Symptoms and treatment of prostate cancer in men. The first signs of prostate cancer in men: alarming symptoms of a dangerous disease

Prostate cancer (carcinoma) is one of the common causes of death among the male population not only in the Russian Federation, but also in many developed countries of the world.

Risk factors

With a biopsy, it is possible to accurately establish the diagnosis of carcinoma, starting with the 1st degree of morphological changes.

The level of changes when using the concept “stage of cancer” is higher: histological, organ, level of organ systems, etc.

If prostate cancer is suspected, it is important to determine not only the degree in order to ensure the correct diagnosis and the nature of morphological changes in the cells, but also the stage, which is important when identifying metastases.

There are 5 degrees of prostate cancer:

Initial (G1), characterized by a very slow morphological transformation of cells. It is not always possible to examine cell transformations.
In the second degree (G2), the altered cells are already noticeably different from healthy ones, and a slight crowding of them in one focus is detected (nodule formation). Treatment of stage 2 prostate carcinoma is faster and with minimal harm to the body.
The third degree of oncology (G3) is characterized by the presence of cells with different morphology and structure. If left untreated, the tumor grows in size through the top of the prostate, introducing malignant cells to nearby tissues and organs.
In grade 4 prostate carcinoma (G4), most cells are difficult to differentiate and are atypical for the prostate.
The final stage of tumor formation (G5) is characterized by absolute non-differentiation of the cell mass, which is completely atypical.

In contrast to the degrees of prostate malignancy, there are 4 stages of disease development:

Ultrasound or palpation examination of the patient's gland does not give any result. Changes are detected only at the microscopic level during organ biopsy. This condition of the gland is characteristic of the first stage of pathology.
At the second stage, the nodular formation already becomes noticeable during an ultrasound examination. The size of the pathological formation does not yet allow it to go beyond the prostate and the node is limited to the capsule of the exocrine organ.
The third stage is characterized by the tumor extending beyond the boundaries of the gland into neighboring organs. Metastases are found in the bladder and rectal tissues.
The last stage of cancer, the fourth, is the most dangerous for a man’s future health, since metastases spread to distant organs: lungs, liver, bones, lymph nodes. The patient feels exhausted, urination rarely occurs without a catheter, and intense pain is noted not only during emptying the bladder.

Most often, lymph nodes and bone tissue are affected by metastases.

Malignant cells easily penetrate these organs, forming tissue specific to the type of cancer.

The growth of metastases is the most dangerous phenomenon in oncological practice. If before their appearance, conservative or surgical treatment brings a positive effect on the patient’s health, then with the beginning of their formation, treatment and prognosis of the disease only in some cases return the patient to health.

It is beyond the power of anyone, even a very famous and experienced oncologist, to completely get rid of metastases surgically.

Diagnostic definition of the disease

At the slightest suspicion of dysfunction of the prostate gland, the patient should immediately consult a urologist.

The examination begins with a medical history and rectal palpation of the prostate.

A urologist can detect by finger palpation, there may be several options:

prostate carcinoma;
(benign hyperplasia);
the appearance of stones in the exocrine organ.

If the size of the gland is normal, an additional examination is prescribed - measuring the concentration of prostate-specific antigen in the blood.

This is the most accurate diagnostic method for determining the presence of a malignant tumor or its individual developing cells.

When a blood test and palpation results indicate prostate cancer, a number of additional procedures are performed to clarify the size of the tumor, the type of cancer, and the presence of metastases:

helps to identify clear boundaries of the tumor and its exact size. The procedure is carried out using an ultrasound probe inserted through the ampulla of the rectum.
Magnetic resonance and computed tomography are performed when an oncological diagnosis is established to obtain the volumetric dimensions of the prostate and localization of metastases.
Fine needle aspiration is prescribed for an unspecified diagnosis, when the nature of the neoplasm is not determined. Cells are collected from different parts of the gland, after which the smear is stained with dyes and a histological analysis of the sample taken is carried out.

How to cure prostate cancer?

The patient treatment regimen does not imply the same algorithm for all patients.

The urologist, in agreement with the patient, offers surgical removal of the tumor if there are no contraindications for the operation (old age, severe illnesses from the nervous, cardiovascular and respiratory systems).

Otherwise, surgery will cause more harm to the patient than the existing tumor.

For stage 1-2 prostate cancer, radical treatment methods can be avoided.

Drug treatment should be regularly monitored by ultrasound and other diagnostic techniques. Postponing treatment for a certain period of time in medicine is called “wait-and-see tactics.”

Surgical treatment

If a patient with prostate cancer is under 65 years of age and has no contraindications to surgery to remove the prostate, he must consent to radical prostatectomy.

The patient is given general anesthesia. In some cases, epidural or spinal anesthesia is performed if there is no sensation in the lower body.

The duration of the operation usually does not exceed 150-200 minutes.

The gland is removed through an incision in the perineum or pubic abdomen.

If the malignant neoplasm is localized only in the prostate capsule, the cancer can be eliminated only by this method. If carcinoma grows into the walls of the bladder and rectum, additional methods will be required to remove it using chemotherapy and radiological methods.

Modern Da Vinci-type equipment allows surgical removal of prostate tumors through a special puncture, which quickly heals.

In this case, the doctor performs the operation automatically with control and control over the work of the robot, which eliminates the risk of performing manual removal with inaccuracies.

Chemotherapy procedure

The treatment method is based on the toxic effects of chemicals on malignant cells.

The mechanism of the destructive effect on cancer cells is based on stopping their proliferation.

