason scale assesses the 2 dominant types of cancer. Each of them is assessed on a scale of 1-5, and then the result is summed up.

The final result of the Gleason scale is therefore from 2 to 10. It is also worth knowing that the order of writing both structures is important. The first structure to be noted is the structure that occupies a greater volume in the tumor.

For example, the description of prostate cancer in the Gleason 5 + 2 scale is not equivalent to the description of 2 + 5, although both of them give the sum of 7. In the first case, however, the tumor tissue rated at 5, and therefore associated with high histological malignancy, dominates . A result of 2 + 5 means that the tumor is dominated by a type 2 structure with a lower malignancy.

Gleason Scale informs about the histological malignancy of prostate cancer, which directlytranslates into the prognosis and chances of a patient's cure. Tumors with low Gleason aggressiveness are considered to score less than 6 points. The result above 8 points, however, proves the high aggressiveness of prostate cancer.

The common TNM classification is also used in prostate cancer to get a complete picture of the severity of the disease. It is a universal method of describing neoplastic diseases, taking into account 3 basic parameters of the neoplasm:

  • tumor size (T - tumor),
  • lymph node involvement (N - nodes)
  • and the presence of distant metastases (M - metastases).

The T parameter is assessed to the 0-4 degree, the remaining parameters (N and M) - to the 0-1 degree. The assessment of tumor advancement on the TNM scale requires decoding the symbols found in the results of diagnostic tests.

  • T0 means no tumor features,
  • T1 - tumor detected only by histopathological examination,
  • T2 - tumor visible in imaging tests, but not exceeding the borders of the prostate,
  • T3 - tumor that crosses the borders of the prostate,
  • T4 - tumor infiltrating other pelvic organs (e.g. bladder, rectum).
  • The features of N0 and M0 mean no metastases in the lymph nodes and distant organs, while N1 and M1 - their presence, respectively.

The appropriate classification of prostate cancer, taking into account the Gleason scale and TNM classification, allows to assign a patient to a specific risk group, and then select the best treatment strategy for him.

Prostate cancer - treatment

Various types of therapies are used in the treatment of prostate cancer. The choice of the treatment method depends on the stage of the cancer and the general he alth of the patient. Each of the available methods of therapy has specific indications - not all patients benefit from similar treatment pathways.

For this reason, the choice of therapy is always made individually. At the beginning of planning the treatment process, its goal should be established. In many patients, prostate cancer is found to be limited before it has time to spread to other organs.

Then radical therapy is undertaken, the aim of which is to get rid of the tumor completely. If the diagnosis of prostate cancer is advanced, it is impossible to fully cure the disease. The goal of the therapy is then to delay the progression of the disease as much as possible and to alleviate its symptoms.

  • prostate cancer surgery

Surgery is the basic method of treating radical prostate cancer. The operation has the best chance of success whenwhen the prostate cancer is limited and does not exceed the boundaries of the gland. The surgical procedure used in prostate cancer is called radical prostatectomy.

During the operation, the entire prostate is removed, along with the adjacent seminal vesicles and the surrounding lymph nodes. The method of carrying out the procedure depends on the experience of the center and the operating team.

Radical prostatectomy can be performed in a traditional (with the opening of the abdominal cavity) or laparoscopic (with the use of instruments inserted into the abdominal cavity through small openings).

In the most advanced centers, prostatectomy procedures are performed with the use of minimally invasive surgical robots (including the da Vinci surgical robot).

The development of modern treatment techniques is aimed at reducing the side effects of prostatectomy, such as erectile dysfunction and urinary incontinence. The gland removed during the operation undergoes a histopathological examination. The best prognosis after surgery applies to those patients who manage to excise the entire tumor with an appropriate margin of he althy tissue.

  • radiotherapy in prostate cancer

Radiotherapy plays an important role in the treatment of prostate cancer, both alone and in combination with other methods. In some patients, radiotherapy may constitute the basis for radical treatment - especially when there are contraindications to surgery.

In prostate cancer, two basic methods of radiotherapy are used: teletherapy and brachytherapy. The difference between them is the location of the source that emits radiation. Teletherapy is a more traditional method of radiotherapy in which the source of radiation is at a distance from the patient.

Brachytherapy involves introducing a source of radiation into the patient's body. In prostate cancer brachytherapy, the radiation source is placed inside the tumor or in its immediate vicinity.

Recent years have brought significant progress in prostate cancer radiotherapy - nowadays it is possible to administer high doses of radiation directed to the tumor area, which saves he althy tissue and reduces the side effects of therapy.

  • hormone therapy in prostate cancer

Hormone therapy is the main method of treating advanced prostate cancer. Hormone therapy is used when radical treatment is impossible or has not brought the expected results.

Prostate cancer is a hormone-dependent neoplasm - the growth of neoplastic cells is stimulated bymale sex hormones (androgens). By blocking their formation, you can reduce the growth of the tumor.

There are several ways to reduce the effects of male sex hormones. The first is surgical castration, i.e. the procedure of bilateral removal of the testicles.

The second is pharmacotherapy with drugs that inhibit the formation of androgens or block their effects on cells.

Prostate cancer - prognosis

The results of prostate cancer treatment depend on many factors. Of these, the most important are the baseline tumor stage, the grade of malignancy determined on the Gleason scale and the general he alth of the patient.

Patients whose cancer is diagnosed in a limited stage have the chances of a complete cure - then it is possible to apply radical therapy.

The currently available treatments extend survival and significantly alleviate the symptoms of the disease also in patients with advanced prostate cancer.

After the end of prostate cancer therapy, patients are under close medical observation. It is obligatory, inter alia, regular PSA level tests to help assess the effectiveness of treatment and detect possible cancer recurrence.

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Where to go for help

Association of Men with Prostate Diseases "Gladiator" im. Prof. Tadeusz Koszarowski

ul. Roentgena 502-781 Warsaw Address for correspondence: ul. Marymoncka 35 lok. 185, 01-868 Warszawa Helplines: (022) 864 08 76 (every Monday from 4 p.m. to 6 p.m.), 0 502 438 648

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Category:

Oncology