What Is Prostate Cancer?| Prostate Cancer Types

• Types of prostate cancer
• Possible pre-cancerous conditions of the prostate

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer cells, and can then spread to other areas of the body. To learn more about cancer and how it starts and spreads, see What Is Cancer?

Prostate cancer begins when cells in the prostate gland start to grow out of control. The prostate is a gland found only in males. It makes some of the fluid that is part of semen.

The prostate is below the bladder (the hollow organ where urine is stored) and in front of the rectum (the last part of the intestines). Just behind the prostate are glands called seminal vesicles that make most of the fluid for semen. The urethra, which is the tube that carries urine and semen out of the body through the penis, goes through the center of the prostate.

The size of the prostate can change as a man ages. In younger men, it is about the size of a walnut, but it can be much larger in older men.

Almost all prostate cancers are adenocarcinomas. These cancers develop from the gland cells (the cells that make the prostate fluid that is added to the semen).

Other types of cancer that can start in the prostate include:

• Small cell carcinomas
• Neuroendocrine tumors (other than small cell carcinomas)
• Transitional cell carcinomas
• Sarcomas

These other types of prostate cancer are rare. If you are told you have prostate cancer, it is almost certain to be an adenocarcinoma.

Some prostate cancers grow and spread quickly, but most grow slowly. In fact, autopsy studies show that many older men (and even some younger men) who died of other causes also had prostate cancer that never affected them during their lives. In many cases, neither they nor their doctors even knew they had it.

Some research suggests that prostate cancer starts out as a pre-cancerous condition, although this is not yet known for sure. These conditions are sometimes found when a man has a prostate biopsy (removal of small pieces of the prostate to look for cancer).

Prostatic intraepithelial neoplasia (PIN)

In PIN, there are changes in how the prostate gland cells look when seen with a microscope, but the abnormal cells don’t look like they are growing into other parts of the prostate (like cancer cells would). Based on how abnormal the patterns of cells look, they are classified as:

• Low-grade PIN: The patterns of prostate cells appear almost normal.
• High-grade PIN: The patterns of cells look more abnormal.

Low-grade PIN is not thought to be related to a man’s risk of prostate cancer. On the other hand, high-grade PIN is thought to be a possible precursor to prostate cancer. If you have a prostate biopsy and high-grade PIN is found, there is a greater chance that you might develop prostate cancer over time.

PIN begins to appear in the prostates of some men as early as in their 20s. But many men with PIN will never develop prostate cancer.

For more on PIN, see Tests to Diagnose and Stage Prostate Cancer.

Proliferative inflammatory atrophy (PIA)

In PIA, the prostate cells look smaller than normal, and there are signs of inflammation in the area. PIA is not cancer, but researchers believe that PIA may sometimes lead to high-grade PIN, or perhaps directly to prostate cancer.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Yang XJ. Interpretation of prostate biopsy. UpToDate. 2019. Accessed at https://www.uptodate. com/contents/interpretation-of-prostate-biopsy on March 15, 2019.

Yang XJ. Precancerous lesions of the prostate: Pathology and clinical implications. UpToDate. 2019. Accessed at https://www.uptodate.com/contents/precancerous-lesions-of-the-prostate-pathology-and-clinical-implications on March 15, 2019.

Zelefsky MJ, Morris MJ, Eastham JA. Chapter 70: Cancer of the Prostate. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Last Revised: August 1, 2019

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Prostate neoplasm (Concept Id: C0033578) – MedGen

A benign, borderline, or malignant neoplasm that affects the prostate gland. Representative examples include benign prostate phyllodes tumor, prostatic intraepithelial neoplasia, prostate carcinoma, and prostate sarcoma.  [from NCI]

Li-Fraumeni syndrome 1

MedGen UID:

322656

•Concept ID:

C1835398

•

Disease or Syndrome

Li-Fraumeni syndrome (LFS) is a cancer predisposition syndrome associated with high risks for a diverse spectrum of childhood- and adult-onset malignancies. The lifetime risk of cancer in individuals with LFS is =70% for men and =90% for women. Five cancer types account for the majority of LFS tumors: adrenocortical carcinomas, breast cancer, central nervous system tumors, osteosarcomas, and soft-tissue sarcomas. LFS is associated with an increased risk of several additional cancers including leukemia, lymphoma, gastrointestinal cancers, cancers of head and neck, kidney, larynx, lung, skin (e.g., melanoma), ovary, pancreas, prostate, testis, and thyroid. Individuals with LFS are at increased risk for cancer in childhood and young adulthood; survivors are at increased risk for multiple primary cancers.

See: Condition Record

Li-Fraumeni syndrome 1

PubMed

A Review of Stereotactic Body Radiation Therapy in the Management of Oligometastatic Prostate Cancer.

Zhang B,
Leech M
Anticancer Res
2020 May;40(5):2419-2428.
doi: 10.21873/anticanres.14211.
PMID: 32366385

The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature.

Eissa A,
Elsherbiny A,
Coelho RF,
Rassweiler J,
Davis JW,
Porpiglia F,
Patel VR,
Prandini N,
Micali S,
Sighinolfi MC,
Puliatti S,
Rocco B,
Bianchi G
Minerva Urol Nefrol
2018 Oct;70(5):462-478.
Epub 2018 Apr 17
doi: 10.23736/S0393-2249.18.03081-3.
PMID: 29664244

Pseudohyperplastic prostate carcinoma: histologic patterns and differential diagnosis.