Chemicals destroy the spindles, nucleus and membranes of malignant cells, which stops their growth and division and causes massive death of pathological tissue.

The feasibility of chemotherapy is justified at stages 3 and 4 of malignant neoplasm of the prostate, when the boundaries of the tumor extend beyond the prostate capsule and metastases penetrate into distant organs.

A course of chemotherapy is prescribed as an intravenous infusion or tablets.

Drugs like Paclitaxel, once in the blood, are carried throughout the body by the bloodstream, seek out cancer cells and lead to their death. Several courses of chemotherapy, with breaks, last about 6 months.

The reasons for the low use of chemotherapy in stages 1 and 2 of cancer are the toxic effects of the drugs on all cells of the body and undesirable side effects (complete hair loss, nausea, malaise).

Radiological method

Irradiation with various rays (X-rays, β-particles, γ-rays, neutrons) leads to premature aging and death of malignant cells as a result of destruction of nuclear DNA. The destruction of the nucleus is also accompanied by the inability of the cell to divide.

The device for emitting radiation in radiology departments is called a linear accelerator.

A specific method involving a linear accelerator is called external beam radiation therapy. The method is used for prostate carcinoma at stages 3 or 4, when metastases are detected in other organs.

Intended to destroy tumors in the prostate gland and lymphatic vessels.

The patient is exposed to 15 minutes of radiation over five days of the week. The duration of the radiological treatment course lasts 2 months.

At the end of the procedure, the patient is required to rest for two hours in a hospital setting, after which he can go home.

Fewer side effects and a greater therapeutic effect are achieved by another radiological method - brachytherapy, after which normally functioning tissues are irradiated with minimal effect, and the pathological tissue of the neoplasm dies.

For this purpose, radioactive elements are used: iodine-131 or iridium. Exposure to radiation is carried out under anesthesia.

There are several methods of radiation exposure without the use of devices. In such cases, needles made of radioactive elements are implanted for a day or granules are left for several days in the prostate gland.

The latest achievement in radiology is considered to be high-frequency ultrasound treatment.

In foreign clinics this method is used more often. A directed beam of high-frequency ultrasound destroys protein molecules formed in cancer cells. The technology is called HIFU.

Modern radiology methods make it possible to treat prostate cancer in initial and advanced stages of development.

Drug therapy

When the concentration of testosterone in the prostate tissue decreases, the growth processes of pathological cells decrease. Elderly men, as well as those with contraindications to radical treatment, take hormonal medications.

Hormone therapy is also indicated for advanced stages of cancer with widespread metastases; in this case, the patient’s life is extended, although not for such a long time as with stage 1 or 2 cancer.

The goal of hormonal therapy is to artificially reduce high androgen levels, so the following hormonal medications are now used:

Selective antagonists of gonadotropic releasing hormones.

Drugs such as Diethylstilbestrol, Honvan, Fosfestrol, Dimestrol, Firmagon, Diethylstilbestrol propionate and others block testosterone activity for a long time by different mechanisms.

While inhibiting the growth of malignant tumor cells, the drugs also promote the acquisition of differentiation by pathogenic cells (more similar to normal prostate cells).

Synthetic analogs of pituitary hormone.

They have the goal of reducing the concentration of testosterone so much that a hormonal blood test can make an erroneous conclusion about the absence of testicles in the patient.

A sharp drop in the level of male hormones is not permanent: after a few weeks, the concentration of testosterone rises again.

Antiandrogens.

They are used in conjunction with analogues of pituitary hormones, which provides the greatest therapeutic effect for prostate carcinoma.

The most common drugs within this group are Niftolid, Flutaplex, Casadex, Anandron.

The list provided does not indicate its use in a single patient.

If Casadex produces the proper therapeutic effect, then the use of other hormonal agents is inappropriate.

When using hormonal drugs, it is often possible to maintain libido and erectile function.

Men under 60 years of age usually receive hormonal medications and cryotherapy (exposing the prostate to low temperatures).

With the help of ice crystals formed in malignant cells, it is possible to destroy them. The combination of hormonal agents with radiological methods has a similar effect.

Monoclonal antibodies.

Synthetic antibodies, which are similar to natural ones and have the function of fighting cancer structures, have been introduced in the West for the last decade.

For this purpose, vaccines are being created to combat cancer cells. In Russia, such treatment has not yet become widespread.

Virotherapy.

A promising method for introducing viruses that recognize cancer cells and destroy them. The technique is effective in the initial stages of the disease.

The use of drugs such as ECHO 7 Rigvir at later stages in order to destroy metastases and stop the growth of carcinoma.

Already, treatment technology can extend life to 15 years. New strains of viruses will allow us to continue working on extending lifespan.

Traditional medicine in the fight against cancer

Folk recipes that have proven themselves in the treatment of prostate cancer use hop plants, willow catkins, meadowsweet fruits, licorice roots, fireweed flowers, and thuja branches.

Parts of the plant are used as an infusion or decoction. They are resorted to only as an additional treatment to the basic methods described above, prescribed by a doctor.

Other treatments

If there are no other treatment options, the patient is offered castration of one or both testicles (orchiectomy).

Psychologically, such an operation is difficult for men, although the morphological changes after the operation are invisible (insertion of testicular prostheses, reservation of the spermatic cords).

Diet

In case of prostate carcinoma, foods rich in animal fats, smoked foods, saltiness, sweets, alcohol-containing drinks, refined sugars, and pungency are excluded from food.

