Prostate cancer – malignant tumoral defeat of tissues of prostate gland. The prostate cancer is shown by symptoms of infravezikalny obstruction (a sluggish faltering stream of urine, a nikturiya, constant desires on an urination); a gematuriya, a gemospermiya, pain in pelvic area, erectile dysfunction. In diagnosis of a prostate cancer apply a manual pryamokishechny research of gland, definition of the DOG, ultrasonography, a biopsy. Treatment at a prostate cancer can include a radical prostatektomiya, remote radiation therapy, brachytherapy, chemotherapy.
In a number of the countries the prostate cancer on occurrence frequency at men concedes in structure of oncological diseases only to cancer of a lung and cancer of a stomach. In urology the prostate cancer is a serious medical problem as it is often diagnosed only at the III-IV stage. It is connected both with long asymptomatic development of a tumor, and with inadequate implementation of measures for early diagnostics. More often men develop a prostate cancer 60 years are more senior, however the tendency to "rejuvenation" of a disease is traced in recent years.
Prostate cancer reasons
The prostate cancer is a polietiologichesky disease with the reasons obscure up to the end. The age of the man is considered the main factor of risk of development of a prostate cancer. More than 2/3 cases of a prostate cancer are the share of age 65 years are more senior; in 7% of observations the disease is diagnosed for men more young than 60 years. As other contributing moment serves the race: so, the prostate cancer is most widespread among the Afro-Americans and most less often occurs at natives of Asia.
A certain value in an etiology of a prostate cancer is allocated for the family anamnesis. Presence of a disease at the father, the brother or other men in a family increases risk of developing of a prostate cancer at 2-10 times. There is an assumption that the probability of a prostate cancer at the man increases if in a family there are relatives, patients with cancer of a mammary gland.
Distinguish the features of food connected with the use of a large amount of animal fats, therapy by testosterone, a lack of vitamin D from other probable risk factors. Some researches indicate the increased probability of developing of a prostate cancer at the men who transferred a vazektomiya (sterilization). The use of the products of soy rich with phytoestrogen and isoflavonoids reduces possible risks of development of a prostate cancer; vitamin E, selenium, carotinoids, a diet with the lowered content of fats.
Classification of a prostate cancer
The prostate cancer can be presented by the following histologic forms: adenocarcinoma (krupnoatsinarny, melkoatsinarny, kribrozny, solid), transitional and cellular, planocellular and undifferentiated cancer. Ferruterous cancer – an adenocarcinoma, making 90% of all revealed prostate new growths is most widespread. Except morphological verification prostate cancer differentiation degree is important (high, moderate, low).
On the TNM system allocate several stages of an adenocarcinoma of a prostate gland. The transitional and cellular prostate cancer is classified similar to urethra cancer.
- T1 – an adenocarcinoma is not shown clinically, not visualized by tool methods and not palpated; it can be found only by means of the biopsy of a prostate and a histologic research which are carried out concerning the increased level of a prostatspetsifichesky anti-gene (DOG)
- T2 – an invasion of an adenocarcinoma is limited to gland fabric (one or two shares) or its capsule. The prostate cancer is palpated and visualized by tool methods.
- T3 – the adenocarcinoma sprouts out of limits of the capsule of gland or in seed bubbles.
- T4 – an adenocarcinoma extends to a neck or a sphincter of a bladder, a rectum, a muscle-levator of back pass, a basin wall.
- N1 – are defined metastasises in lymph nodes of a small pelvis
- By M1 – the remote metastasises of a prostate cancer in lymph nodes, bones, etc. bodies are defined.
Prostate cancer symptoms
The prostate cancer is characterized by the long latent period of development. The first symptoms of a prostate cancer remind displays of prostatitis or adenoma of a prostate gland. As symptoms of the localized prostate cancer serves increase an urination with difficulty of the beginning of a miktion; feeling of incomplete depletion of a bladder; faltering and weak stream of urine; frequent desires to an urination, problems with urine deduction.
At a locally-spread prostate cancer there are a burning or pain at an urination or an ejaculation; gematuriya and gemospermiya; crotch pains, over a pubis or a basin; the waist pains caused gidronefrozy; erectile dysfunction; anury and symptoms of a renal failure. Continuous dull aches in a backbone and edges, as a rule, testify to prostate cancer metastasis in a bone. In late stages of a prostate cancer the hypostases of the lower extremities caused limfostazy, weight loss, anemia, a kakheksiya can develop.