Arista-Nasr J,
Martínez-Benítez B,
Aguilar-Ayala EL,
Aleman-Sanchez CN,
Bornstein-Quevedo L,
Albores-Saavedra J
Ann Diagn Pathol
2015 Aug;19(4):253-60.
Epub 2015 May 22
doi: 10.1016/j.anndiagpath.2015.04.009.
PMID: 26101154

See all (9)

Curated

NCCN Clinical Practice Guidelines in Oncology, Prostate Cancer, Version 4.2022

Etiology

Androgen deprivation therapy and depression in the prostate cancer patients: review of risk and pharmacological management.

Alwhaibi A,
Alsanea S,
Almadi B,
Al-Sabhan J,
Alosaimi FD
Aging Male
2022 Dec;25(1):101-124.
doi: 10.1080/13685538.2022.2053954.
PMID: 35343371

Transperineal Prostate Biopsy Is the New Black: What Are the Next Targets?

Lenfant L,
Barret E,
Rouprêt M,
Rozet F,
Ploussard G,
Mozer P;
Cancerology Committee of Association Française d’Urologie (CCAFU)
Eur Urol
2022 Jul;82(1):3-5.
Epub 2022 Feb 23
doi: 10.1016/j.eururo.2022.01.046.
PMID: 35216857

Lifestyle and Dietary Factors and Prostate Cancer Risk: A Multicentre Case-Control Study.

Al Qadire M,
Alkhalaileh M,
ALBashtawy M
Clin Nurs Res
2019 Nov;28(8):992-1008.
Epub 2018 Feb 9
doi: 10.1177/1054773818757311.
PMID: 29426230

The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature.

Eissa A,
Elsherbiny A,
Coelho RF,
Rassweiler J,
Davis JW,
Porpiglia F,
Patel VR,
Prandini N,
Micali S,
Sighinolfi MC,
Puliatti S,
Rocco B,
Bianchi G
Minerva Urol Nefrol
2018 Oct;70(5):462-478.
Epub 2018 Apr 17
doi: 10.23736/S0393-2249.18.03081-3.
PMID: 29664244

Magnetic resonance imaging in prostate cancer detection and management: a systematic review.

Monni F,
Fontanella P,
Grasso A,
Wiklund P,
Ou YC,
Randazzo M,
Rocco B,
Montanari E,
Bianchi G
Minerva Urol Nefrol
2017 Dec;69(6):567-578.
Epub 2017 May 8
doi: 10.23736/S0393-2249.17.02819-3.
PMID: 28488844

See all (67)

Diagnosis

Transperineal Prostate Biopsy Is the New Black: What Are the Next Targets?

Lenfant L,
Barret E,
Rouprêt M,
Rozet F,
Ploussard G,
Mozer P;
Cancerology Committee of Association Française d’Urologie (CCAFU)
Eur Urol
2022 Jul;82(1):3-5.
Epub 2022 Feb 23
doi: 10.1016/j.eururo.2022.01.046.
PMID: 35216857

Prostate Cancer Survival by Risk and Other Prognostic Factors in Mallorca, Spain.

Montaño JJ,
Barceló A,
Franch P,
Galceran J,
Ameijide A,
Pons J,
Ramos M
Int J Environ Res Public Health
2021 Oct 24;18(21)
doi: 10.3390/ijerph282111156.
PMID: 34769675Free PMC Article

The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature.

Eissa A,
Elsherbiny A,
Coelho RF,
Rassweiler J,
Davis JW,
Porpiglia F,
Patel VR,
Prandini N,
Micali S,
Sighinolfi MC,
Puliatti S,
Rocco B,
Bianchi G
Minerva Urol Nefrol
2018 Oct;70(5):462-478.
Epub 2018 Apr 17
doi: 10.23736/S0393-2249.18.03081-3.
PMID: 29664244

Magnetic resonance imaging in prostate cancer detection and management: a systematic review.

Monni F,
Fontanella P,
Grasso A,
Wiklund P,
Ou YC,
Randazzo M,
Rocco B,
Montanari E,
Bianchi G
Minerva Urol Nefrol
2017 Dec;69(6):567-578.
Epub 2017 May 8
doi: 10.23736/S0393-2249.17.02819-3.
PMID: 28488844

Pseudohyperplastic prostate carcinoma: histologic patterns and differential diagnosis.

Arista-Nasr J,
Martínez-Benítez B,
Aguilar-Ayala EL,
Aleman-Sanchez CN,
Bornstein-Quevedo L,
Albores-Saavedra J
Ann Diagn Pathol
2015 Aug;19(4):253-60.
Epub 2015 May 22
doi: 10.1016/j.anndiagpath.2015.04.009.
PMID: 26101154

See all (60)

Therapy

Androgen deprivation therapy and depression in the prostate cancer patients: review of risk and pharmacological management.

Alwhaibi A,
Alsanea S,
Almadi B,
Al-Sabhan J,
Alosaimi FD
Aging Male
2022 Dec;25(1):101-124.
doi: 10.1080/13685538.2022.2053954.
PMID: 35343371

Metastasis-directed therapy and prostate-targeted therapy in oligometastatic prostate cancer: a systematic review.

Miura N,
Pradere B,
Mori K,
Mostafaei H,
Quhal F,
Misrai V,
D’Andrea D,
Albisinni S,
Papalia R,
Saika T,
Scarpa RM,
Shariat SF,
Esperto F
Minerva Urol Nefrol
2020 Oct;72(5):531-542.
Epub 2020 Jun 16
doi: 10.23736/S0393-2249.20.03779-0.
PMID: 32550632

Psychological impact of different primary treatments for prostate cancer: A critical analysis.

