Diagnosis and treatment of prostate cancer. Errors in diagnosis and staging of prostate cancer Prostate cancer research methods

Content

Carcinoma, adenocarcinoma, prostate tumor, prostate cancer are the names of one disease, which is the most common type of oncology among men over 50 years of age. Most representatives of the stronger sex at this age have a subclinical asymptomatic form of this disease. According to studies, in every third man whose cause of death was not prostate cancer, previously clinically unidentified areas of malignancy were identified. After 80 years, a similar problem occurs in 80% of men.

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.

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.

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.

Reasons

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:

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.
Impact of carcinogenic factors on the body.
Eating style. Fatty, high-calorie foods and a lack of vegetables in the diet increase the risk of cancer.
Progression of prostate adenoma.
Age after 45 years.
Race. African peoples are more susceptible to cancer.
Sedentary lifestyle.

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:

First stage A. Malignant cells practically do not differ from normal ones, the tumor is encapsulated, the course of the disease is asymptomatic.
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.
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.
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.

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:

Rectal palpation (palpable in later stages).
Analysis for PSA (prostate-specific antigen) level. If a man has prostate cancer, his PSA level increases.
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.

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:

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

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.

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

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.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

Found an error in the text? Select it, press Ctrl + Enter and we will fix everything!

Discuss

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

Prostate cancer is one of the most common diseases that affects the male sex. In the general list of cancer diseases, prostate cancer is second only to lung cancer.

The high mortality rate from this disease is due to the fact that diagnosing prostate cancer is quite difficult, since at the initial stage the symptoms are practically invisible, and the diagnosis is made when the disease has become irreversible.

What symptoms indicate a disease, how to diagnose it, and what preventative measures are best to use, we will look into this article.

The first signs of prostate cancer

Prostate cancer is a rather insidious disease, since at the initial stage it does not manifest itself at all. A tumor in the prostate gland develops quite slowly, and therefore the patient does not notice a significant deterioration in health or pain.

That is why most experienced specialists strongly recommend that men over the age of 45 take a blood test for prostate cancer and see a urologist at least once a year. Agree, this does not take much time, but it can save lives.

The earlier the disease is detected, the greater the chance that everything will end well, the postoperative period will be easy, and the function of urinary continence and potency will be fully preserved.

The first signs that indicate the onset of the disease include problems associated with urination:

Frequent urge to go to the toilet.
Weak stream pressure or interruptions during urination.
The appearance of pain or a burning sensation.
There is a feeling that the bladder has not completely emptied; some fluid is still present in it.

With such symptoms, most males think that they just have a cold or that this is a temporary phenomenon, and therefore do absolutely nothing, not even go to the doctor. This aggravates the situation and allows the disease to develop further. This is why it is so important to get tested for prostate cancer regularly.

Diagnostic methods

There are several methods by which prostate cancer can be diagnosed:

The first thing the doctor will do after contacting him is to conduct palpation of the gland. With the help of such a simple rectal examination, the specialist will be able to determine whether there are neoplasms that require closer attention, and how large they are.
Transrectal ultrasound of the prostate, which doctors call more simply - TRUS. This method involves diagnostics using an ultrasound machine. The diagnostic device is inserted directly into the rectum, and the screen immediately shows whether there really is a problem and how big it is.
Prostate biopsy. To do this, using a special device, a part of the tumor is pinched off and examined in order to better understand its nature. This procedure is prescribed by a doctor only if PSA levels are 30 or higher or if a characteristic lump on the gland is detected by palpation or ultrasound.
As you know, cancer can quickly metastasize to other organs and tissues of the body. Therefore, a more accurate diagnostic method was invented - PET CT for prostate cancer. It has a prostate tumor marker, the level of which will be constantly monitored by a specialist. This method of diagnosing prostate cancer without a biopsy can give a clear understanding of the size of the tumor, its location and metastases that may have already appeared in other tissues.

There are other, more complex methods, but those described above are among the most common and fairly accurate.