Disease prognosis

As the stage of cancer increases, the prognosis worsens. If cancer in stage 1, successfully cured, does not limit the life of the patient, then in stage 2 it is possible to extend the life of patients by 15 years, in stage 3 - by 5, in stage 4 - up to 3 years, unless a miracle occurs when medicine cannot explain no signs of disease after stage 4.

Prevention of prostate cancer

There is no clear way to avoid prostate cancer, but the factors that provoke its occurrence have been identified.

The risk of getting prostate cancer is lower if a person:

adjusted your diet correctly;
avoids taking carcinogenic substances;
strives for a healthy lifestyle;
systematically gets enough sleep;
regularly subjects the prostate and blood to examinations;
leads a regular sex life and correctly distributes physical activity throughout the day.

Treatment of prostate carcinoma has recently begun to improve through the use of innovative methods, boldly used in Israeli and Western clinics.

Bottom line

Any cancer is always scary, and prostate carcinoma is no exception. In this case, it is very important to identify diseases in the early stages, then you will have more chances to get rid of the disease.

It would be stupid to say that self-medication and the use of traditional methods can help.

Only comprehensive professional treatment in specialized hospitals can overcome this malignant tumor. Don't get sick!

Prostate cancer (prostate carcinoma)– a malignant tumor that develops from prostate cells. Only representatives of the stronger sex have this internal genital organ. It is deservedly called the second male heart because it plays a large role in the sexual sphere. A malignant prostate tumor grows relatively slowly. It can remain small for years, but, like other types of cancer, it is dangerous and forms metastases.

Prostate cancer is the most common malignant tumor in men and has become increasingly common in recent decades. Every year, 14,000 Russians hear from a doctor a diagnosis of prostate cancer. But our compatriots are relatively lucky, because this disease more often affects representatives of the Negroid race. But the Japanese and residents of South Asia get sick several times less often than Europeans.

The tumor can occur after 35 years in 1 in 10,000, but with age the risk of getting the disease increases hundreds of times. Among men over 60 years of age, every hundred people are already sick. And in old age, after 75 years, prostate cancer is found in one out of eight men. Therefore, after 50 years, you need to be especially attentive to your health and take special blood tests, which will indicate that there are problems with the prostate.

Prostate anatomy

Prostate or prostate gland - internal sex gland in men. In shape it resembles a chestnut, measuring 4 by 3 cm. It consists of lobes of different sizes: right, left and middle.

The prostate gland is located in the pelvis. It is located below the bladder, between the rectum and pubis. The prostate surrounds the urethra (urethra) with a wide, open ring. Therefore, its increase causes problems with urine excretion.

The prostate performs many functions , which provide “male strength”:

Supports Sperm Production
Increases their activity
Liquefies sperm with its secretion
Promotes its removal
Increases libido
Participates in orgasm
Blocks the outlet of the bladder during an erection

Structure of the prostate

Prostatic glands, there can be from 30 to 50 of them - this is the main part of the prostate. They consist of glandular epithelium and look like tubes surrounded by vesicles. Their task is to produce prostatic juice, which makes up a third of sperm.
Smooth muscle contract and remove prostatic juice from the gland. Its stagnation in the prostate can cause inflammation.
Connective tissue capsule covers the gland from the outside. Elastic partitions extend from it inside, between which glands are located.
The prostate can be felt through the rectum. It is located at a depth of 5 cm from the anus. Normally, the gland feels firm and elastic to the touch, without compacted areas or nodules.

Causes of prostate cancer

Scientists are still looking for an answer to the question of what causes prostate cancer. Some doctors argue that a malignant tumor develops only on the affected gland. Chronic diseases and other changes undermine the functioning of the organ and cause disturbances in the structure of cells.

Most often, the appearance of a tumor is preceded by:

Hormonal imbalance. The cause of a cancerous tumor can be an increase in the concentration of male sex hormones: testosterone, dihydrotestosterone and androstenedione. They cause the gland to grow and tumor cells to multiply. Due to this feature, prostate cancer is called a hormone-dependent tumor.
Prostate adenoma and other benign changes cause the growth of cells that should not be in the gland. They mutate more often than healthy glandular epithelial cells.
Prostatitis. Chronic inflammation in the prostate causes poor circulation and lack of oxygen.

In addition, prostate cells are attacked by bacteria and immune bodies. Under their pressure, the genetic apparatus in the nucleus, which is responsible for cell reproduction, changes. Such conditions contribute to the appearance of tumors.

Precancerous conditions

There are also precancerous conditions . They more often than others lead to the appearance of a cancerous tumor. These changes may be congenital or occur in adulthood. These include:

Atypical adenosis(atypical prostatic hyperplasia). Nodules appear in the central part of the gland, in which cells grow and multiply more actively than the surrounding ones. In addition, they change their structure. Their large nuclei indicate that the cells are in a borderline state between normal and tumor. It is considered a facultative precancerous condition - this means that cancer can arise in its place if mutagenic factors act on the body.
Hyperplasia with malignancy(prostate intraepithelial neoplasia). Cells in individual foci of the prostate begin to actively multiply. Gradually, they become less similar to typical prostatic gland cells, and acquire the properties and signs of a malignant tumor. It is considered an obligate precancer - this means that the likelihood of a malignant tumor is very high.

But not every man has changes in the prostate that turn into cancer. This happens if the body is exposed to factors that increase the risk of developing a malignant tumor.