Maggi M,
Gentilucci A,
Salciccia S,
Gatto A,
Gentile V,
Colarieti A,
Von Heland M,
Busetto GM,
Del Giudice F,
Sciarra A
Andrologia
2019 Feb;51(1):e13157.
Epub 2018 Oct 3
doi: 10.1111/and.13157.
PMID: 30281167

Lifestyle and Dietary Factors and Prostate Cancer Risk: A Multicentre Case-Control Study.

Al Qadire M,
Alkhalaileh M,
ALBashtawy M
Clin Nurs Res
2019 Nov;28(8):992-1008.
Epub 2018 Feb 9
doi: 10.1177/1054773818757311.
PMID: 29426230

The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature.

Eissa A,
Elsherbiny A,
Coelho RF,
Rassweiler J,
Davis JW,
Porpiglia F,
Patel VR,
Prandini N,
Micali S,
Sighinolfi MC,
Puliatti S,
Rocco B,
Bianchi G
Minerva Urol Nefrol
2018 Oct;70(5):462-478.
Epub 2018 Apr 17
doi: 10.23736/S0393-2249.18.03081-3.
PMID: 29664244

See all (40)

Prognosis

How the Analysis of the Pathogenetic Variants of DDR Genes Will Change the Management of Prostate Cancer Patients.

Sciarra A,
Frisenda M,
Bevilacqua G,
Gentilucci A,
Cattarino S,
Mariotti G,
Del Giudice F,
Di Pierro GB,
Viscuso P,
Casale P,
Chung BI,
Autorino R,
Crivellaro S,
Salciccia S
Int J Mol Sci
2022 Dec 30;24(1)
doi: 10.3390/ijms24010674.
PMID: 36614122Free PMC Article

Prostate Cancer Survival by Risk and Other Prognostic Factors in Mallorca, Spain.

Montaño JJ,
Barceló A,
Franch P,
Galceran J,
Ameijide A,
Pons J,
Ramos M
Int J Environ Res Public Health
2021 Oct 24;18(21)
doi: 10.3390/ijerph282111156.
PMID: 34769675Free PMC Article

Lifestyle and Dietary Factors and Prostate Cancer Risk: A Multicentre Case-Control Study.

Al Qadire M,
Alkhalaileh M,
ALBashtawy M
Clin Nurs Res
2019 Nov;28(8):992-1008.
Epub 2018 Feb 9
doi: 10.1177/1054773818757311.
PMID: 29426230

Magnetic resonance imaging in prostate cancer detection and management: a systematic review.

Monni F,
Fontanella P,
Grasso A,
Wiklund P,
Ou YC,
Randazzo M,
Rocco B,
Montanari E,
Bianchi G
Minerva Urol Nefrol
2017 Dec;69(6):567-578.
Epub 2017 May 8
doi: 10.23736/S0393-2249.17.02819-3.
PMID: 28488844

Hormone and radiotherapy versus hormone or radiotherapy alone for non-metastatic prostate cancer: a systematic review with meta-analyses.

Schmidt-Hansen M,
Hoskin P,
Kirkbride P,
Hasler E,
Bromham N
Clin Oncol (R Coll Radiol)
2014 Oct;26(10):e21-46.
Epub 2014 Jul 21
doi: 10.1016/j.clon.2014.06.016.
PMID: 25059922

See all (44)

Clinical prediction guides

Androgen deprivation therapy and depression in the prostate cancer patients: review of risk and pharmacological management.

Alwhaibi A,
Alsanea S,
Almadi B,
Al-Sabhan J,
Alosaimi FD
Aging Male
2022 Dec;25(1):101-124.
doi: 10.1080/13685538.2022.2053954.
PMID: 35343371

A Review of Stereotactic Body Radiation Therapy in the Management of Oligometastatic Prostate Cancer.

Zhang B,
Leech M
Anticancer Res
2020 May;40(5):2419-2428.
doi: 10.21873/anticanres.14211.
PMID: 32366385

Lifestyle and Dietary Factors and Prostate Cancer Risk: A Multicentre Case-Control Study.

Al Qadire M,
Alkhalaileh M,
ALBashtawy M
Clin Nurs Res
2019 Nov;28(8):992-1008.
Epub 2018 Feb 9
doi: 10.1177/1054773818757311.
PMID: 29426230

Magnetic resonance imaging in prostate cancer detection and management: a systematic review.

Monni F,
Fontanella P,
Grasso A,
Wiklund P,
Ou YC,
Randazzo M,
Rocco B,
Montanari E,
Bianchi G
Minerva Urol Nefrol
2017 Dec;69(6):567-578.
Epub 2017 May 8
doi: 10.23736/S0393-2249.17.02819-3.
PMID: 28488844

Pseudohyperplastic prostate carcinoma: histologic patterns and differential diagnosis.

Arista-Nasr J,
Martínez-Benítez B,
Aguilar-Ayala EL,
Aleman-Sanchez CN,
Bornstein-Quevedo L,
Albores-Saavedra J
Ann Diagn Pathol
2015 Aug;19(4):253-60.
Epub 2015 May 22
doi: 10.1016/j.anndiagpath.2015.04.009.
PMID: 26101154

See all (58)

A systematic scoping review of multidisciplinary cancer team and decision-making in the management of men with advanced prostate cancer.