Diagnosis of prostate cancer

In addition to the basic methods described above, various tests are often used, which also help doctors understand what is happening in the patient’s body and monitor his condition. These research methods include:

Blood and urine analysis quite familiar to each of us. Indicators for oncology change, but not specifically. A decrease in the level of iron in the blood is often observed, leukocytes in prostate cancer are increased, as is the ESR. In some cases, the number of platelets in the blood also increases significantly, which can lead to additional problems.
One of the most accurate analyzes is blood test for prostate-specific antigen - PSA. With its help, you can diagnose even at an early stage and organize constant monitoring of the condition.

In the absence of disease, the level of the tumor marker will not exceed 4 ng/ml; with various inflammatory processes in the prostate, this figure can reach 8.8, but only in old age.

A reading of 10 ng/ml may indicate benign hyperplasia, but only if there are no other pathological changes. But if PSA is above 30, then it is definitely prostate cancer. Although, in some cases, oncology is diagnosed at lower rates. It all depends on age and related factors.

Diagnosis at later stages

In later stages, it is often necessary to use additional diagnostic methods to understand whether the disease has affected other organs. Most often, prostate cancer also affects the lymph nodes, which are located in the pelvic organs and bone tissue.

scintigram;
tomography;
X-ray.

The data obtained together will make it possible to determine the location of cancer cells and assess the general condition of the body. The scintigram will show how metabolic processes occur and whether everything is normal in this area.

X-ray is a mandatory procedure, since very often metastases from the prostate spread to the lungs, which ends in death.

It is important to complete all these studies as early as possible. In this case, the therapy will begin to act faster, and the patient will have additional chances for recovery.

It is important to carry out all tests in specialized laboratories, which are responsible for the results they give to patients.

Prevention of prostate cancer in men

Quite often, urologists cannot fully explain why some men develop prostate cancer and others do not. But still, experts identify several factors, the presence of which increases the risk several times:

Man's age. The disease is diagnosed extremely rarely in young people, but the older a man gets, the greater the risk.
Race. As strange as it may sound, African Americans are diagnosed with prostate cancer much more often than the light-skinned population of the country. The reasons for this phenomenon are still unknown.
Food. More often, oncology affects those who constantly have red meat, fatty and smoked foods in their diet. But the disease affects lovers of vegetables and fruits much less often.
Passive lifestyle now predominates in many people, and it is precisely this that provokes the occurrence of many diseases, including prostate cancer in men.
Bad habits not only affect certain organs, but also cause harm to the entire body as a whole, weakening the immune system. Therefore, we strongly recommend that you abandon them as quickly as possible.
Heredity plays an important role. If your male relatives suffered from cancer, then you also have an increased predisposition to similar diseases. Therefore, you need to be especially attentive to your own health.

In addition to the fact that it is better, whenever possible, to exclude these factors from your own life, it is also worth engaging in the prevention of prostate cancer. The term prevention refers to a set of measures that will help protect you from the disease. Of course, if you have a genetic predisposition, then it’s unlikely that anything can be done about it. But you can fight with other factors:

Diet, although it’s hard to call it that. Rather, it is the use of proper nutrition standards. Try to fill your diet with fresh vegetables and fruits, which will bring a large amount of vitamins and will not burden your stomach.
Try to exclude foods that contain animal fats and calcium.

Scientists have noticed an interesting fact: in Japan, the level of prostate cancer in men is significantly lower than in other countries. After lengthy research, it was discovered that men often include soy in their diet, which contains substances similar to female sex hormones. They normalize hormonal levels and prevent oncology from appearing. Moreover, this fact does not affect potency and libido in any way.

Lead the right way of life. This means not only giving up smoking and alcohol abuse, but also adding regular exercise to your daily routine. It is outdoor sports that can protect you from a large number of diseases and strengthen your body as a whole.
At least once a year need to visit a urologist. This is important even if there are no symptoms. This way you can make sure that you are absolutely healthy.

Finally

Prostate cancer is quite common in older men. In order to avoid illness, it is important to regularly visit a doctor and monitor your own health, approaching this extremely responsibly.

If you know about your predisposition to the disease, constantly monitor your PSA level, this will give you confidence that everything is fine with your prostate gland.

