Prostate tumors

In terms of frequency of occurrence, these neoplasms are one of the first places in men, accounting for, according to various sources, from 5 to 18 percent of cancer cases. Most often, the age of sick men is over 60-70 years. It is believed that prostate cancer is caused by disorders of endocrine regulation in the sexual sphere.

What is this?

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. Prostate cancer cells do not divide normally, grow uncontrollably and spread to other tissues. Prostate cancer is usually a tumor that grows very slowly, often without causing any symptoms until the advanced stages. Most men with prostate cancer die from other causes — many don’t even know they have the disease. But when prostate cancer begins to grow faster or spread outside the prostate gland, it is dangerous. This aggressive type of prostate cancer can occur at any age. Although this disease tends to progress slowly, it is usually fatal if it spreads beyond the prostate gland itself.

Prostate cancer in the early stages (within the prostate gland) can be cured. Fortunately, approximately 85% of men are diagnosed with prostate cancer in the early stages.

Cancer of the prostate gland can give early metastases, that is, even a small tumor can begin to spread to other organs.

Most often, the spread occurs in 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 be impossible to completely cure the person.

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 the patient’s blood, the more likely he is to develop prostate cancer and the more malignant the disease will be.

In any given case, doctors cannot say with certainty what caused prostate cancer, but experts generally agree thatdiet influences your risk. Men who consume large amounts of fat, especially from red meat and other animal fat sources, are most likely to develop advanced prostate cancer. The disease is much more common in countries where meat and dairy products are staple foods than in countries where the diet mainly consists of rice, soy products and vegetables.

Perhaps the underlying factor that links diet and prostate cancer is hormones. Fats stimulate increased production of testosterone and other hormones, and testosterone accelerates the growth of prostate cancer. High levels of testosterone can stimulate the activity of dormant prostate cancer cells. Some findings suggest that high testosterone levels also influence the occurrence of prostate cancer. Eating meat can be risky for other reasons: Meat cooked using high temperatures produces cancer-causing substances that directly attack the prostate gland. Several other risk factors have been noted. Welders, battery makers, rubber industry workers, and blue-collar workers who are frequently exposed to the metal cadmium are particularly susceptible to prostate cancer.

There is no proven link between prostate cancer and sexual activity, masturbation, alcohol or tobacco use, circumcision, infertility, prostate infection, or the common non-cancerous disease benign prostatic hyperplasia, which causes the prostate to become enlarged. In most older men, the prostate gland is somewhat enlarged.

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), pain in the chest.

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

Rarer symptoms of prostate cancer are impotence or weak erections (the cancer has affected the nerves that control erections), a decrease in the volume of sperm during ejaculation (the tumor blocks the ejaculatory channel).

The best way to detect prostate cancer in the early stages is regular digital examinations of the prostate gland and a PSA blood test. Because most prostate cancers arise in the part of the gland closest to the rectum, many tumors can be detected during a routine rectal examination. Many doctors recommend that most men, starting at age 50, undergo an annual rectal examination, as well as a blood test for PSA (prostate-specific antigen). For men with a family history of prostate cancer, screening examinations are recommended starting at age 40.

PSA is a protein whose blood levels typically increase in the presence of prostate cancer, making it a valuable tool in detecting early stage prostate cancer. Together, these two screening tests offer the best chance of detecting prostate cancer while it is localized and best treatable. Prostate cancer can also be discovered incidentally during treatment for bladder disorders. Because of the possibility of a false positive PSA test result, it is important to discuss the test with your doctor before taking it. An elevated PSA level does not mean you have cancer. Rather, it raises questions that need to be addressed and explained. There are many causes of elevated PSA levels, and cancer is only one of them.