Holmes A,
Kelly BD,
Perera M,
Eapen RS,
Bolton DM,
Lawrentschuk N
World J Urol
2021 Feb;39(2):297-306.
Epub 2020 Jun 4
doi: 10.1007/s00345-020-03265-1.
PMID: 32500304

The role of 68Ga-PSMA PET/CT scan in biochemical recurrence after primary treatment for prostate cancer: a systematic review of the literature.

Eissa A,
Elsherbiny A,
Coelho RF,
Rassweiler J,
Davis JW,
Porpiglia F,
Patel VR,
Prandini N,
Micali S,
Sighinolfi MC,
Puliatti S,
Rocco B,
Bianchi G
Minerva Urol Nefrol
2018 Oct;70(5):462-478.
Epub 2018 Apr 17
doi: 10.23736/S0393-2249.18.03081-3.
PMID: 29664244

Magnetic resonance imaging in prostate cancer detection and management: a systematic review.

Monni F,
Fontanella P,
Grasso A,
Wiklund P,
Ou YC,
Randazzo M,
Rocco B,
Montanari E,
Bianchi G
Minerva Urol Nefrol
2017 Dec;69(6):567-578.
Epub 2017 May 8
doi: 10.23736/S0393-2249.17.02819-3.
PMID: 28488844

Hormone and radiotherapy versus hormone or radiotherapy alone for non-metastatic prostate cancer: a systematic review with meta-analyses.

Schmidt-Hansen M,
Hoskin P,
Kirkbride P,
Hasler E,
Bromham N
Clin Oncol (R Coll Radiol)
2014 Oct;26(10):e21-46.
Epub 2014 Jul 21
doi: 10.1016/j.clon.2014.06.016.
PMID: 25059922

Racial differences in prostate cancer treatment outcomes: a systematic review.

Peters N,
Armstrong K
Cancer Nurs
2005 Mar-Apr;28(2):108-18.
doi: 10.1097/00002820-200503000-00004.
PMID: 15815180

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Prostate cancer is a common cancer in men

Have you been diagnosed with prostate cancer?

Surely you are wondering: what to do now? Such a diagnosis always divides life into “before” and “after”. All the emotional resources of the patient and his family are thrown into experiences and fear. But it is at this moment that it is necessary to change the vector “for what” to the vector “what can be done”.
Very often, patients feel overwhelmingly alone at the beginning of the journey. But you must understand that you are not alone. We will help you cope with the disease and will go hand in hand with you through all stages of your treatment.
We bring to your attention a brief but very detailed overview of prostate cancer.
It was prepared by highly qualified specialists of the Urological Department of the P.A. Herzen – a branch of the Federal State Budgetary Institution “NMITs Radiology” of the Ministry of Health of Russia, edited by the head of the department Nikolai Vorobyov.

This booklet provides information about the diagnosis and treatment of prostate cancer. Here are collected the main methods of treating this disease, including the latest developments of domestic and foreign oncologists.

Every year more than 38 thousand new cases of prostate cancer are detected in Russia, which is especially alarming, the disease is increasingly manifested in young men.

We want to help you beat cancer!

Introduction. Anatomy of an organ

The prostate gland (synonym: prostate) is an external secretion gland, found only in men. The prostate gland is located below the bladder, in front of the rectum. Through it passes the initial part of the urethra. The excretory ducts of the prostate gland open into the urethra (Fig. 1). The functions of the prostate are controlled by hormones, the male sex hormone, testosterone, has the greatest influence on the growth of prostate cells. Androgens are the common name for all male sex hormones. The fluid produced by the prostate gland is the main constituent of seminal fluid. This liquid is a nutrient medium for spermatozoa. Also, the prostate acts as a valve – it closes the exit from the bladder during an erection.

What is prostate cancer?

Prostate cancer is a malignant tumor that develops from the epithelial cells of the prostate glands.

The tumor can be located in one or both lobes of the gland, acquire a total distribution with invasion beyond the capsule of the gland, involving the seminal vesicles.

Prostate cancer is a relatively slowly progressive disease. But with long-term existence and lack of treatment, like other malignant tumors, it has the ability to progressively increase and grow into adjacent organs and structures, as well as give screenings to the lymph nodes closest to the organ (regional metastases). An advanced prostate tumor may grow into the bladder neck, rectum, or pelvic wall. Tumor cells can be carried with the bloodstream to other organs (bones, lungs, liver, etc.) and give rise to new foci (distant metastases).

Prostate cancer statistics (epidemiology)

Over the past decade, in the structure of the incidence of malignant neoplasms in the male population of Russia, prostate cancer ranks second after lung cancer.

The incidence rate of prostate cancer in Russia over the past 15 years from 2001 to 2015 increased 3.0 times from 19.01 to 57.22 cases per 100,000 population.

In Russia in 2016, 38371 new cases of this pathology were noted, and the average annual rate of increase in the incidence was 7.12%

Morphological classification of prostate cancer

The most common morphological variant of prostate cancer is acinar adenocarcinoma up to 85-90% of cases. The degree of differentiation and aggressiveness of the prostate tumor is expressed in morphological characteristics, which are evaluated according to the Gleason scale.