Prostate cancer is considered the most common type of cancer and the second cause of cancer death in men. The average age of men diagnosed with this disease is 66 years. In 6 out of 10 cases, prostate cancer is found in men aged 65 years and older, and in rare cases in men under 40 years of age. This disease is asymptomatic and undetected by screening tests due to false positives from current screening tests. Most often, in 90% of cases, prostate cancer spreads only to this organ and does not affect the rest, which means that almost 100% of men survive this disease within five years. If you are concerned that you may have prostate cancer, learn to recognize its symptoms and learn more about the stages of the disease so that you can receive timely treatment.

Steps

Recognizing symptoms of prostate cancer at an early stage

Detect the symptoms of this disease at an early stage. Note any symptoms so you can tell your doctor about them later. They are not concrete proof that you have prostate cancer, but they do signal that you need to see a specialist.

Pay attention to the frequency of urination processes. If they change dramatically, this may indicate the presence of cancer. For example, if you need more time to complete the process. The tumor may be located near the urethra or bladder and interfere with the normal flow of urine. Remember that if it takes you longer than usual to complete the urination process, this is a clear sign that you need to pay attention to.

Burning when urinating. If excess urine accumulates in your bladder or urethra, you may develop an infection that causes inflammation. When urine passes through the urethra, you feel a sharp pain. Prostatitis develops - an infectious inflammation of the prostate gland.

Urine is reddish or pink due to blood. When the prostate tumor grows, blood vessels begin to become injured and burst, and hematuria develops. An enlarged prostate gland leads to inflammation and urinary tract infections, which cause blood to appear in the urine.

Pay attention to pain during ejaculation. It is known that such symptoms may also indicate prostate cancer and prostatitis. Inflammation of the prostate gland irritates the seminal glands during ejaculation, which causes pain during orgasm.

Keep in mind that swelling of the extremities or weakness in the legs, arms, and bones may also be signs of prostate cancer. This disease also spreads to the lymph nodes, which are located throughout the body, including in the groin area. With oncology, they increase and cause swelling in the corresponding area. Pay attention to swelling of the limbs; if you think that the swelling has spread to only one side, compare it with a healthy area.

You should also pay attention to shortness of breath, chest pain and/or cough with blood. Prostate cancer can affect the lung area. A cough that does not respond to antibiotics, chest pain, and shortness of breath are serious signs. Cancer interferes with the normal functioning of the lungs, leading to damage and inflammation of tissues and arteries. This inflammation leads to pleurisy (fluid accumulation in the lungs) causing shortness of breath and chest pain.

Difficulty walking, headaches, loss of function of certain parts of the body, memory loss and urinary incontinence are signs of advanced prostate cancer. Quite often, prostate cancer is provoked by a brain tumor - leptomeningeal carcinomatosis. It manifests itself as headaches, numbness in certain parts of the body, difficulty walking, urinary incontinence and memory problems.

Pay attention to pain and increased sensitivity in your back. Prostate cancer can spread to the spinal cord, causing compression of the spine, causing back pain, soreness and muscle weakness. Neurological problems such as urinary or bowel retention or incontinence may also occur.

Be aware that rectal bleeding during bowel movements may be a sign that cancer has spread to the rectal area. According to research, prostate cancer spreads to the rectum as a nearby organ. Watch for bleeding and/or pain in the anus during bowel movements.

You should also understand that symptoms associated with prostate cancer may be signs of other diseases. For example, with a urinary tract infection, a burning sensation when urinating and an increase in temperature may also occur. In any case, in order to find out whether these signs are symptoms of prostate cancer, you need to consult a specialist. It is recommended to seek qualified medical advice, conduct routine examinations and undergo tests to make the correct diagnosis.

Keep in mind that prostate cancer can be asymptomatic. Many men suffering from this disease do not experience any suspicious symptoms at all. If you are at risk, you should be checked regularly to check for possible symptoms.

Diagnosis of prostate cancer

Visit your healthcare provider. If you notice any signs of prostate cancer, it is recommended to consult a doctor. Although other diagnoses also have many symptoms similar to prostate cancer, such as prostatitis, urinary tract infection and benign prostatic hyperplasia, it is best to rule out the possibility of cancer as soon as possible. Your doctor will conduct a detailed collection of data and test results to prescribe an appropriate examination, and ask you questions about symptoms, family history, diet, sex life, tobacco and drug use.