If, as a result of a routine screening examination, there is a suspicion of cancer and/or the PSA level is elevated, the doctor may perform a biopsy of the prostate gland under the control of an ultrasound probe that is inserted into the rectum (transrectal ultrasound). To help make the diagnosis, X-rays of the urinary tract, as well as blood and urine tests, are usually taken. A biopsy will confirm whether cancer is present or not. Using ultrasound images, the doctor inserts a needle into the prostate gland and removes small pieces of tissue from the suspicious area. Sometimes a biopsy is performed using a cystoscope, a narrow instrument that is inserted through the urethra. A pathologist then examines the tissue sample under a microscope to determine whether cancer cells are present. To determine whether cancer has spread beyond the prostate gland, doctors may do a CT scan of the bones, a chest X-ray, or other imaging procedures.

Prostate cancer: Treatment methods

In this article we look at different types of treatments and their side effects. We will consider treatment options, taking into account:

• Grade of malignancy and stage (severity) of cancer
• Age
• Lifestyle factors

What are the treatment options for early stage prostate cancer?

Early stage prostate cancer is cancer that is located entirely within the prostate gland. It did not spread (metastasize) to nearby tissues or bones. This type of cancer, often called a low-risk disease by doctors, is most treatable.

There are three main treatment options for early stage prostate cancer. Two active treatments, surgery and radiation therapy, can often be curative when used alone. To achieve a high chance of cure or control of the disease, men with moderate-to-high-risk disease usually need a combination of several types of treatment.

Three treatment options for early stage/low risk prostate cancer:

• Surgical
• Radiation therapy – external irradiation or implantation of radioactive grains (brachytherapy).
• Hormonotherapy.

What does surgery include?

If the tumor is completely within the prostate gland, an experienced surgeon can remove the gland completely. This procedure is known as radical prostatectomy.

To make sure the cancer has not spread, surgeons perform a lymphadenectomy in the pelvis. In this procedure, they remove the pelvic lymph nodes. The nodes are then examined by a pathologist, who checks for the presence of cancer cells. In a radical prostatectomy, the prostate gland and seminal vesicles are completely removed. The seminal vesicles are small glands that produce a significant portion of the seminal fluid. Surgeons can reach the prostate gland in several ways:

The first is retropubic prostatectomy. To reach the prostate gland, the surgeon makes an incision in the wall of the abdomen. During the operation, the surgeon also removes nearby lymph nodes. This is a precaution that can help prevent the spread of the disease.

The second option is perineal prostatectomy. The surgeon makes an incision in the perineum. This is the area between the scrotum and anus. This surgery requires another incision in the abdomen to remove lymph nodes.

In some hospitals, surgeons can perform a laparoscopic prostatectomy. The surgeon uses instruments that are inserted through several small incisions. This option is usually associated with fewer complications and faster recovery. But it is technically difficult and may not be suitable for removing all types of tumor.

Some men may have a transurethral resection of the prostate. This type of surgery is also used in the treatment of benign prostate enlargement. The surgeon inserts a small surgical instrument into the urethra. This is the tube that carries urine from the bladder to the penis. The surgeon then removes the prostate tissue that is causing problems, such as difficulty or painful urination. However, this operation does not completely remove the prostate gland. It is sometimes used to relieve prostate-related symptoms in older men. The fact is that radical prostatectomy may not be suitable for such men.

Some medical centers also perform cryosurgery. This is an experimental method in which prostate tissue is destroyed by alternating freezing and thawing. Experience with this type of surgery for prostate cancer is limited. Therefore, it is not yet clear whether it offers any advantages over traditional surgery or radiation therapy.

What are the complications and side effects of the operation?

One ​​of the possible complications is erectile dysfunction. Some surgeons use a nerve sparing technique. Erectile dysfunction after prostate cancer surgery tends to go away after some time. Approximately half of all men whose nerves were not affected during surgery regain normal erectile function after one year. And three-quarters regain normal function after two years. Studies have shown that drugs such as Viagra, Cialis and Levitra can help men with erectile dysfunction after nerve-sparing surgery. But these drugs are less effective if the nerves of the penis are significantly damaged.