Poor diet: predominance of fatty foods and red meat.
Bad habits: alcoholism and smoking.
Exposure to cadmium: in rubber and textile production, in printing houses and welding shops.
Age over 50 years.
Sexually transmitted infections.
Congestion in the prostate with irregular sexual activity.
A decrease in the body's defenses caused by prolonged stress and chronic diseases.
Heredity: special genes BRCA 1 and BRCA2 have been identified that cause tumor development. A father's cancer increases the risk of his son developing the disease by 2-3 times.
Infection with viruses: XMRV (retrovirus), herpes type 2, cytomegalovirus.

Signs of prostate cancer

In the early stages, signs of prostate cancer may not be noticeable. The tumor behaves secretly and does not cause any symptoms. It can only be revealed by an increase in the blood level prostate specific antigen (PSA).

Therefore, doctors discover prostate cancer by chance when a man is being examined for another disease. Symptoms of the disease appear when the tumor has affected neighboring organs: the bladder and intestines.

The first signs of the disease are associated with the fact that the prostate gland increases in size. It puts pressure on the sensitive wall of the bladder and irritates it. This causes the following symptoms:
- at night you have to get up 2-3 times to empty your bladder (normally 1 time)
- urination during the day becomes more frequent up to 15-20 times
- there is a strong urge to urinate that is difficult to tolerate
- severe pain and burning during urination
- pain in the perineum and pubis
When the prostate compresses the urethra and blocks the flow of urine from the bladder, the following signs of the disease appear:
- difficulty starting urination
- intermittent stream of urine
- at the end of urination, urine does not flow, but is released in drops
- after visiting the toilet there is a feeling that the bladder is still full
Low bladder tone means you have to strain your abdominal muscles to urinate. And still the urine comes out slowly, with little pressure and a sluggish stream.
Lower back pain and the appearance of kidney stones are due to the fact that when the bladder is full, urine rises in the opposite direction. It causes dilation of the ureter and renal pelvis.
In difficult cases, the outlet from the bladder is completely blocked. The man cannot urinate on his own. Then you need to urgently seek medical help so that the doctor inserts a catheter. This is a thin, flexible and soft tube that is inserted into the bladder through the opening of the urethra.
The appearance of blood in urine and semen indicates that the tumor has damaged blood vessels in the urethra, bladder or seminal vesicles.
The appearance of metastases in the inguinal lymph nodes causes swelling of the scrotum, penis and lower extremities.
If the tumor has damaged the sensory nerves that lead to the genitals, then the man may suffer from problems with potency.
Constipation and pain during bowel movements may indicate that cancer has affected the rectum.
Pain in the pelvic bones and spine appears in the later stages with metastases in the bones.
Secondary tumors in the liver cause heaviness in the right hypochondrium and jaundice, and a dry cough indicates metastases in the lungs.

All these symptoms do not appear at one moment, but gradually, and increase over several years. But none of these signs clearly indicate prostate cancer, and may be a manifestation of other diseases. But in any case, this is a reason to consult a urologist.

Degrees and stages of prostate cancer

The grade or stage of prostate cancer is determined based on the size of the tumor and its spread to nearby organs. Another important factor is the presence of metastases. This is the name given to secondary tumors that appeared due to the fact that blood and lymph carried malignant cells to distant organs.

In order to determine the stage of prostate cancer, an examination is necessary. For this they use different diagnostic methods .

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

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

Stage I – the tumor is microscopic in size. It cannot be felt or seen with ultrasound. It is indicated only by an elevated level of prostate specific antigen (PSA).
At this stage, the patient does not notice any signs of the disease.

Stage II – the tumor grows, but does not go beyond the boundaries of the organ. It is limited to the prostate capsule. Second-degree cancer can be palpated by digital examination in the form of dense nodes and detected on ultrasound.
With prostate cancer of the second stage, urination problems may occur, which are associated with the fact that the prostate compresses the urethra. In this case, the stream of urine becomes sluggish, pain and pain appear in the perineum. The need to go to the toilet makes a man wake up 3-4 times at night.

Stage III – a cancerous tumor extends beyond the prostate and grows into neighboring organs. The first to be affected are the seminal vesicles, bladder and rectum. Tumor metastases do not penetrate to distant organs.
Prostate cancer of the third stage is manifested by impaired potency, pain in the pubis and lower back. There is blood in the urine and a strong burning sensation when emptying the bladder.

IV stage – the malignant tumor increases in size. Metastases form in distant organs: bones, liver, lungs and lymph nodes.

With fourth-degree cancer, severe intoxication, weakness, and loss of strength appear. When emptying the bladder and bowels, difficulties and severe pain occur. Often a man cannot urinate on his own and has to have a catheter inserted.

Prostate cancer treatment

The doctor selects treatment for prostate cancer individually for each man. The urological oncologist necessarily takes into account the age, stage of the tumor, concomitant diseases and the wishes of the patient.

Waiting tactics. A man's advanced age (over 70 years), severe chronic diseases of the heart, blood vessels and lungs can become contraindications to treatment for prostate cancer. It can be more life-threatening than the disease itself. If the tumor is small, does not extend beyond the boundaries of the gland and has stopped its development, the doctor will suggest postponing treatment. In this case, you will have to do an ultrasound of the prostate and take a PSA test every 6-12 months.

Operation

Surgery to remove the prostate gland (radical prostatectomy) is one of the main methods of treating the tumor. This is the most common method of fighting cancer in men under 65 years of age.

The surgeon makes a small incision in the lower abdomen or perineum. Through it, the gland is completely removed. The doctor also excises the surrounding tissue and, if necessary, lymph nodes. The operation lasts 2-4 hours. The man is under general anesthesia at this time. Sometimes regional anesthesia (epidural anesthesia) is given when there is no sensation below the belt.