Find out how your doctor will diagnose prostate cancer. You can tell him about your symptoms, but an accurate diagnosis can only be made through specific medical tests. If you suspect you have cancer, your doctor may refer you for a variety of screening tests and tests:
- Digital rectal examination. In this case, the doctor will examine the prostate by inserting a gloved index finger through the rectum and then palpating the navel and prostate area. The doctor will be able to determine the presence of any compactions and irregularities, changes in contour, size. With pathology, the prostate gland is enlarged, the tumor is hard and uneven. Negative results of a rectal examination, unfortunately, do not exclude the presence of prostate cancer.
- Blood test for prostate specific antigen (PSA). For this test, your doctor will draw blood from your arm. This antigen is a protein substance that is found in the prostate. According to most doctors, a level of 4ng/ml is considered normal. Men whose PSA levels range between 4 and 10 have about a one in four chance of developing prostate cancer. If the PSA level is more than 10, the chance of developing cancer is more than 50%. This test can produce both false positives and false negatives. An elevated PSA level may not indicate the presence of prostate cancer or related problems. It serves as a definition, and a normal PSA level may not mean the absence of cancer. Ejaculation, prostate infections, rectal examinations, and even cycling can cause elevated PSA levels. In this case, the analysis should be repeated after two days. If your PSA level is still elevated, a rectal exam or prostate biopsy (removing a piece of tissue for analysis) may be needed. Prostate cancer can occur even with normal PSA levels.
- Transrectal ultrasound (TRUS). When performing an ultrasound, a probe lubricated with a special substance is inserted into the rectum, and the required organ is displayed on the display. The doctor will examine the prostate gland to look for enlargement, irregular shape, or contour. This method cannot always accurately determine the presence of prostate cancer.
- Biopsy. During TRUS, a needle is inserted into the prostate gland to remove a sample of tissue for analysis. Your doctor may need several tissue samples. This is the most reliable test to confirm the presence of BPH or prostate cancer. If previous tests have shown a negative or normal result, your doctor may use this type of test if your symptoms are still suspicious. When analyzing prostate tissue biopsies, the Gleason index is used. The scoring system ranges from 1 to 5, where 5 means the presence of cancer and 1 means its absence.

16810 0

The high mortality rates from prostate cancer in Russia are explained by the poor quality of diagnosis. Despite the increasing pace of introduction of modern diagnostic methods into clinical practice, in the last decade the number of localized forms of prostate cancer not only has not increased, but even decreased from 35 to 33%. Only 4.5% of new cases of the disease are detected during preventive examinations. In this regard, the task of building a system for early diagnosis of prostate cancer becomes a priority.

Diagnostic triad- determination of the level of prostate specific antigen in combination with palpation of the prostate and transrectal echography is currently the best way to early detect prostate cancer and select a group of patients for prostate biopsy. An increase in the level of prostate specific antigen allows one to suspect the presence of the disease at the preclinical stage. Published data indicate that sequential prostate cancer screening based on prostate specific antigen can, within a few years, reduce the proportion of locally advanced and metastatic cancers in the morbidity structure and reduce mortality.

It is generally accepted that in adult men the serum level of prostate-specific antigen should not exceed 4 ng/ml. Its level depends on the volume of the prostate, which increases with age. Age norms for prostate specific antigen were calculated: 40-49 years - 0-2.5 ng/ml, 50-59 years - 0-3.5 ng/ml, 60-69 years - 0-4.5 ng/ml, 70 -79 years - 0-6.5 ng/ml.

The level of this antigen can be affected by prostate massage or ejaculation on the eve of the study, inflammatory changes in the prostate, instrumental manipulations in the prostatic urethra, ischemia or infarction of the prostate. Routine palpation of the prostate probably does not change antigen levels. The sensitivity of the method is 75-87%, specificity - 37-63%. It is necessary to take into account the rather high frequency of false negative and false positive results, which in patients with localized prostate cancer reach 20-40 and 15-25%, respectively.

