Prostate Cancer – One Of The Leading Prostate Problems

Prostate cancer is one of the leading causes of death among men older from malignant tumors and constitutes 5,6% of all tumors. In Russia, prostate cancer is the 4th place.

Risk Factors:

Heredity (if a man has a father or brother suffers from prostate cancer, the probability of contracting doubles), increased consumption of animal fats, low intake of vitamin E, vitamin D.

Pathological Anatomy.

Most prostate cancer arise on the periphery of the body, only 25% of cancers in the central regions of the prostate gland. The most common (more than 90% of cases), distant metastases, bone is affected somewhat less – the soft tissue, lymph nodes, lungs, and liver.

Tnm Classification

Primary Focus.

Tx – the primary focus has not been investigated T0 – the primary tumor is not determined. T1 – tumor showed no clinically not visualized T1a – a random discovery, the tumor is not more than 5% of tissue resected T1b – a random discovery, a tumor more than 5% of tissue resected T1c – a tumor detected during puncture biopsy carried out at elevated PSA T2 — visualized in the prostate, did not grow beyond the capsule T2a – tumor is localized in one lobe T2b – tumor shares T3 – tumor grow beyond the prostate capsule T3a – tumor grow beyond the prostate capsule with one or both sides T3b – tumor germination seminal vesicles T4 – tumor sprouting surrounding tissues or organs: bladder neck, external sphincter of the bladder, rectum, muscle lifts the anus.

Clinical Picture

Disease at the time of initial diagnosis are palpable center seal prostate (watching more than 50% of patients), dysuria, delayed or incontinence, hematuria, thamuria.

Diagnosis

Early lesions of the prostate remains difficult.

Physical Examination.

Digital rectal examination

The main method of diagnosis of prostate cancer. Only 15-40% of prostate tumors identified by digital rectal examination. Histological examination of tissue removed during adenomectomy, only 10% of cases reveal the initial malignant growth. The remaining cases are neglected cancers; prostate cancer is often detected on clinical examination of patients with bone metastases. In cases of prostate cancer, germinating capsule of the prostate, found increased activity of phosphatase acid. Patients with distant metastases, this figure increased to more than 80% of cases. The activity of phosphatase acid should be determined prior to rectal examination or prostate massage, because after such procedures in the blood of a non-specific increase of this enzyme within 1-2 days. as a diagnostic marker to determine the serum prostate-specific Ag, but there may be false positive results.

Confirmation Of The Diagnosis.

Accurate diagnosis allows establishing needle biopsy of the prostate, performed through the anus, perineum, or urethra. Laboratory tests used to assess kidney function, while at the same time Radioisotope bone scan, radiography, excretory urography, CT of the pelvis and / or retroperitoneal space can detect metastases in different bodies.

Determining The Stage Of Disease.

Tumors stage T0-1 asymptomatic, detected at autopsy or in the study of prostate tissue, removed at the expected adenoma. T2 tumors grow within the prostate, detect the finger in a study of prostate specific sites, and may be surgically removed. Unfortunately, in fact only 10% of prostate cancers can be treated with surgical intervention. In many cases, pelvic lymph node metastases are present, can not be detected during rectal examination. T3 tumors: the cancers that spread beyond the prostate capsule (e.g, seminal vesicles, bladder neck), but not to other pelvic structures. Such tumors account for 40% of all newly diagnosed prostate cancers and are not subject to surgical treatment. T4 tumors: the cancers that grow in the pelvic bones, lymph nodes or more. About 50% of newly diagnosed cases refer to the stage T4.

Treatment And Prognosis

• Early stage cancers require a radical prostatectomy, distant therapy, or interstitial radiation
• Shown prostatectomy patients under the age of 70 years and provides a 10-15-year survival. Radical prostatectomy with preservation of the nerve plexus around the prostate shows patients with small tumors and in 40-60% of cases allows you to keep a normal sexual function, but in 5-15% of causes in patients with urinary incontinence
• Radiation therapy is shown elderly patients with high incidence of cancer or in the presence of other diseases of internal organs, do not allow surgery. Irradiation is also used by persons wishing to retain sexual activity. Cases of impotence with interstitial implantation of isotopes are less common than in the remote _-therapy.
• T4 tumors can not be cured, patients receiving palliative hormonal therapy
• Testectomy performed in patients with high risk of developing cardiovascular disease. Postoperative administration of hormones (e.g, diethylstilbestrol by 1-3 mg daily) leads to a decrease in testosterone levels
• Leuprolide as monotherapy or in combination with flutamide. Flutamide and aminoglutethimide – drugs of choice in patients that can not be a primary hormonal therapy, cause remission in about 50-80% of cases, although full recovery is observed infrequently. Typically, lesions of the prostate and soft tissue regressed, serum levels of alkaline phosphatase and prostate-specific Ag reach normal values, bone pain rapidly diminished. The average duration of therapeutic effect of hormone replacement therapy is 9-18 months.

• Temporary effect may provide adrenalectomy followed by administration of flutamide and aminoglutethimide.
• Chemotherapy is usually not shown. Often used cisplatin, doxorubicin, cyclophosphamide and fluorouracil.

This entry was posted on Wednesday, March 10th, 2010 at 4:22 pm and is filed under Prostate Cancer. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.