Other common complications of radical prostatectomy include urinary incontinence, the involuntary leakage of urine from the bladder, and fecal incontinence, the involuntary leakage of feces from the rectum. These complications may become less severe over time. They may even disappear completely. But for some men, complications persist for an indefinite period of time. About 25% of men experience urine leakage after surgery and should use absorbent pads or disposable absorbent underwear for up to six months after surgery. In severe cases, some men may need surgery to maintain the sphinker muscles, which control urine flow.

What does radiation therapy include?

There are two main types of radiation therapy: external beam radiation therapy and brachytherapy, or “radioactive seed implantation.”

With external beam radiation therapy, the prostate gland is exposed to high-energy X-rays emitted by a device outside the body. This process is repeated over numerous treatment sessions. In brachytherapy, small radioactive beads or “beads” are placed in or near the tumor. Radiation therapy can also be delivered to the prostate gland using needles, wires, or thin tubes called catheters.

Proton beam therapy is a type of external beam radiation therapy. It involves the use of a carefully focused beam of protons. These are particles of an atom with a positive electrical charge. The advantage of this type of treatment is that the beam delivers the most energy to the target tissue. This protects surrounding, healthy tissue from large doses of radiation. This type of treatment is very expensive. It is only offered at a few medical centers in the United States and may not be covered by insurance. There is currently no convincing evidence that proton beam therapy is better than standard radiation techniques.

Modern radiation therapy is often performed using the conformal method. This is a technique in which three-dimensional imaging systems map the shape of the prostate tumor. This allows for more precise delivery of high-dose radiation directly to the tumor. At the same time, it minimizes the impact on nearby healthy organs such as the intestines or urinary tract. Advanced conformal radiation therapy is called intensity modulated radiation therapy (IMRT). It allows high-energy radiation to be more accurately delivered to the tumor with less impact on healthy tissue. This often results in a reduced incidence of urinary or bowel side effects.

Large comparative studies have not been conducted that compare the effectiveness of surgery and radiation therapy for low-risk prostate cancer. But there is general agreement that patients should not choose treatment based on comparative cure rates. It would be better if men consider the possibility of side effects and the impact they can have on quality of life.

What are the complications and side effects of radiation therapy?

Common complications of radiation therapy include erectile dysfunction and urinary incontinence. Erectile dysfunction after radiation therapy tends to improve more gradually than after surgery. But new radiation therapy techniques have reduced the risk of long-term erectile dysfunction.

Other complications may include short-term bladder infections and irritation or discomfort when passing urine. Men who receive radiation therapy are often given a short course of alpha blockers. These are drugs that are usually prescribed to treat problems with urine output caused by benign enlargement of the prostate gland. Drugs in this category include Flomax and Hytrin.

Radiation therapy can also lead to infections of the anal lining and intestinal infections. However, the incidence of such complications is significantly lower when conformal radiation therapy or IMRT is used rather than traditional external beam radiation. Some men also experience fatigue after multiple rounds of radiation therapy. Fatigue usually goes away with time.

Does hormone therapy, or androgen deprivation, play a role in localized prostate cancer?

Hormonal therapy, or androgen deprivation, uses drugs that block the effect of testosterone or other hormones on prostate cancer. There is new evidence that suggests it does not provide any survival benefit to men who have a tumor within the prostate gland. Moreover, it may be harmful compared to watchful waiting. However, androgen deprivation therapy has an important role in the treatment of men with locally advanced or metastatic prostate cancer. This will be discussed in the next section of this article.

What are the treatment options for locally advanced, recurrent or metastatic prostate cancer?

Locally advanced cancer is stage 3 cancer that has spread beyond the prostate gland to the seminal vesicles and/or nearby lymph nodes. Metastatic or stage four cancer – prostate cancer cells have spread through the lymphatic system to other parts of the body.

In general, locally advanced, recurrent and metastatic prostate cancer cannot be cured with current treatments. But there are several treatments that provide long-term cancer control. With these types of treatments, many men live years or even decades with a good quality of life. In addition, there are several promising treatments for advanced prostate cancer that are currently being studied.