Changes in serum prostate specific antigen levels may be related to therapy. Antiandrogens and 5α-reductase inhibitors significantly reduce antigen levels, and thermal treatments (hyperthermia, thermotherapy, thermal ablation) can significantly increase its values for several months. Therefore, a study of the level of prostate-specific antigen in the blood serum must be carried out in all patients with benign prostatic hyperplasia (adenoma) before prescribing long-term drug therapy or referral for treatment with alternative methods that do not involve obtaining prostate tissue for histological examination.

To increase the specificity of the test, they suggest calculating the prostate-specific antigen density index, for which its value is divided by the volume of the prostate determined by transrectal echography. An indicator exceeding 0.15 most likely indicates the presence of prostate cancer.

It has been established that 20-40% of all malignant neoplasms of the prostate gland are not accompanied by an increase in the level of prostate antigen. In this case, the rate of growth of the antigen becomes an important criterion. A prostate biopsy is considered indicated even for patients with normal antigen values, if over the past year its level has increased by more than 20% or by 0.75 ng/ml.

In blood serum, prostate specific antigen circulates in the form of free and bound forms with α1-antichymotrypsin and α2-macroglobulin. In recent years, to improve the accuracy of laboratory diagnosis of prostate cancer, in addition to the total prostate specific antigen, free and bound fractions are determined. The most widely used clinical practice today is to assess the concentration of free prostate specific antigen and the ratio of free/total prostate specific antigen. If this ratio is below 15%, a prostate biopsy is indicated.

What should be the frequency of prostate antigen testing in older men? A study of the growth dynamics of prostate-specific antigen demonstrated that only 1.9% of men with an initial value of 0-0.99 ng/ml after 3 years exceeded 4 ng/ml. With initial antigen values of 1-1.99, 2-2.99 and 3-3.99 ng/ml, the probability of achieving an antigen level of more than 4 ng/ml after 3 years is 4.5, 23.6 and 66%, respectively. Thus, men with an initial level of prostate specific antigen of more than 2 ng/ml need to be determined annually, while with a value of less than 2 ng/ml, annual screening becomes meaningless and should be carried out less frequently - once every 2-3 years. As intervals increase to 5 years or more, the risk of detecting already disseminated cancer increases sharply.

Determination of the level of prostate specific antigen is complemented by digital rectal examination of the prostate gland, which to this day remains a popular method for diagnosing prostate cancer. Every man over 45 years of age should undergo rectal palpation of the prostate gland annually. Identification of focal compactions in the prostate gland requires clarification of the diagnosis.

In the initial stages of the disease (T1), it is impossible to palpate the tumor. At T2, digital examination reveals small focal indurations or nodules in unchanged prostate tissue. The latter can be of normal size or enlarged due to concomitant benign hyperplasia (adenoma) of the prostate gland. A large palpable node, as a rule, corresponds to a locally advanced process. Gradually, the growth of the tumor leads to deformation of the organ, which acquires a cartilaginous or stony consistency. In some cases, dense strands of infiltrate can be felt, spreading from the prostate gland to the seminal vesicles. Subsequently, the tumor conglomerate may occupy most or even the entire gland, spreading without clear boundaries to the surrounding tissue.

The sensitivity of the method for localized prostate cancer is low. Digital rectal examination allows us to suspect the disease in less than half of patients with histologically confirmed stage T2 prostate cancer. At the same time, at stage T3-4, the sensitivity of the test approaches 100%.

Transrectal echography of the prostate gland is an informative method for diagnosing prostate cancer, allowing visualization of the tumor when palpation is still uninformative. In the early stages, the neoplasm usually has a hypoechoic structure. In 70% of cases, it is localized in the peripheral zone of the prostate and is defined as a clearly demarcated node that differs from the surrounding normal tissue and benign prostatic hyperplasia (adenoma) (Fig. 1).

Rice. 1. Transrectal echography. Local prostate cancer

Less commonly, the primary tumor is localized in the central or transitory zone of the organ. The unchanged prostate capsule is clearly visible. Already with a tumor size of 5-10 mm in diameter, it is possible to perform a targeted biopsy followed by histological examination. In later stages, as the tumor grows, its echogenicity may change: along with hypoechoic tissue, normo- and hyperechoic zones appear. The method allows you to assess the size of the tumor node, its relationship with surrounding tissues, deformation or germination of the prostate capsule, invasion of the bladder, seminal vesicles, infiltration of surrounding tissues, which is important for determining the stage of the disease (Fig. 2).

