What are the symptoms of prostate cancer?
Prostate cancer accounts for 5% of all malignant neoplasms in men, the symptoms early detected prostate cancer allow to carry out timely treatment. The causes of prostate cancer is still unclear. The disease occurs due to hormonal disorders, the role of which is increasing on the background of hereditary predisposition. Other possible causes of prostate cancer: benign growths, mutating into malignant tumors, precancerous lesions (adenos, hyperplasia with malignancy), prostatitis, infections, sexually transmitted.
Pathological changes occur in the organism under the influence of risk factors. These include alcohol, abuse of meat and fatty foods, the toxicity of cadmium used in the production of rubber and textiles, during welding, in the printing. The emergence and growth of tumor cells becomes possible by reducing the immunity. Lack of immunity occurs, for various reasons, including after suffering stress.
- Stage 1 – single knots in the prostate gland without germination capsule metastases are defined;
- Stage 2 – the tumor affected a significant portion of the prostate gland without damaging the surrounding tissue. In lymph nodes revealed solitary metastases;
- Stage 3 – the tumor affected the entire prostate gland with invasion into the capsule. Defined metastases in regional lymph nodes;
- Stage 4 – the tumour grows into surrounding tissues and organs, are determined by multiple metastases. Developing cachexia.
The classification of V. V. Bialik (morphological types):
- Undifferentiated form;
- Undifferentiated and unclassified forms.
International clinical classification of prostate cancer according to TNM determines the status of the primary tumor in the prostate gland (T), lymph nodes (N) metastases (M). This classification allows to determine the indications for different treatment methods.
To Express the degree of malignancy of the tumor Gleason scale is used, based on histological examination of cells. In her five digits, each of which shows the degree of distinction of malignant from normal cells. If no difference, it corresponds to the figure 1, if the difference between tumor and normal cell maximum is 5. Choose from two of the biggest tumours and evaluate each, giving one of the numbers.
More than the sum of the digits, the more malignant the tumor. Low aggressive tumor is increased by a Gleason score 2 to 4 points. Highly malignant tumor has a Gleason score of 8-10 points.
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Prostate cancer for a long time asymptomatic and detected incidentally on screening tests or the examination of another disease. The first symptoms of prostate cancer is minimal, basically it is a violation of urination. Prostate cancer spreading to nearby organs (rectum, bladder neck) and forming metastases, causing the corresponding symptoms. It late symptoms of prostate cancer. Pain in the perineum, hematuria, urinary retention — the main symptoms of the disease. If a tumor spreads towards the ureters hydronephrosis develops in connection with compression of the distal ureters.
Typical bone metastases that cause severe pain. The most frequent metastases in prostate cancer localized in the pelvis, sacrum, lumbar spine, femur, causing pain in the affected bones.
Metastases in the cervical and thoracic vertebrae, ribs, skull bones appear less frequently. Signs of prostate cancer usually appear when the tumor metastases.
Clinically, there are the following types of tumors:
- Incidentally discovered prostate cancer (tumor localization is limited to a microscopic segment of the prostate), symptoms, the tumor has reduced biological potential;
- Latent prostate cancer is clinically diagnosed because the symptoms are absent, but the histological picture is not different from lesions with obvious clinical manifestations. Most latent forms refers to histologically well-differentiated adenocarcinoma with low biological potential.
- Clinically evident form of the disease when the symptoms of prostate cancer become apparent;
- Occult prostate cancer is known as the "silent" metastatic carcinoma that is clinically evident metastases at nepodozrevaya primary focus.
When referring to the urologist performed the following tests: finger examination through the rectum (in the early stages of the pathology does not reveal), ultrasound, CT and MRI (detects even small changes in the density of the body). Diagnosis of prostate cancer is based on the level of prostate-specific antigen blood (PSA), acidic and alkaline phosphatase, biochemical blood test, General blood test.
PSA allows to identify prostate cancer at early stages. This specific glycoprotein produced by the secretory epithelium is the most sensitive and specific among all tumor markers. Its level increases when there is cancer of the prostate, whereas tumor markers other bodies increase not only Oncology, but also inthe inflammation of the organ.