If the tumor does not extend beyond the connective capsule, then the disease can be defeated in 100% of cases. But if the tumor has grown into neighboring organs, then it can also be removed, but the prognosis for recovery worsens. Additional chemotherapy or radiotherapy may be required.

Modern clinics offer treatment with the help of a special robotic surgeon “Da Vinci”. The doctor controls all the actions of the robotic system, which rids the body of the tumor with high precision. The operation is performed through small punctures, which then heal quickly. New technologies make it possible to reduce the risk of complications to a minimum. Side effects such as urinary incontinence and impotence are avoided.

Chemotherapy

Chemotherapy for prostate cancer is the destruction of tumor cells using drugs that contain special toxins. These substances destroy cells that divide quickly. This is precisely the feature that distinguishes cancer cells from others. Chemotherapy drugs destroy the nuclei and membranes of tumor cells, causing their death.

Chemotherapy is used instead of surgery in stages III and IV, when the tumor has grown and metastases have appeared. Toxins are carried by the blood throughout the body, find cancer cells and destroy them. The drugs are administered intravenously in courses (Paclitaxel), sometimes they are taken in tablet form. In total, treatment lasts six months.

Prostate cancer is sensitive to chemotherapy, but it is rarely prescribed in the early stages. The reason is that chemotherapy drugs also act on healthy cells and cause many side effects (baldness, weakness, nausea).

Radiotherapy

Radiotherapy is the treatment of prostate cancer using x-rays, neural, gamma, beta or other radiation. Radiation disrupts the DNA of tumor cells. This leads to the fact that they cannot divide, grow old and die.

When treating prostate cancer, irradiation is carried out using special equipment - a linear accelerator. This method is called external beam radiotherapy.

The doctor will recommend external irradiation if the tumor is large and there are metastases in other organs. In this case, it is necessary to irradiate not only the tumor itself, but also the lymph nodes. The course of treatment lasts about 2 months, 5 days a week. The irradiation lasts 15 minutes and is absolutely painless. After the procedure, you need to rest for 1-2 hours and you can return home the same day.

But it would be more effective to inject particles of a radioactive substance directly into the prostate. The method was called - brachytherapy. For this purpose, iridium or radioactive iodine is used. As a result of this exposure, the cancerous tumor dies, and healthy tissues are minimally irradiated. This avoids serious side effects.

The procedure is performed under anesthesia. There are techniques where radioactive granules remain in the gland. There are also those where needles with irradiating material are inserted for a while and removed on the same day.

Radiation therapy is used to treat cancer in the early stages and in advanced cases when surgery can no longer be performed.

Fewer complications occur if prostate cancer is cauterized with a thin beam of high-frequency ultrasound (HIFU therapy). Under its influence, the protein in cancer cells is destroyed and they die. HIFU therapy is widely used in foreign clinics.

Treatment with medications

Prostate cancer is a hormone-dependent tumor. The more male sex hormones in the body, the faster it grows. Treatment with medications is aimed at reducing the concentration of hormones - androgens and reducing the sensitivity of the tumor to their effects. As a result, it is possible to stop the development of cancer. The sooner you start taking medications, the better the results will be. But even in the last stages of prostate cancer, treatment can significantly alleviate the condition and prolong life.

Treatment with hormones

For older men who cannot undergo surgery for health reasons and for patients with stage 4 cancer, hormone therapy is the only available treatment method.

To treat prostate cancer without surgery, use:

Gonadotropin-releasing hormone antagonists: Firmagon, Fosfestrol, Diethylstilbestrol. The drugs reduce testosterone levels. They inhibit tumor growth and help its cells become more differentiated (similar to other prostate cells).
Pituitary hormone analogues: Diphereline, Lucrin, Decapeptyl. Injections of these hormones provide “medical castration.” After 2-3 weeks, the level of male hormones drops as much as if a man had his testicles removed. But this phenomenon is temporary, and gradually the concentration of testosterone in the blood increases again.
Antiandrogens: Casodex, Flucinom, Anandron. These drugs prevent tumor cells from interacting with hormones that are secreted by the adrenal glands. They are used in conjunction with pituitary hormone analogues. This combination is called “maximum androgen blockade” and allows you to achieve the best results in cancer treatment.

In some cases, the doctor prescribes only one drug from the group of antiandrogens - Casodex. If a man is suitable for this treatment, then it is possible not only to stop the growth of the tumor, but also to maintain libido and erection.

In men under 60 years of age, hormone treatment is combined with cryotherapy - freezing the tumor using low temperatures. Ice crystals that form in cancer cells destroy their membranes. The combined use of hormones and radiation therapy has a good effect.

If hormonal treatment does not produce results, the doctor will recommend surgery to remove the testicles. After it, testosterone levels drop and tumor growth stops. But men have a hard time with surgical castration psychologically.

Monoclonal antibodies

These drugs contain antibodies similar to those produced by the human immune system to fight tumors. Over the past decades, special vaccines have been created and tested that help the immune system defeat prostate cancer. In the USA, such drugs were approved in 2006. In our country, immunotherapy for prostate cancer is not often used.

Virotherapy

Among new treatment methods, virotherapy is considered the most promising. Viruses are specially developed that find and dissolve (lyse) cancer cells. ECHO 7 Rigvir has proven itself best. The drug reduces tumors and stimulates the immune system so that it independently fights mutant cells. It is prescribed in the early stages of the disease before and after surgery.

If cancer is detected at stage 4, the doctor prescribes treatment that is aimed at relieving pain and improving the condition. In this case, the tumor is not removed, but rather an attempt is made to stop the spread of metastases.