Rice. 2. Transrectal echography. Locally advanced prostate cancer

The transrectal echography method is characterized by high sensitivity and relatively low specificity: not all hypoechoic formations in the prostate gland are caused by prostate cancer. Similar changes can be observed in benign prostatic hyperplasia (adenoma) and chronic prostatitis. Transrectal Dopplerography of the vessels of the prostate gland allows expanding the capabilities of the method, especially against the background of the use of ultrasound contrast agents. In this case, pathological blood flow and tumor vessels are more clearly identified.

Transabdominal echography for prostate cancer is not very informative. At the same time, the method is important for assessing the condition of the upper urinary tract, bladder, as well as identifying metastases in the liver.

The presence of palpation or ultrasound signs suspicious for prostate cancer, the level of prostate-specific antigen above 4 ng/ml with a prostate-specific antigen density index of more than 0.15 and the ratio of free prostate-specific antigen to total less than 15% make a prostate biopsy necessary. When using the diagnostic triad, the efficiency of detecting prostate cancer exceeds 90%.

The use of high-tech methods for diagnosing prostate cancer does not negate classical examination techniques. When collecting anamnesis, it is necessary to study the patient’s heredity in relation to prostate cancer, pay attention to possible contact with carcinogenic factors, assess the duration of the disease and the nature of the increase in symptoms. The general condition of the patients worsens gradually. As the disease progresses, the patient complains of weakness and weight loss. The patient's appearance changes only when the tumor process is advanced. During the examination, you should pay attention to the condition of the lymph nodes, liver, kidneys, and bladder. It is advisable to supplement the examination with a detailed assessment of the symptoms of the lower urinary tract, the degree of urination disturbance using uroflowmetry and determination of the amount of residual urine using the ultrasound method.

The next mandatory stage of the examination is morphological confirmation of the alleged diagnosis. Prostate biopsy can be performed transrectally, perineally, or via a transurethral approach. The method of choice is transrectal multifocal puncture biopsy of the prostate gland under ultrasound guidance (Fig. 3). This minimally invasive test is usually performed on an outpatient basis, after premedication or under local anesthesia, and is associated with few complications. Special instruments: cutting needles with a diameter of 16-20G, allowing you to obtain a column of tissue for research, and an automatic biopsy device.

Rice. 3. Transrectal prostate biopsy (a, b)

Material for histological examination must be taken from at least 6 points of the right and left lobes of the prostate (sectoral biopsy), which is considered a recognized standard. If the organ volume is large, the number of biopsies can be increased to 12. Complications of transrectal biopsy are limited to minor bleeding from the urethra, rectum, hematospermia and acute prostatitis, the frequency of which does not exceed 1%.

The obvious advantages of the transrectal approach are replacing transperineal biopsy from clinical practice. This is a more invasive method requiring general or local anesthesia. Complications during perineal biopsy are more common and, in addition to prostatitis or damage to the bladder, urethra, seminal vesicles, can be associated with the occurrence of perineal or retropubic hematoma.

The frequency of false negative biopsy results with transrectal or perineal access does not exceed 20%. At the same time, if there are strong suspicions regarding the presence of the disease and negative results of the primary histological examination, repeat biopsies are resorted to, which are performed using an expanded technique. Detection of high-grade prostatic intraepithelial neoplasia is an absolute indicator for repeat biopsy. Sometimes the diagnosis of prostate cancer is confirmed during the third or even fourth study, although, of course, we are talking about localized cancer.

Prostate biopsy should be performed in medical institutions with the necessary technical equipment and qualified pathological services. Carrying out a biopsy without ultrasound guidance, from an insufficient number of points or by aspiration cannot be considered justified.

Transurethral resection of the prostate gland in some cases, with severe urination disorders, can become a therapeutic and diagnostic procedure and help not only clarify the diagnosis, but also ensure the restoration of urination. At the same time, it should be borne in mind that the resection zone mainly includes the tissue of the central zone of the prostate, while the cancer is predominantly localized in the peripheral zone. Open transvesical biopsy is used extremely rarely. This is a forced manipulation in patients with suspected prostate cancer, who require urgent cystostomy due to acute urinary retention, exacerbation of chronic pyelonephritis and high azotemia.