In men younger than age 60 is considered normal PSA levels below 4 ng/ml in men older than 60 years – below the 5.4 ng/ml. showed that with increased PSA less than 4.0 ng/ml, prostate cancer was detected in men only in 0.5% of cases, 5 to 20 ng/ml in 27-37% of cases, more than 30 ng/ml in 74% of cases.
With PSA over 50 ng/ml prostate cancer in 80% is accompanied by damage of its capsule, 66% — defeat regional lymph nodes. PSA levels over 100 ng/ml indicates the presence of regional or distant metastases.
If the PSA level from 5 to 20 ng/ml to distinguish prostate cancer from benign tumors makes determination of free and bound fractions of PSA. In healthy or patients with benign tumors, this ratio is usually more than 15-20%, if the malignant tumor is less than 15-20%. PSA test is used to diagnose disease, to monitor its course, the appearance of metastases and recurrence of the disease.
Acid phosphatase is widely presented in tissues and organs throughout the body, she is present in the prostate gland, where its activity compared to the other bodies above and is controlled by androgens. Increased activity of acid phosphatase causes not only prostate cancer, but the tumor in a different location, it can be osteoporosis, Paget's disease, hyperparathyroidism. Elevated levels of serum acid phosphatase in the blood is noted in 74% in bone metastases, and less than 10% in focal lesions. Determination of acid phosphatase in the urine does not matter for the diagnosis, as it reflects the enzymatic activity of the kidneys.
The level of alkaline phosphatase is also an enzymatic marker. Increased serum alkaline phosphatase in the blood observed in the activation of osteoclasts in bone metastases. Alkaline phosphatase is nonspecific and may be elevated in other diseases, especially liver damage. However, its increased level in the blood is closely correlated with the clinic metastatic tumors.
Lymphogenic metastasis is the most early in the process of dissemination of malignant cells, therefore, early detection of metastases in pelvic lymph nodes is of practical importance. Various diagnostic methods such: lymphangioscintigraphy, transabdominal, percutaneous, prostatic lymphoscintigraphy, aspiration biopsy of pelvic lymph nodes.
Hematogenous spread of malignant cells frequently occurs in bone (50-70%). Diagnosis of prostate cancer have bone metastases based on the data of x-ray examination, radionuclide scanning, determining acid phosphatase in the bone marrow and serum.
The treatment, prognosis and statistics
The success of treatment depends on earlydiagnosis, the prognosis is much worse in case of late detection of the disease with metastases. Treatment is complicated by patients ' age (50% of patients on average were older than 65 years) and a significant frequency of latent developing tumors at this age (20-30%).
Surgical methods include radical intervention or palliative. Radical prostatectomy is used when a localized form of tumors in the absence of metastases. Palliative surgery for tumors of the prostate include epicystostomy, cryosurgery, transurethral resection of the prostate. They are held on the background of hormonal treatment with androgens, female hormones (sinestrol) and inhibitors of prolactin, chemotherapy, and radiation therapy.
Relapse of prostate cancer occurs when the impossibility to conduct a complete removal of the tumor surgically, and compared to other methods of treatment. Recurrence of prostate cancer confirmed increase in PSA level, data, biopsy of prostate and lymph nodes, ultrasound data, and MRI.
The prognosis depends on the stage of the disease, the histological structure of the tumor, the treatment, the patient's age. In localized form without metastases after operative treatment of the most favorable prognosis, remission long-term. In men older than 50 years without surgical treatment the prognosis is poor, you will feel resistance to estrogenterpii.
The survival rate of cancer patients is the number of patients who have lived 5 years after diagnosis. Life expectancy is the time that can accommodate a patient, it is different for each patient because many factors.
Without treatment, the life expectancy of patients is about one year from the moment of appearance of the signs of the disease. The life expectancy of men after surgical treatment in 50% of cases up to 10 years or more, survival to 90%.
In radiation therapy, the survival rate to 70%, the life expectancy for men in 48% of cases up to 10 years. In the presence of metastases after orchiectomy and estrogenterpii life expectancy of more than three years is noted in 20-60% of patients.