An operation or properly selected treatment helps a man live 15 years or even more. Research is constantly being conducted in this area and new drugs are being tested. This gives hope that in a few years doctors will be able to cope with the disease in its later stages.

Prognosis for prostate cancer

The prognosis for prostate cancer is favorable if a man consults a doctor on time and the disease is detected at stage I. Treatment allows you to completely get rid of the tumor, as well as preserve male strength and avoid problems with urinary incontinence. The man can continue to work. Life expectancy with successful treatment is unlimited.

If you are diagnosed with stage II or III prostate cancer, more complex and lengthy treatment will be required. Its success depends not only on the skill of the doctor, but also on the age of the man and his state of health. The life expectancy of most patients with stage II is more than 15-20 years. Patients with stage III who are successfully treated can live 5-10 years.

It is believed that stage IV prostate cancer has a poor prognosis for recovery. The average life expectancy is 3 years. But combined treatment and the will to live can work wonders. And some men manage to live longer than 5-7 years.

Doctors have a “five-year survival rate” indicator. He talks about what percentage of patients live for five years or more after treatment. This allows us to judge the chances of treatment success in patients with different stages of cancer.

Prevention of prostate cancer

Modern medicine has not yet found a way to 100% prevent the development of prostate cancer. But doctors have developed recommendations that will help reduce the risk.

Eat right. It is advisable not to eat fatty meats, and include a lot of fresh fruits and vegetables in the menu.
Avoid carcinogens. These substances, which cause cell mutation, are found in tobacco smoke, nitrates, food additives, and hazardous industries.
Lead an active lifestyle. 15 minutes of morning exercise and 40 minutes of walking help strengthen blood vessels and the heart, and improve immunity.
Get enough sleep. During sleep, the body releases the hormone melatonin, which protects against tumor development.
Avoid prostate congestion. Regular sex life and physical activity are especially important for people who have a sedentary job. These measures ensure the outflow of prostatic juice and help avoid inflammation.
Get checked regularly. After 50 years of age, prostate cancer screening should be performed once every two years. It is necessary to take a blood test for specific prostatic antigen and do an ultrasound of the prostate. Those who suffer from adenoma or prostatitis need to be examined once a year.

Take care of yourself and be attentive to your health, this will help maintain your virility and live a long, happy life.

In recent years, there has been a significant increase in the incidence of prostate cancer (PCa). It occupies a leading place among cancer diagnoses in men. Despite improvements in the early diagnosis of prostate cancer, detection of advanced cases and mortality remain high. In 22% of patients, the disease is first diagnosed at the 4th stage, in 35% - at the 3rd stage.

Despite the fact that prostate cancer in the early stages is most often asymptomatic, there are a number of nonspecific signs by which this pathology can be suspected.

Changes in the prostate due to cancer

The prostate gland is a small organ located in the pelvis. Consists of two lobes connected by an isthmus. The rectum is adjacent to it at the back, the neck of the bladder is located on top, and the seminal vesicles are on the posterolateral surfaces.

The prostate covers the initial part of the urethra, and the seminal ducts pass through its thickness. Conventionally, the entire prostate gland is divided into 3 zones: central (closer to the bladder), transitional (middle) and peripheral, where the vast majority of malignant tumors arise.

Normally, the prostate measures 3x4x2.5 cm, its volume and shape are compared to a walnut.

With prostate cancer, it can significantly increase in size and put pressure on the urethra. Impaired urination is the main local symptom.

As the process progresses, general signs of the effect of cancer on the entire body (paraneoplastic symptoms) may appear.

Metastasis of the primary tumor forms a picture of damage to other organs; sometimes prostate cancer initially manifests itself precisely as the influence of distant metastases.

Local signs

The first symptoms of prostate cancer in men appear when the tumor is already quite large or located in the central or transition zones.

Clinic from the lower urinary tract

Weakening and/or splashing of the urine stream.
Intermittent urination.
Increased urge to go to the toilet. Urge – a sudden, strong desire to urinate, even to the point of incontinence.
Having to wake up at night to empty your bladder.
Dissatisfaction after urination, feeling of incomplete emptying of the bladder.
Urinary incontinence.
It is difficult to begin the act of urination, the need to strain. This is especially noticeable in the morning.
Discomfort and burning when urinating.
Constant pain in the suprapubic region, back, perineum.

As a result of partial obstruction (blockage) of the urethra, the bladder may not empty completely, leaving a residual volume. If the patient ignores these symptoms and does not see a doctor, chronic urinary retention may develop. This condition is manifested by the following symptoms:

Paradoxical ischuria - constant leakage of urine.
Heaviness in the lower abdomen.
Enlargement of the abdomen due to stretching of the bladder (sometimes it can reach the navel).
Pain in the lumbar region due to stretching of the renal pelvis.
Attachment of infection and pyelonephritis.
Development of renal failure (increased blood pressure, weakness, nausea, itching, swelling of the whole body).

Symptoms of sexual dysfunction

Sexual intercourse is incomplete and does not end with ejaculation.
Hemospermia is an admixture of blood in semen.
Pain during ejaculation.
Impotence.

Damage to the pelvic lymph nodes and tumor growth into nearby organs

Swelling of one or both legs.
Constant pain in the lower abdomen, in the perineum.
Hematuria is the presence of blood in the urine when it spreads into the bladder or urethra.
Constipation, false urge to defecate, mucus and blood in the stool when spreading into the rectum.