Men with more advanced cancer are often treated with a combination of several treatments. These include surgery, radiation therapy, hormonal therapy and chemotherapy. For example, some studies show that men with locally advanced prostate cancer have better overall survival when radiation therapy is used in combination with hormone therapy. They also have longer survival rates and no progression of disease compared to men who receive radiation therapy alone. When planning a treatment strategy, the man’s age and general health are taken into account. For example, if a man is elderly or has other medical conditions, the risks of surgery for advanced prostate cancer may outweigh the benefits.

In general, surgery cannot completely remove cancerous tissue in men with stage three prostate cancer. Instead, the role of surgery is to “shrink” the tumor. This means removing as much of the tumor tissue as possible. Surgery may also be used to remove cancerous lymph nodes or relieve symptoms such as urinary retention. Surgery is often used in combination with radiation therapy and/or hormonal therapy. Men with symptoms such as painful or difficult urination caused by an enlarged prostate or large tumor may benefit from surgery to open the narrow urethra.

What are the complications and side effects of surgery for late stage prostate cancer?

Like surgery for early-stage prostate cancer, surgery at a later stage can cause significant side effects. These include erectile dysfunction, urinary incontinence and fecal incontinence.

Can radiation therapy be used for late stage prostate cancer?

External beam radiation therapy can help control the growth of localized tumors. It can also prolong men’s symptom-free lives. Brachytherapy (implantation of radioactive seeds) is technically difficult if the prostate tumor is large. Therefore, it is less often used in the treatment of men with late-stage disease.

External beam radiation therapy can also be an effective method of controlling disease that has returned after radical prostatectomy. Radiation therapy is aimed at the area of ​​the body from which the diseased prostate gland was removed. Brachytherapy cannot be used in this case because the gland has been removed. There is nowhere to implant grains.

Some men’s tumors are not diagnosed until they reach stage three or more. If this occurs, whether radiation therapy will be effective depends on the condition of the regional lymph nodes. If the nodes are removed or are not affected by disease, the chance of long-term survival is much higher than if they contain cancer cells.

What are the complications and side effects of radiation therapy in the treatment of late stage prostate cancer?

Common complications of radiation therapy include erectile dysfunction and urinary incontinence.

Men treated with radiation therapy may experience impotence and problems urinating. Other complications include:

• Short-term bladder infection
• Infections of the anal canal lining
• Intestinal infections
• Some men feel fatigued after multiple radiation therapy sessions.

How can hormone therapy, or androgen deprivation, be used for late stage prostate cancer?

Most prostate tumors grow faster in the presence of testosterone and other male hormones – androgens. Treatment can block the effects of androgens or stop the body from producing them. This can significantly delay the progression of the disease.

There are several methods of androgen deprivation. Any of them can be used alone or in combination with each other. These methods include:

• LHRH agonists (luteinizing hormone releasing factor). These are drugs that mimic the action of naturally produced hormones. They essentially “deceive” the body by depleting testosterone production. Commonly used LHRH agonists include Zoladex, Lupron, and Trelstar. These drugs are delivered into the body through long-term injections monthly or four times a year. They can also be supplied to the body with an implant, which is inserted under the skin once annually.
• Antiandrogen drugs. They are also called androgen blockers. These are drugs that block the effect of the hormone dihydrotestosterone on prostate cancer cells. These drugs are taken orally daily. They can be used alone or in combination with LHRH agonists. Common drugs in this category include Casodex, Eulexin, and Nylandron.
• Orchiectomy (castration). This is a surgical procedure. It involves removing the testicles, the source of testosterone production. This method has been used for many decades to treat men with advanced prostate cancer. Research shows that medications can achieve the same effect. However, some men choose this option over repeated LHRH agonist injections.

What are the complications and side effects of hormonal therapy?

The use of LHRH agonists causes a temporary surge in testosterone production at the beginning of treatment. This results in a release of testosterone, which can cause bone pain and frequent or difficult urination. These side effects can often be alleviated by using LHRH agonists in combination with antiandrogen drugs.

