Prostate cancer is a disease in which prostate cells change, become maligne, multiply uncontrollably and increase rapidly creating a prostate tumor mass. Cancer cells can develop both in the prostate tissue, destroying adjacent normal tissue, or can migrate through blood vessels or lymphatic vessels causing metastases ( “seeding” the disease in other organs or tissues).
Prostate Cancer Prevalence
Prostate cancer is the first neoplasia in terms of the frequency with which it is encountered in urology. Prostate cancer is the second cause of cancer related death after lung cancer in men. In the U.S. 95 of 100,000 inhabitants, in Europe 40 in 100,000 people, and in Asian countries 4 in 100,000 people develop prostate cancer.
Prostate Cancer Causes
Several factors were associated with an increased risk of developing prostate cancer. Of these we mention the most important:
- Age – prostate cancer rarely occurs before age 50 years and is very common in men of 60-70 years over 75 years of prostate cancer will occur in 1 in 9 men.
- Race – African-American population is exposed to a higher risk of other races, opposite the Asian populations.
- Hormonal status – the level of testosterone increased by over 50% of the average serum causes a 2.34 times higher risk of developing prostate cancer.
- Family history – men who had a first-degree relative diagnosed with prostate cancer are twice as likely to develop prostate cancer, while the presence of two or three patients family increases the risk of 5 and 11 times.
- Diet – a diet rich in animal fat may increase prostate cancer risk
The risk of prostate cancer increases with age.
Prostate Cancer Symptoms
Prostate cancer has no typical symptoms. Prostate cancer can evolve from the beginning asymptomatic, being discovered by chance after a digital rectal examination. It often manifests itself through a subvezical obstruction syndrome, similar to benign prostatic hyperplasia (prostate adenoma), with or without a urinary infection. The natural evolution of prostate cancer symptoms usually occurs late because in most cases the starting point of the cancer is on the periphery of the gland tissue. The presence of symptoms and signs already betrays a locally advanced stage or a metastatic disease.
Usually the symptoms that trouble and bring the patient to the doctor are:
- Frequent urination especially at night
- Urgent need to urinate
- Weak urinary stream designed (falls closer to you)
- Interrupted urinary stream
- Feeling that the bladder does not empty completely after urination
- Start and end of urination difficulties
- Hematuria – the presence of blood in the urine
- Hemospermia – presence of blood in semen
- Decreased semen volume ejaculation
- Local pain as discomfort, stinging, foreign body sensation located in the perineum.
Micturition disorders, as dysuria, urinary flow force reduction, frequent urination, nocturia has different degrees and can ultimately lead to the emergence of complete urine retention. The patient can present symptoms (considered to be late symptoms), due to metastasis: bone pain, pathological fractures. Also, there may be signs of an anemic syndrome, secondary invasion of the bone marrow or chronic renal failure, neoplastic infiltration of the ureteric orifices.
Prostate Cancer Diagnosis
In prostate cancer diagnosis is suggested by a DRE (digital rectal examination). It finds either a isolated node or hard lump or lobe surface irregularities, increased consistency or hardness, or a ”wooden” prostate as a whole. Infiltration is possible and seminal vesicles, which are increased in volume and are in tension. If there is clinical suspicion of prostate cancer, transrectal prostate biopsy is mandatory, a puncture under digital guidance or if possible, ultrasound, using a transrectal transducer. Histopathology of harvested fragments can clearly indicate the type of cancer.
Cytological diagnosis. Prostate biopsy is the standard diagnosis of prostate cancer. This is done under transrectal ultrasound guidance (using a fine needle to obtain a small fragment of the prostate). Puncture is performed under local anesthesia and the optimal number of biopsy fragments is between 10 and 12. After the procedure blood in urine may appear. Microscopic examination of smear provides information about the presence of atypical cells, their proportion and severity characteristics of malignancy.
Ultrasound examination shows: prostate with irregular structure, uneven, bladder with residue after urinating (kidney with a normal appearance or various degrees hydronephrosis) due to neoplastic infiltration of the ureteric orifices. The transrectal ultrasound examination of the prostate method is preferable. Although changes in structure are not pathognomonic for prostate cancer, the method is especially useful in transrectal prostatic puncture guide. Transrectal ultrasound allows accurate measurement of prostate and identifies suspicious areas, also provides seminal vesicles and vicinity prostate tissue images
Radiological examinations provides data mainly on neoplastic invasion. Direct renal radiography can indicate bone metastases. Urography may show a delay in the elimination of the contrast substance, dilated ureter or mute kidney. Asymmetry of the upper excretory tract is an important sign in the diagnosis of prostate cancer.
Strontium or technetium bone scan with radioactive elements allows early diagnosis of bone metastases.
Uretrocistoscopic examination may reveal changes in the prostate or bladder neck lodge.
Tomography and magnetic resonance imaging examination. CT examination is used to evaluate local extension, and for post-therapy monitoring . Pelviabdominal CT can identify lymph node enlargement or abnormalities in other organs, but can not determine whether they are related to prostate cancer or not.
Laboratory tests, two biochemical markers are important in prostate cancer: – the serum prostate specific antigen (PSA secreted by prostate epithelial cells) and acid phosphatase. In prostate cancer have both increased.Serum PSA (VN 1-4 mg / ml) increases with tumor volume. Acid phosphatase increased in advanced stages of disease, especially in the presence of bone metastases.
Prostate Cancer Treatment
The diagnosis of prostate cancer usually scares the patient, but this disease, diagnosed in early stages benefits from curative treatment. Therapeutic means that are able to bring healing are:
- Radical prostatectomy,
- External radiotherapy
The treatment option method choice belongs to the urologist, oncologist in collaboration with the patient. Stages of prostate cancer in which curative treatment may apply are stage I, II and III stage (only in particular situations).
Radical prostatectomy is the surgical removal of the prostate and seminal vesicles entirely. The most common complications of this type of intervention are urinary incontinence and impotence. Modern surgery keeps intact the neuromuscular bands responsible for erection and ensures the preservation of striated urinary sphincter. Only in late prostate cancer stages these goals can not be met.
External radiation represents iradiation of patients in early stages of prostate cancer in the pelvic area, in the prostate region.
Brachytherapy is also a method of radiation consisting of planting in the prostate, “seeds” containing a radioactive substance (usually radioactive iodine), which will release its radiation inside the prostate. The advantage of this method is that the patient gets rid of “cuts” and complications from surgery or classic radiotherapy.
Bilateral orchidectomy or surgical castration, is a method that has lost more and more ground and approaching extinction in the current urological arsenal, being overthrown by modern medical treatment.
If prostate cancer stage is advanced and does not allow a radical curative intervention,or the disease is metastatic, the treatment consists of hormone therapy, which is able, at least initially, to stop the disease at the stage it was diagnosed. Management of hormonal treatment is performed under close supervision of PSA values and patient symptoms and will be adjusted whenever necessary to achieve a better control.
Drugs used in prostate cancer are grouped according to how and where they act, in several categories, but all with the same principle, namely the reduction of circulating testosterone: estrogen, LHRH analogues, LHRH antagonists, anti-androgens (steroid or non-steroidal).
There are cases of prostate cancer in which the best treatment is to “do nothing”. This is what the Anglo-Saxons meant by “watchful waiting”. In other words urologists are closely monitoring any changes in the disease and start the treatment when appropriate.