General symptoms

A growing malignant tumor tends to affect the entire body. This is explained by the release of toxic metabolic products, as well as the release into the blood of biologically active substances produced by carcinoma cells.
General and paraneoplastic symptoms of prostate cancer include:

Decreased hemoglobin.
Weakness, fatigue, poor appetite.
Losing weight.
Skin itching.
Inflammation of the joints.
Increased body temperature.
Dermatitis.
Polyneuropathy – numbness in the limbs, weakness.

Signs of prostate cancer metastases to other organs

Skeleton

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

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

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

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

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

Liver

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

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

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

Metastases to the bronchopulmonary system

In the presence of tumor deposits in the lungs, the following signs of prostate cancer in men are possible:

A persistent, untreatable cough.
Hemoptysis.
Increasing shortness of breath.
Constant pain in the chest.

Brain damage

Brain metastases are always accompanied by neurological symptoms. Depending on the size of the lesions, number and location, the following may be observed:

Expanding headaches, with nausea.
Cramps.
Speech disorders.
Complete (plegia) or partial (paresis) paralysis of the limbs on one side.
Dizziness, unsteadiness of gait.
Mental disorders.

Dynamics of symptoms depending on stage

Prostate cancer is conventionally divided by oncologists into:

localized form (limited to the organ capsule);
locally advanced (with regional metastases to lymph nodes or surrounding tissues);
generalized (with spread to other organs distant from the primary focus).

The initial form of prostate cancer (stage 1-2), especially coming from the peripheral zone, is most often asymptomatic. But sometimes even at the first stage there may be signs of urination problems or erectile dysfunction.

However, these symptoms for early-stage prostate cancer are nonspecific; they are also characteristic of benign prostate adenoma, which occurs in 50% of men over 50 years of age. It is possible to detect prostate cancer against the background of adenoma only through a special examination.

Stage 3 cancer (locally advanced) is characterized by more pronounced signs of urination problems, there may be an admixture of blood in the urine or semen, pain in the pelvis, in the perineum, and general and neoplastic symptoms.

Generalized prostate cancer gives a very clear clinical picture with metastases to the bones and brain. Signs of cancer intoxication increase (weakness, weight loss, anemia). In this case, local symptoms may fade into the background.

Conclusion

Most types of prostate cancer are slow-growing tumors. In the early stages, there are no specific symptoms of prostate cancer, which is why it is so difficult to recognize. But we must remember that every third man over 70 years of age has a chance of developing RP and 3% have a risk of dying from it.

Even with minor urination problems, you should contact a urologist. Most likely, a benign pancreatic adenoma will be diagnosed and treatment will be prescribed. But this does not mean that you need to calm down and not go to the doctor anymore.

Benign prostatic hyperplasia does not exclude the possibility of cancer. For timely detection of a malignant neoplasm, it is necessary to undergo regular examinations (dynamic PSA levels, transrectal ultrasound, and, if necessary, pelvic MRI and gland biopsy may be prescribed).

Prostate cancer detected in the early stages has every chance of cure. And the patient himself plays a big role in identifying it.

The prostate or prostate gland is an internal organ of the male reproductive system, which, like a wide bracelet, covers the initial sections of the urethra. The main functions of the prostate are to produce part of the seminal fluid (up to 30% of the total volume) and participate in the act of ejaculation. The prostate also has a direct bearing on a man's ability to hold urine.

Prostate cancer is a malignant tumor that usually develops from the tissue of the prostate glands. Like other malignant tumors, prostate cancer has a tendency to metastasize (spread throughout the body).

The statistics are inexorable: prostate cancer occurs in every seventh man over 50 years of age. And, unfortunately, this disease is one of the most common causes of death in elderly men.

Reasons

Until now, the causes of prostate cancer have not been fully elucidated. However, it is known for certain that the disease is associated with the male sex hormone - testosterone. The higher its level in a patient's blood, the more likely he is to develop prostate cancer and the more malignant the disease will be.

Risk factors also include:

old age;
poor heredity (close relatives have prostate cancer);
existing progressive prostate adenoma;
bad environment;
work with cadmium (welding and printing works, rubber production);
improper diet (lots of animal fats, little fiber), etc.

What's happening?

Prostate cancer usually has a slow and malignant course. This means that the tumor grows relatively slowly (from the moment a microscopic tumor appears in the prostate to the last stage of cancer, an average of 10-15 years passes).

Prostate cancer can give early metastases, that is, even a small tumor can begin to spread to other organs. Most often, the spread goes to the lymph nodes, bones (pelvis, hips, spine), lungs, liver, adrenal glands. This is the biggest danger of cancer. Before metastases appear, the tumor can be removed, and this will stop the disease. But if metastases appear, no surgeon can remove them all, and it will no longer be possible to completely cure the person.

How to recognize?

The problem is that the symptoms of the disease begin to bother a man only when the disease has gone too far and there is little chance of a complete cure. Prostate cancer can manifest itself as increased frequency of urination, pain in the perineum, and blood in the urine and semen. But you may not experience any of these symptoms. And then the first manifestation of the disease will be signs that are characteristic of metastases: pain in the bones (pelvis, hip, spine) and fractures, chest pain.

In advanced cases, acute urinary retention may develop, as well as symptoms of cancer intoxication: a person suddenly loses weight, becomes weaker, and his skin becomes very pale with an earthy tint.

More rare symptoms of prostate cancer are impotence or weak erection (the cancer has affected the nerves that control erection), a decrease in the volume of sperm during ejaculation (the tumor is blocking the ejaculatory canal).