Gleason score

The Gleason score is used to describe the malignancy of a tumor found on prostate biopsy. The higher the Gleason score, the more aggressive/malignant the tumor tissue. The Gleason score can only be determined by examining morphological material – material from a core biopsy or postoperative material.
The Gleason score is based on the degree to which cancer cells found in prostate tissue differ from normal prostate cells. If the cancer cells look like regular prostate cells, then the tumor gets a score of 1. If cancer cells are maximally different from normal ones, then the tumor receives the maximum number of points – 5. Most often in diagnoses, there are estimates of 3 points or higher.
Gleason sum includes Gleason scores (scores of 1 to 5) for the two largest or most malignant tumors found in prostate tissue (usually prostate cancer affects multiple areas of the prostate). For example, a Gleason score of 7 means that the two largest or most malignant tumors scored 3 and 4, respectively (3+4=7). There are three types of malignancy of prostate cancer:

• Tumors with a Gleason score of 6 or less are often called low-grade Gleason scores.
• Tumors with a Gleason score of 7 are called intermediate Gleason scores.
• Tumors with a Gleason score of 8 to 10 (10 is the maximum score) are called high-grade Gleason scores.

Stages and symptoms of prostate cancer

Like all malignant neoplasms, there are 4 stages in the development of prostate cancer:

• The first stage of the process corresponds to the spread of the tumor in no more than half of one lobe of the gland.
• The second stage is characterized by the presence of a localized tumor of the prostate (without the tumor protruding beyond the capsule of the gland), while either one or both lobes of the gland may be affected.
• The third stage is characterized by the presence of a locally advanced prostate tumor (tumor protrusion beyond the gland capsule).
• Fourth stage is always determined in the presence of regional (metastases in the pelvic lymph nodes N1) or distant metastases (M1).

Prostate cancer classification

TNM classification

TNM classification (Tumour, Node, Metastasis – Tumor, Lymph node, Metastases) is an international classification of the stages of development of malignant tumors.

T – primary tumor:
T1-2 – tumor does not extend beyond the prostate capsule
T3-4 – the tumor grows beyond the capsule of the prostate gland, can grow into neighboring organs (bladder, rectum)

N – lymph nodes:
N0 – no metastases in the lymph nodes, N1 – the presence of metastases in one or more lymph nodes

M – a symbol indicating the presence or absence of distant metastases:
M0 – No distant metastases,
M1 – Distant metastases in bones or internal organs.

Clinical manifestations of prostate cancer

In the early stages of the disease, prostate cancer (PCa) does not have independent clinical manifestations. Clinical symptoms in localized prostate cancer are most often associated with concomitant benign prostatic hyperplasia. Most often, patients with localized prostate cancer have symptoms of bladder outlet obstruction associated with benign prostatic hyperplasia, such as: frequent, difficult urination, sluggish stream, imperative urge to urinate, nocturia.

Locally advanced prostate cancer is characterized by symptoms of urinary tract obstruction due to both concomitant benign prostatic hyperplasia and large tumor volume. With the germination of the tumor in the neck of the bladder, the urethra, blood may appear in the urine, urinary incontinence.

An extensive tumor lesion of the bladder neck can lead to a block of the ureteral orifices, the development of renal failure. The spread of the tumor process to the neurovascular bundles leads to the development of erectile dysfunction. Symptoms of tumor growth or compression of the rectal wall are a violation of the act of defecation, an admixture of blood in the urine. The spread of the tumor to the muscles of the pelvic floor can cause discomfort when sitting, pain in the perineum. A massive tumor lesion of the pelvic lymph nodes leads to lymphostasis, swelling of the external genitalia, lower extremities.

Causes and risk factors for prostate cancer

Prostate cancer (PC) is one of the most common cancers in men. The morbidity and mortality from this pathology is steadily increasing all over the world. The question of the cause of the development of this pathology remains open, since the causes of prostate cancer are not fully understood. However, some risk factors for the development of this disease have already been identified. The main, most studied risk factors for developing prostate cancer are age, race, and the presence of so-called familial prostate cancer. In addition, a number of studies show the impact on the incidence of prostate cancer and other factors such as hormonal status of the body, diet, sexual behavior, environmental factors and genetic characteristics. Currently, a huge number of factors have been established that can directly or indirectly contribute to the occurrence of prostate cancer. However, the impact of many of these factors is not persistent and constant, while the influence of other factors is not reliably proven in order to make any clear statements about their impact on the incidence of this pathology. Many studies have focused on the role of diet, food, hormonal influences, and infection in causing prostate cancer.

Diagnosis of prostate cancer

Digital rectal examination

Digital rectal examination is a routine method for examining patients with suspected prostate cancer, one of the main methods of examination along with measuring the level of PSA in blood serum. The advantages of digital rectal examination are accessibility, safety and does not require economic costs. This method allows you to identify prostate tumors localized in the peripheral regions, if their volume exceeds 0. 2 ml.

Prostate-specific antigen (PSA)

The first prostate-specific antigen was isolated from seminal fluid in 1979. At the same time, its presence was established in the prostate tissue. In 1980, a serological test was performed to determine PSA in the blood. Since 1987, PSA has been widely used in the diagnosis of prostate cancer, establishing the stage of the process, and evaluating the effectiveness of treatment. The widespread use in clinical practice of determining the level of PSA has radically changed the structure of the incidence of prostate cancer throughout the world. PSA measurement is currently the screening method for detecting prostate cancer.

The concentration of PSA in the blood serum is normally not more than 2.5 – 4 ng / ml.
An increase in PSA levels can be due to a number of reasons, among which the most significant are:

1. Prostate cancer;
2. Benign prostatic hyperplasia;
3. Presence of inflammation or infection in the prostate gland;
4. Damage to the prostate (ischemia or infarction of the prostate).