Diagnosis of a prostate cancer
The inspection volume demanded for detection of a prostate cancer includes a manual research of gland, definition of the DOG in blood, ultrasonography and UZDG of a prostate, a prostate gland biopsy. At a manual research of a prostate density and the sizes of gland, existence of the palpated knots and infiltrates, localization of changes are defined by a wall of a rectum (in one both shares). However only by means of a palpation it is impossible will distinguish a prostate cancer from chronic prostatitis, tuberculosis, a giperplaziya, prostate gland stones therefore additional verification researches are required.
The widespread screening test at suspicion of a prostate cancer is determination of the DOG level in blood. In andrology it is accepted to be guided by the following indicators: at the DOG level of 4-10 ng/ml the probability of a prostate cancer makes about 5%; 10-20 ng/ml - 20-30%; 20-30 ng/ml — 50-70%, is higher than 30 ng/ml — 100%. It is necessary to consider that increase in indicators of prostates - a specific anti-gene is also noted at prostatitis and a good-quality giperplaziya of a prostate gland.
Ultrasonography of a prostate can be carried out from transabdominal or transrectal access: the last allows to reveal even small tumoral knots in a prostate. Under ekhoskopichesky control the prostate gland biopsy allowing is carried out will receive material for a morphological research and to carry out histologic typing of a prostate cancer. The biopsy can be carried out through a crotch, a wall of an urethra or rectum. Sometimes for receiving biopsiyny material resort to a transurethral resection of a prostate.
In addition at a prostate cancer determination of level of testosterone, MRT of a prostate, ultrasonography of an abdominal cavity, a skeleton stsintigrafiya, a X-ray analysis of lungs can be carried out.
Cancer therapy of a prostate
Taking into account a stage of a prostate cancer surgical treatment, radiotheraphy (remote or interstitial), chemotherapy can be undertaken. A main type of surgical intervention at a stage T1-T2 prostate cancer – a radical prostatektomiya during which gland, seed bubbles, pro-static department of an urethra and a neck of a bladder completely is removed; the limfodissektion is made. Carrying out a radical prostatektomiya can be followed by the subsequent incontience of urine and impotence.
For the purpose of induction of androgenic blockade at a prostate cancer the enukleation of testicles (a bilateral orkhiektomiya) can be executed. This operation leads to the termination of production of endogenous testosterone and decrease in growth rate and a dissemination of a tumor. In recent years instead of surgical castration medicamentous suppression of production of testosterone is more often used by agonists of LHRH hormones (, , ). In some cases at a prostate cancer resort to the maximum androgenic blockade combining surgical or medicamentous castration with reception of anti-androgens in the individual mode. Hormonal therapy can be followed by heat inflows, development of osteoporosis, decrease by a libido, impotence, a ginekomastiya.
At a prostate cancer of T3-T4 of a stage the radiotheraphy is applied by a remote or interstitial method. At interstitial radiation (brachytherapy) the special radioactive implant which selectively destroys tumor cells is entered into a prostate. The chemotherapy is carried out at widespread stages of a prostate cancer and inefficiency of hormonal therapy, allowing to prolong life to the patient. At a stage of studying and pilot studies there are such methods of cancer therapy of a prostate as cryotherapy, a hyperthermia, laser therapy, the focused ultrasonic therapy.
Forecast and prevention of a prostate cancer
The prospect of survival at a prostate cancer depends on a stage of an onkoprotsess and a differentiation of a tumor. Low degree of a differentiation is followed by deterioration in the forecast and decrease in an indicator of survival. At stages of T1-T2 N0M0 the radical prostatektomiya promotes 5-year survival at 74-84% of patients and 10-year-old - at 55-56%. After radiation therapy 72-80% of men, 10-year-old - 48% have the favorable 5-year forecast. At patients is after an orkhiektomiya and being on hormonal therapy 5-year survival does not exceed 55%.
Completely it is not possible to exclude development of a prostate cancer. To men 45 years are more senior passing of annual inspection at the urologist-andrologist is necessary for early detection of a prostate cancer. The recommended screening for men includes a rectal manual research of gland, prostate TRUZI, definition of a marker of a prostate cancer (DOG) in blood.