Diagnostics

If you have problems with urination, immediately contact a urologist. Perhaps not everything is so bad, and this is just an adenoma or inflammation of the prostate.

First of all, the doctor will check the condition of the prostate gland - conduct a digital rectal (through the rectum) examination. This is the simplest test method to suspect prostate cancer. Unfortunately, if the tumor can be felt, most often it is already one of the later stages of cancer. Therefore, even if the tumor cannot be palpated, the patient will be prescribed an additional test: a blood test for prostate-specific antigen (PSA).

PSA is a substance whose concentration in a man’s blood increases sharply with prostate cancer. To clarify the diagnosis, the patient may also be prescribed an ultrasound of the prostate, computed tomography, X-ray and radioisotope studies.

The final diagnosis of prostate cancer is made after a prostate biopsy - a small piece of the prostate is taken through the perineum or through the rectum for examination.

Treatment

There are surgical, drug and radiation treatments for prostate cancer. The oncologist will decide which method to choose individually, depending on the patient’s age, the extent and stage of the cancer, and the presence of metastases.

Surgical treatment methods (removal of the prostate gland) are usually used only when the tumor has not yet metastasized. If the operation is performed successfully, it practically guarantees a complete cure for prostate cancer without any health consequences.

Drug treatments are treatments with hormones that reduce or block testosterone, thereby reducing the rate of tumor growth and metastasis. Treatment with hormones does not provide a complete cure, but it improves the patient’s condition for a long time and reduces the symptoms of the disease. Radiation therapy - radioactive irradiation of a prostate tumor, also reduces the rate of tumor growth and reduces the likelihood of metastases, but does not guarantee a complete cure for cancer.

Radiation therapy and drug therapy are often used together to enhance the effect of treatment.

An alternative method of radiation exposure to the prostate gland in the initial stages of the disease is brachytherapy. The essence of the method: under ultrasound control, granules of radioactive iodine are injected into the prostate gland, due to which a high dose of radiation is achieved in the area of malignancy, and the surrounding tissues are practically not affected. The procedure for introducing capsules takes about an hour and is carried out on an outpatient basis, which distinguishes it from other types of radiation treatment.

The first two stages of prostate cancer are such a small pathological focus that most often it does not interfere with normal functioning. This cancer is usually found by chance during surgery or screening.

The tumor grows slowly and the disease progresses unnoticed by the man. In this regard, the first signs of prostate cancer, which clearly attract attention, develop on average 20 years from the onset of the disease.

It is quite difficult to identify symptoms characteristic of the first stage of prostate cancer, but this could allow treatment to begin on time and get a good result.

Stage 1

Stage 1 – tumor in the submucosal layer, microscopic in size. There are no characteristic symptoms of stage 1 prostate cancer. Nonspecific symptoms are possible:

weight loss;
headache;
decreased appetite;
fatigue;
recurrent thrombophlebitis;
bleeding

Most often, prostate cancer at this stage is completely asymptomatic.

A doctor may suspect a developing cancer process based on a general blood test. Persistent anemia, increased ESR, and changes in the leukocyte formula are detected.

In a biochemical blood test, there is a decrease in the level of all proteins, in particular albumin - hypoalbuminemia.

Stage 2

Stage 2 – the tumor grows throughout the entire thickness of the organ and capsule. Depending on whether the tumor interferes with the flow of urine through the ureter, symptoms of stage 2 prostate cancer may or may not occur.

If the tumor compresses the ureter, then the following appear:

feeling of incomplete emptying;
frequent urination;
nocturia – frequent urination at night;
weakening of the urine stream;
false urge to urinate;
Urgency – the inability to hold urine when wanting to urinate.

Sometimes urinary incontinence occurs, which is a consequence of either urinary retention or a tumor lesion of the sphincter. Tumor growth into the sphincter is a symptom of stage 4 prostate cancer.

Stage 3

Stage 3 – the tumor grows outside the capsule. Symptoms of prostate cancer either just appear if there were no manifestations up to stage 3, or progress. Mostly, the tumor is detected at this stage, because the discomfort it causes forces you to consult a doctor.

All those signs that were in the previous stages come into full force. Minor pain in the pelvis or back becomes bothersome, it becomes more and more difficult to urinate, weakness increases, and performance decreases. Back pain at this stage is caused by compression of the sensitive nerve endings of the pelvis by the overgrown gland.

The tumor is already quite large and may begin to disintegrate. A sign of this process is an increase in the level of urea with an unchanged level of creatinine in a biochemical blood test.

Stage 4

Stage 4 – tumor invasion into neighboring organs, metastases to regional or distant lymph nodes, bones, internal organs. The first symptom of the appearance of metastases is moderate pain in the pelvis and lower back.

Signs of prostate cancer spreading into the rectum include symptoms such as:

constipation;
tenesmus - painful urge to defecate without bowel movement;
bleeding from the rectum;
secretion of mucus and anus;
intestinal obstruction.

Prevention

No specific prevention has been developed. Men over forty years old should be examined annually by a urologist to detect a tumor in its early stages.

This examination includes a digital examination of the prostate and determination of the PSA level in the blood. To reduce the risk of prostate cancer you need:

limiting the amount of animal fats in food consumed, observing;
eliminating the toxic effects of alcohol and nicotine on the body;
regular ;
high physical activity and light (with doctor's approval!);
rational mode of work and rest.

A careful and careful attitude towards your own health will allow you to notice the signs and symptoms of incipient prostate cancer in time. Cancer diagnosed in the early stages and treated is a guarantee that there are still many years of a fulfilling life ahead.