Mechanical action on the prostate parenchyma also leads to an increase in serum PSA levels. Interventions such as prostate biopsy, transurethral resection, or the presence of an inflammatory process can cause a significant increase in PSA levels and require at least 4-6 weeks for PSA to return to baseline.
Thus, having organ-specificity, PSA is not a tumor-specific marker, and therefore the interpretation of data on the content of total PSA in the blood serum of patients should be carried out by a doctor, taking into account the above factors. For a long time, the PSA level = 4.0 ng/ml was considered the upper limit of normal. Given the relevance of the problem of early detection of PCa based on PSA levels, several large studies have been conducted that confirm the continued importance of PSA diagnostics in prostate cancer screening and identify new approaches to PSA thresholds.

Age (years)	Mean (ng/ml)	Mean limit (ng/ml)	Recommended limit (ng/ml)
4 0-49	0. 7	0.5-1.1	0-2.5
50-59	1.0	0.6-1.4	0-3.0
60-69	1.4	0.9-3.0	0-4.0
70-79	2.0	0.9-3.2	0-5.5

Table1. The value of the conditional norm of total PSA, taking into account age

The most difficult to interpret the increase in the level of PSA in the range from 2.5 to 10 ng / ml, called the “gray zone”, since the reasons for the increase in PSA along with prostate cancer are – prostatitis, benign hyperplasia prostate, etc.
Along with the recommended PSA cut-off value, age-specific values ​​for normal PSA levels have been developed. Based on the analysis of the results of the examination of a large number of patients of various age groups, a table of the dependence of the PSA level on age was compiled. This approach is considered more accurate than using a specific PSA threshold, as PSA levels are lower in younger patients and higher in older patients. The use of PSA data, taking into account the age of patients, increases the sensitivity and specificity of the test, and also helps to avoid “unnecessary” biopsies. However, the use of age thresholds also does not have an unambiguous assessment.

Prostate Cancer Ultrasound

If an elevated PSA level is detected and PCa is suspected, a digital rectal examination will perform a pelvic ultrasound (ultrasound) and a transrectal ultrasound (TRUS). TRUS is an ultrasound examination of the prostate performed with a specially designed high-frequency ultrasound transducer through the patient’s rectum. In this case, the ultrasonic sensor is located in close proximity to the prostate and is separated from it only by the wall of the rectum. The main advantage of TRUS is the ability to obtain a complete and very accurate image of the prostate, its various sections (zones), and, consequently, the pathological processes of this organ. TRUS also allows you to examine the seminal vesicles in detail. TRUS is the most accurate in determining the volume of the prostate and, with the appropriate equipment, has a high resolution.

Prostate biopsy

Prostate biopsy is performed for the histological diagnosis of cancer and the final diagnosis. It also allows you to determine the degree of aggressiveness of the tumor and the stage of the disease (its prevalence). The results of a prostate biopsy are the most important factor in determining the tactics of a patient’s treatment, as well as the prognosis of the disease.
Prostate biopsy and histological examination (examination of prostate tissue) is the only way to make a diagnosis of prostate cancer.

Magnetic resonance imaging of prostate cancer

Magnetic resonance imaging (MRI) is a method for examining internal organs and tissues using electromagnetic waves in a constant magnetic field of high intensity. MRI is a clarifying method of examination. MRI allows you to better detect the spread of the tumor beyond the prostate capsule and to neighboring organs, enlarged lymph nodes (which may indicate the presence of metastases, or the presence of an inflammatory process).

Radionuclide examination of the skeleton

Osteoscintigraphy, or skeletal scintigraphy, is a method of radionuclide diagnostics based on the introduction of a special drug into the patient’s body and subsequent registration of its distribution and accumulation in the skeleton using gamma radiation of an isotope that is part of the drug. Registration of the distribution of the radiopharmaceutical is carried out using a gamma camera. This method allows you to determine whether the tumor has spread to the bone. In the case of the presence of bone metastases, the drug selectively accumulates in them, which is determined during the study. The radiation dose during bone scintigraphy is very low and does not cause any harm to health.

Treatment of prostate cancer

Treatment of patients with prostate cancer largely depends on the stage and extent of the tumor process at the time of diagnosis. The main treatment options for localized tumors without distant metastases are surgery and radiation therapy in combination with hormonal therapy. In the case of distant metastases, drug systemic therapy is performed. Below we present information about the different types of treatment for prostate cancer.

Surgical treatment Surgical treatment is radical prostatectomy, which consists in the removal of the prostate gland with seminal vesicles and surrounding tissue to ensure complete removal of the tumor. Often this operation is accompanied by the removal of the pelvic lymph nodes, since the lymph nodes are the first barrier to the spread of tumor cells. This operation is aimed at eliminating the malignant process while maintaining the function of urinary continence and, if possible, potency. Radical prostatectomy is performed in the classical version with an open method and minimally invasive laparoscopic methods. Currently, methods of robotic-assisted (robotic) surgical treatment on the da Vinci robot are also used.