After establishing a morphological diagnosis, it is necessary to determine the stage of cancer, which is fundamentally important for choosing adequate treatment. This involves assessing the local extent of the process and identifying metastases. The first data on the spread of the tumor in the organ are obtained from digital examination and transrectal echography. Blurredness, deformation, or disruption of the integrity of the prostate capsule on transrectal echography indicate tumor spread beyond the gland.

This information can be refuted or confirmed by other imaging methods: X-ray computed tomography or nuclear magnetic resonance imaging. The tomograms also show tumor nodes, their size, the degree of germination of the prostate capsule, infiltration of the bladder, seminal vesicles, and surrounding tissue. It is believed that nuclear magnetic resonance imaging is more informative in assessing the local extent of the tumor and bone metastases falling within the scanning area (lumbosacral spine and pelvic bones), while computed tomography better visualizes metastases in regional lymph nodes.

Dynamic nuclear magnetic prostatovesiculography is a new method for early diagnosis of prostate cancer, when tomography is performed against the background of the introduction of a magnetic contrast agent that selectively accumulates in the tumor.

The standard method for detecting bone metastases is skeletal scintigraphy. It is advisable to perform it during the initial examination and the level of prostate specific antigen is above 20 ng/ml, when bone damage is most likely (Fig. 4). Areas of pathological accumulation of radiopharmaceuticals are additionally examined using targeted radiography. Bone metastases are predominantly osteoblastic (98%), while osteolytic metastases are much less common (2%). With massive dissemination, metastases can be mixed, causing the pelvic bones to take on a spotted or “marbled” appearance. Metastases to the lungs and bones of the chest are determined by radiography.

Rice. 4. Skeletal scintigraphy for prostate cancer

The appearance of bone metastases is usually preceded by lymphogenous metastasis. In prostate cancer, a high frequency of micrometastases in the pelvic lymph nodes has been revealed, which are not detected even with the help of modern imaging tools: ultrasound, computed tomography, nuclear magnetic resonance imaging. They are trying to solve this problem using a new diagnostic method - radioimmunoscintigraphy, which is based on recording the distribution in the body of tumor-tropic monoclonal antibodies with a radioactive label and makes it possible to detect metastases of prostate cancer in soft tissues. In some cases, diagnostic lymphadenectomy is resorted to.

Cystoscopy and excretory urography are auxiliary diagnostic methods for prostate cancer and are performed for special indications.

Palpation of the prostate gland, determination of the level of prostate-specific antigen, transrectal echography, tomography and bone scintigraphy are methods of dynamic monitoring of the condition of patients, allowing to monitor the effectiveness of the treatment and the progression of the disease.

Differential diagnosis

Differential diagnosis of prostate cancer should be carried out with chronic prostatitis, benign prostatic hyperplasia (adenoma), sclerosis and prostate stones, tuberculosis and bladder neck cancer. In differential diagnosis, determination of the level of prostate specific antigen, transrectal echography and puncture biopsy of the prostate gland are of primary importance.

Lopatkin N.A., Pugachev A.G., Apolikhin O.I. and etc.

The gland, being part of the reproductive system, produces a secretion that ensures the viability of sperm. In the total volume of seminal fluid, this secretion can account for about 30 percent. The prostate is also important in providing the ability to hold urine inside the bladder.

What is prostate cancer: symptoms, prognosis? Prostate cancer is considered a common disease; it is a malignant tumor that develops inside the glandular tissues. Prostate cancer can metastasize, like any malignant neoplasm.

Prostate cancer - symptoms, prognosis for life: according to medical statistics, the disease affects over 12% of men over fifty years of age. Death from prostate cancer in the world is in third place in frequency after cardiovascular diseases and lung cancer in older men.

Every year, over 400 thousand cases of prostate cancer are recorded worldwide. In localization statistics, signs of prostate cancer in European countries rank second after lung cancer. In Russia, the incidence is up to 6% and is one of the most frequently recorded cases of cancer.

It is known that residents of Asia, South America, and Africa are less likely to suffer from this type of cancer than residents of North America and Europe.