Other side effects of hormone therapy include:

• Erectile
• Loss of libido (sexual desire)
• Hot tides
• Fatigue
• Osteoporosis
• Weight gain
• Memory disorders
• Anemia
• Loss of muscle mass

Hormonal therapy can effectively suppress the growth of prostate cancer and last for many months or years. But eventually, it may lose its effectiveness when prostate cancer cells that are not dependent on testosterone begin to dominate the tumor. This condition is known as hormone-refractory or hormone-refractory prostate cancer. Several clinical trials are investigating new treatments for hormone-resistant disease.

What is palliative treatment and how is it used for prostate cancer?

Certain treatments may relieve the pain and symptoms associated with late-stage metastatic prostate cancer. These types of treatment include:

• External beam radiation therapy or intravenous administration of a radioactive drug to relieve bone pain
• Painkillers
• The use of bisphosphonates (such as Zometa), which help repair weakened bones and prevent or delay fractures.

How can clinical trials for prostate cancer treatments help those with advanced prostate cancer?

Men with advanced prostate cancer, including hormone-resistant disease, can participate in several ongoing clinical trials. These drug studies examine new treatments that can be used alone or in combination with radiation and/or hormonal therapy. Treatment strategies being studied include:

• Angiogenesis inhibitors. These are drugs that affect the development of blood vessels necessary for tumor growth.
• Chemotherapy with taxane-containing drugs. These preparations are obtained from the needles of the yew tree. They block the growth of cancer cells by inhibiting the mechanism that allows them to divide and reproduce.
• Steroids.
• Antiandrogen drugs. The drugs being studied have a new mechanism for blocking testosterone production in the body. Choosing the best type of treatment for you is up to you. You should resolve this issue with the help of your doctor and your family.

Prevention of prostate cancer

There is currently no evidence that prostate cancer can be prevented. However, you can reduce your risk.

A low-fat diet that consists primarily of vegetables, fruits and grains can help reduce your risk of prostate cancer. The American Cancer Society recommends limiting your intake of high-fat foods from animal sources. Eat five or more servings of fruits and vegetables every day. A healthy diet also includes bread, grain dishes, rice, pasta and beans.

Substances found in foods, especially fruits and vegetables, called antioxidants, help prevent DNA damage to the body’s cells. This damage has been linked to diseases including cancer. Lycopenes, in particular, are antioxidants that have been linked to a reduced risk of prostate cancer. They are found in foods such as tomatoes (raw or cooked), spinach, artichokes, beans, berries (especially blueberries), pink grapefruits and oranges, and watermelon.

Clinical studies are being conducted in some hospitals to look at various “chemoprevention” protocols designed to reduce the risk of prostate cancer. That is, it will soon be known whether there are new ways to prevent prostate cancer.

Using vitamin supplements may reduce the risk of developing prostate cancer. Some studies suggest that taking vitamin E may reduce your risk of prostate cancer, while other studies have found no effect on cancer risk. Taking selenium may also reduce your risk. A large study is currently underway to determine whether any of these supplements may provide protection against prostate cancer.

Before taking any supplements, it is advisable to first talk to your doctor.

Studies of men taking Proscar found that they were 25% less likely to develop prostate cancer than men who took a placebo. Proscar is currently used in the treatment of benign prostatic hyperplasia (BPH). The findings revealed that Proscar use is associated with an increased risk of sexual side effects and prostate cancer that tends to be more aggressive (high-grade tumor). There is currently no certainty that taking Proscar to prevent prostate cancer is beneficial.

General recommendations:

Not all health care providers and patient advocacy organizations agree on whether men should be routinely screened for prostate cancer. But as with most cancers, early detection often means more treatment options are available and less intensive treatment is needed.

• Annual digital rectal examination from the age of 40.
• PSA analysis from the age of 50, followed by annual testing.
• Annual digital rectal examination and PSA test starting at age 40 for black men and those with a family history of prostate cancer.

Is there a diet for prostate cancer?