Radiotherapy

Radiation therapy is a treatment method using ionizing radiation. Radiation therapy in the treatment of prostate cancer is divided into remote and interstitial (brachytherapy).
External beam radiation therapy (EBRT) – the radiation source is located at some distance from the patient, with remote exposure, healthy tissues may lie between the focus of exposure and the radiation source. The more of them, the more difficult it is to deliver the required dose of radiation to the focus, and the more side effects of therapy. Interstitial radiation therapy (brachytherapy) – radiation sources, the so-called “grains” with the help of special tools are introduced directly into the tissue of the prostate gland.
In some cases, a combination of brachytherapy with EBRT is used to improve the effectiveness of anticancer treatment. For prostate cancer, radiation therapy provides the same life expectancy as surgery. The quality of life after radiation therapy is at least as good as after surgical treatment. In our Center, the choice of treatment tactics is made at a consultation with the participation of a surgical oncologist and a radiotherapist and a chemotherapist. A prerequisite is the consent of the patient, based on full information about the diagnosis, treatment methods and possible complications.

Focal Therapy Techniques

Cryosurgical destruction of the prostate, the use of high-intensity focused ultrasound, and photodynamic therapy (PDT) are currently being used as alternative experimental treatments for localized prostate cancer. It must be remembered that the above methods are used only in case of detection of cancer at an early stage.

Hormone therapy for prostate cancer

Sex hormones – androgens, regulate a number of physiological processes in the male body, including the growth and functioning of the prostate gland. At the same time, they also stimulate the growth of tumor cells in prostate cancer. The goal of hormone therapy is to stop the production of androgens or block their action, which can significantly slow down the development of the malignant process. There are different modes of hormonal treatment, they are selected together with you by an oncologist, based on the stage of cancer detected, the possibilities of radical treatment, the course of the disease, the risk of progression and other factors.
Hormonal treatment may be prescribed for patients who have relapsed prostate cancer after radiation therapy or radical prostatectomy surgery. In addition, given that in many men hormonal treatment has been effective for many years, this type of therapy may be indicated as a primary treatment in older people who have various comorbidities and are therefore at high risk of other aggressive treatments. Also, hormone therapy can be recommended for those patients who, for various reasons, refuse surgery or radiation therapy.
To monitor the effectiveness of hormonal treatment, the determination of the level of prostate-specific antigen (PSA) in the blood is used. The best option is to reduce the PSA level to 0.1 ng / ml 1.5–2 months after the start of treatment, although a value of no more than 0.5 ng / ml is very favorable for the patient. The effectiveness of hormone therapy largely depends on the initial value of PSA, the degree of malignancy of the tumor and the presence of metastases.

What is an orchitectomy?

Orchidectomy (or surgical castration) is the removal of the testicles by surgery, the purpose of which is to reduce the level of testosterone in the body to eliminate its effect on the prostate tumor. The operation is usually performed under local or intravenous anesthesia. In this case, the testicles are removed through one incision 3–4 cm long in the region of the scrotum root, or through two similar incisions located on the sides of the scrotum. With a visual examination of the scrotum a month after the operation, it is almost impossible to determine that the testicles have been removed.
The advantages of this type of hormonal therapy include a fairly rapid and irreversible decrease in testosterone levels, and the disadvantages are possible complications of the operation – hematoma (hemorrhage) of the scrotum and wound infection. In addition, many men refuse to have their testicles removed for emotional reasons.

What is hormone therapy by injection?

During hormone therapy by injection (shots), patients are given drugs called LHRH analogs (analogues of pituitary hormones – an endocrine gland located in the brain). 3–4 weeks after the administration of drugs of this group, the testosterone content in the blood decreases to a minimum level similar to that after orchidectomy, i.e. the so-called “medicated castration” occurs. In this case, there is no need to remove the testicles, and the operation remains a backup method of treatment, which can be used in the future if side effects of hormonal treatment appear or the patient refuses to continue it. In Russia, the most famous drugs of this group are Diferelin, Lukrin, Decapeptil, Suprefact, Prostap, and Zoladex, which is produced in a ready-to-use syringe and is injected under the skin of the abdomen monthly or once once every 3 months – depending on the dose (3.6 mg or 10.8 mg).

What is maximal androgen blockade?

A small amount (about 5%) of male sex hormones (androgens) is produced in the adrenal glands – endocrine glands located in the region of the upper poles of both kidneys. It is believed that during hormone therapy, in addition to injections of LHRH analogues (for example, Zoladex) or removal of the testicles, it is also necessary to take drugs – antiandrogens.
Antiandrogens block the ability of tumor cells to interact with sex hormones, causing, together with injectable drugs, an effect called maximum androgen blockade. According to a large number of studies, the effectiveness of maximum androgen blockade is higher than orchidectomy or isolated therapy by injection.
Among the antiandrogen drugs in Russia, the most commonly used are Flucin, Anandron, Androkur and Casodex (bicalutamide), produced in the form of 50 mg tablets to be taken once a day, which is quite convenient for patients.

What are the possible side effects of hormonal treatment?

The undesirable effects of hormone therapy include sensations of “hot flashes”, decreased libido and potency, swelling and soreness of the mammary glands, diarrhea, changes in liver function, etc. It must be emphasized that most of these side effects of hormonal drugs are relatively rare and rarely require discontinuation of treatment.

What is antiandrogen monotherapy?

Antiandrogen monotherapy is indicated in patients with locally advanced non-metastatic prostate cancer as an alternative to medical or surgical castration. Casodex 150 mg per day is used for this type of treatment. The use of Casodex in this dosage provides patients with a better quality of life compared to orchidectomy. Many men retain their libido and the ability to have an erection. An undesirable effect of this therapy is an increase in size (gynecomastia) and soreness of the mammary glands.

What is intermittent hormone therapy?