Reasons for development

Medicine does not have accurate data on the factors causing the disease. It has been established that the cause of a malignant tumor is DNA changes in gland cells, the cause of which has not been established.

It is known that the older a man is, the higher the likelihood of developing the disease.

According to the findings of medical statistics, the hereditary factor plays a significant role.

The presence of prostate cancer among direct relatives increases the risk of the disease by 2 times or more

Research has established that the disease is associated with excess testosterone, the male sex hormone.

The likelihood of the disease and the aggressiveness of the tumor directly depend on the level of testosterone in a man’s blood.

Official medicine suggests the following risk factors for the occurrence of the disease:

excessive consumption of animal fats, lack of fiber in the diet;
age over 50 years;
cases of prostate cancer among direct relatives;
poor environmental situation;
harmful production factors (work in a printing house, welding work).

The risk of disease increases for lovers of fatty foods, “red” meat - beef, pork, lamb against the background of reduced fiber consumption.

You can reduce the risk of disease by using several rules:

Including enough plant fiber in your diet.
Active lifestyle, playing sports.
Maintaining normal weight levels.
Moderate consumption of animal fats and “red” meat.

How to recognize the disease?

The first signs of prostate cancer are not felt, there is no discomfort until the malignant tumor begins to grow. For this reason, men over 40 years of age are recommended to undergo regular preventive examinations to identify prostate pathology.

Prostate cancer: symptoms, signs

How does prostate cancer manifest in men?

The first symptoms of prostate cancer in men:

The presence of several or one of the listed symptoms is enough to visit a specialist - a urologist or oncologist.

The first symptoms of prostate cancer in men:

erectile dysfunction;
impotence;
decreased sperm volume during ejaculation.

Such symptoms of prostate cancer often occur in men over 50 years of age. The symptoms of prostate adenoma, which is a benign tumor, are the same as for cancer. Therefore, you should urgently undergo examination at a medical institution to make an accurate diagnosis.

In later stages of prostate cancer, you may experience:

blood in semen or urine;
with prostate cancer, pain in the perineum.

In advanced cases of metastasis, the first symptoms and signs of prostate cancer in men:

pain in the spine, hip area or chest;
Urinary retention may develop due to tumor growth.

Late stages are characterized by cancer intoxication, which manifests itself in:

a sharp decrease in body weight;
weaknesses;
rapid fatigue.

In this case, the patient’s skin acquires a characteristic pale earthy tint.

Read more about the stages of prostate cancer development.

IMPORTANT! A timely visit to a specialist will help the patient overcome the first signs of prostate cancer in men and the disease in general. If you have any alarming symptoms, you should consult a specialist.

Prostate cancer symptoms - photo:

Diagnostics

As long as the disease is localized and the period of metastasis has not begun, there may be no symptoms, so it is important to periodically test for prostate specific antigen, which is produced by a healthy gland and is found in the blood.

An increase in this factor in the blood serum, as well as a change in the ratio of free and bound forms of the antigen, is a probabilistic factor indicating the presence of a malignant neoplasm. The higher the PSA reading, the higher the likelihood of cancer.

When examining a patient for prostate cancer, a number of tests and studies are performed:

An extensive blood test, which includes determination of PSA and tumor markers.
Urine tests - general, biochemical, and culture.
Ultrasound examination of the genitourinary area.
Studies of the skeletal system using computed tomography to detect metastasis.
Consultative examination by an oncologist.
Palpation, examination of the gland by palpation.

Chances of healing and methods of therapy

According to medical statistics, more than 80 percent of patients successfully overcome the disease after diagnosis. Often, obvious symptoms of the disease appear in the later stages, when the disease is advanced, and the chances of a quick cure are rapidly declining.

If the diagnosis is confirmed, treatment should begin immediately. If the tumor has a clear localization, endoscopic or . An effective method is radiation therapy using advanced medical equipment.

IMPORTANT! For timely detection of the disease, men over 40 years of age are recommended to undergo preventive examinations with a urologist at least once every 6 months.

home » Diseases » Diagnosis and treatment of prostate cancer. Errors in diagnosis and staging of prostate cancer Prostate cancer research methods