prostate cancer

prostate cancer

Morbidity. prostate cancer etiology. It is believed that prostate cancer is caused by endocrine regulation disorders in the genital area (see Appendix 2. Hereditary diseases: mapped phenotypes). Pathological anatomy. Almost all prostate cancers are adenocarcinomas (small acinar, large acinar, cribriform, solid trabecular). Transitional and squamous cell carcinomas are less common.

    • According to Gleison prognostic criteria, 6 degrees (from 0 to 5) of tumor differentiation are distinguished
    • Most prostate tumors occur in the periphery of the organ; only 25% of cancers appear in the central parts of the prostate
    • Most often (more than 90% of cases), distant metastases affect the bones, somewhat less often – soft tissues, lymph nodes, lungs and liver. TNM classification (see also Tumor, staging)
    • T0 – primary tumor is not determined
    • T (- the tumor occupies less than half of the prostate and is surrounded by gland tissue that is normal to the touch
    • T2 – the tumor occupies half of the prostate or more, but does not cause it to enlarge or deform
    • T3 – the tumor has led to an increase or deformation of the prostate, but does not extend beyond the organ
    • T4 – the tumor grows into the surrounding tissues or organs.

The clinical picture of the disease at the time of initial diagnosis is a palpable focus of prostate compaction (observed in more than 50% of patients), dysuria, urinary retention or incontinence, hematuria, pollakiuria. Diagnosis of early prostate lesions remains difficult

    • Physical examination. Digital rectal examination is the main method for diagnosing prostate cancer. Only 10% of prostate tumors detected by digital examination of its focal

seals are quite limited and can be effectively treated

    • Histological examination of tissues removed during adenomectomy reveals initial malignant growth only in 10% of cases.
    • The remaining cases are advanced cancers; often prostate cancer is detected during a clinical examination of patients with bone metastases
    • In cases of cancer invading the prostate capsule, an increased activity of acid phosphatase is found. In patients with distant metastases, this indicator is increased in more than 80% of cases. Acid phosphatase activity should be determined prior to rectal examination or prostate massage, as after such procedures in the blood, a non-specific increase in this enzyme is observed within 1-2 days
    • As a diagnostic marker, specific prostate Ag is determined in the serum, but false positive results are possible. Confirmation of the diagnosis
    • Accurate diagnosis allows you to establish a puncture biopsy of the prostate, performed through the rectum, perineum or urethra
    • Laboratory studies are used to assess kidney function, while radioisotope bone scans, radiography, excretory urography, pelvic and/or retroperitoneal CT can detect metastases in various organs.

Determining the stage of the disease

    • Stage T0-1 tumors are asymptomatic; found at autopsy or examination of prostate tissue removed for suspected adenoma
    • Stage T2 tumors grow within the prostate gland; are found in the digital examination of the prostate in the form of characteristic nodes; can be removed surgically. Unfortunately, in fact, only 10% of prostate cancers can be treated with surgery. In many cases, metastases are present in the pelvic lymph nodes that are not detected during rectal examination.
    • Stage T3 tumors are cancers that spread beyond the capsule of the gland (for example, to the seminal vesicles, bladder neck), but not to other pelvic structures. Such tumors account for 40% of all newly diagnosed cancers and are not subject to surgical treatment.
    • Stage T4 tumors are cancers that invade the pelvic bones, lymph nodes, or beyond. About 50% of newly diagnosed cases are stage T4.

Treatment and prognosis

    • Early stage cancer requires radical prostatectomy, external beam y-therapy, or interstitial irradiation
    • Prostatectomy is indicated for patients under the age of 70 years and provides a 10-15-year survival rate.
    • Radical prostatectomy with preservation of the nerve plexus within the gland is indicated for patients with small tumors; in 40-60% of cases allows you to maintain normal sexual function, but in 5-15% causes urinary incontinence in patients
    • Radiation therapy is indicated for elderly patients with a significant spread of cancer or other diseases of the internal organs that do not allow surgery. Irradiation is also used in persons who wish to maintain sexual activity. Cases of impotence with interstitial isotope implantation are less common than with remote y-therapy.
    • Stage T4 tumors cannot be cured, patients receive palliative hormonal therapy
    • Orchiectomy is performed in patients with a high risk of developing cardiovascular disease. Postoperative administration of hormones (for example, diethylstilbestrol 1-3 mg daily) leads to a decrease in testosterone levels
    • Leuprolide alone or in combination with flutamide. Flutamide and aminoglutethimide are the drugs of choice in patients who do not respond to primary hormonal therapy, causing remission in about 50-80% of cases, although complete cure is not often observed. As a rule, lesions of the prostate and soft tissues regress, serum levels of alkaline phosphatase and prostate-specific AG reach normal values, and bone pain quickly decreases. The average duration of the therapeutic effect of hormone therapy is 9-18 weeks.
    • A temporary effect can be provided by adrenalectomy followed by the introduction of flutamide or aminoglutethimide.
    • Chemotherapy is not traditionally indicated. The most commonly used are cisplatin, doxorubicin, cyclophosphamide, and fluorouracil.

See also Tumor, radiotherapy; tumor, markers, tumor,

methods of treatment; tumor, stage

ICD. C61 Malignant neoplasm of the prostate

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