The term “intermittent (intermittent) therapy” refers to the cessation of hormonal treatment when the PSA level drops to a minimum value. Treatment is resumed when a rise in PSA levels is noted. Such a treatment regimen reduces its cost and minimizes possible side effects. It should be noted that at present there is not enough information about how effective intermittent therapy is and, most importantly, safe from the point of view of the progression of prostate cancer. That is why this technique is still considered experimental.

Why is hormonal treatment prescribed before surgery or radiation therapy?

Taking hormonal drugs for several months before surgery or prostate radiation (neoadjuvant therapy) can reduce the size of the prostate gland and thus facilitate the operation or increase the effectiveness of radiation treatments. The disadvantage of this type of therapy is the risk of negative manifestations of hormonal treatment – for example, erectile dysfunction or “hot flashes”, which could be avoided with immediate operation. The study of this technique is also ongoing.

Chemotherapy for prostate cancer

Chemotherapy is the use of a single or combination of anti-cancer drugs. It is prescribed for recurrence or advanced prostate cancer that does not respond to hormonal treatment, but it is not used in the treatment of early stages of the disease. Chemotherapy is given in cycles of treatment followed by a recovery period. The entire treatment usually lasts 3 to 6 months, depending on the type of chemotherapy drugs used.

What are the side effects?

Chemotherapy not only kills cancer cells, it also kills healthy cells in the body, such as the membranes lining the mouth, the lining of the gastrointestinal tract, hair follicles, and bone marrow. As a result, the side effects of chemotherapy depend on the amount of damage

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Prostate cancer is one of the most common cancers in men.

In Russia, it occupies one of the leading places among malignant diseases of the male population.

In the structure of cancer incidence, prostate cancer ranks third after lung and stomach cancer and fourth among the causes of death of cancer patients.

It should be added that due to the lack of screening programs for the early detection of the disease, its diagnosis is imperfect.

Most cases of the disease are diagnosed at stages 3-4, including 25% with generalization of the tumor process.

To date, mortality from prostate cancer in men is in second place after lung cancer.

Prostate cancer can develop in absolutely any man older than 45-50 years.

What are the reasons for the development of the disease?

The causes of this disease are not fully understood. The development of prostate cancer is associated with hormonal changes in older men, in particular, with a high level of testosterone, the male sex hormone.

Prostate cancer is a hormone-dependent tumor, that is, tumor growth is stimulated by testosterone. Therefore, in men who have a higher level of testosterone in the blood, the occurrence of prostate cancer is more likely and its course will be more malignant.

Prostate cancer is characterized by a slow and malignant course. This means that the tumor grows slowly (if we compare it with, say, liver cancer), it may not appear for many years. On the other hand, prostate cancer gives early metastases, that is, a small tumor can already begin to spread to other organs. Most often, the spread goes to the bones (pelvis, hips, spine), lungs, liver, adrenal glands. This is the biggest danger of cancer. Before the appearance of metastases, the tumor can be removed, and this will stop the disease. But if metastases appear, not a single surgeon can remove them all, and it will be impossible to completely cure a person.

How does prostate cancer manifest itself?

This is precisely the biggest problem with cancer – the disease begins to bother a person only when it has already gone very far and the chances of a cure have decreased significantly.

Prostate cancer may present with increased urination, pain in the perineum, blood in the urine and semen. But none of these symptoms may be noted. Then the first manifestation of the disease will be metastases of a cancerous tumor. It can be pain in the bones (in the pelvis, hips, spine), pain in the chest. In advanced cases, acute urinary retention may develop, as well as symptoms of cancer intoxication – sudden weight loss, weakness, pale skin with an earthy tint.

What will a urologist do when a patient with prostate cancer comes to him?

The best and most progressive method today is the determination of PSA in the blood – the so-called prostate-specific antigen. This is a substance, the amount of which in the blood increases dramatically when cancer occurs in the prostate. The advantage of this method is that today it is practically the only way to suspect prostate cancer at an early stage, when it can still be removed. The method is very simple and looks like a regular blood test to the patient. The disadvantages of the method include its very low prevalence in Russia and its relatively high cost.

Other studies – ultrasound, x-ray methods, only allow to more accurately determine the size of the tumor and the condition of other organs

The fundamental method for diagnosing prostate cancer is a biopsy. The indication for its appointment is elevated values ​​of the prostate specific antigen (PSA) of the blood (up to 60 years – more than 2.5 ng / ml, in older men – more than 4.0 ng / ml). For a more accurate assessment of the prevalence of the tumor and preoperative staging of the oncological process, magnetic resonance imaging of the pelvic organs is shown.

The main methods of treatment of patients suffering from prostate cancer are radical surgery (various options for radical prostatectomy), radiation therapy, and various options for drug treatment. A combination of several methods is possible. The patient should be aware of any treatment for this disease, because. each of them is associated with various complications and deterioration in the quality of life.

• Diagnosis of prostate cancer.
• Recommendations for the detection of prostate cancer.
• Prostate biopsy (transrectal, perineal).
• MRI-guided targeted biopsy of the prostate (Fusion biopsy).
• If the diagnosis of prostate cancer is confirmed. What treatment options exist?
• Radical prostatectomy with Da Vinci surgical robot.

City Hospital No. 40 uses the most advanced high-resolution ultrasound machines to perform prostate biopsies. For residents of St. Petersburg who have medical poles of compulsory medical insurance, this procedure is carried out free of charge (record by phone +7 (911) 288-04-98 from 15.00 to 17.00 on weekdays).

How to avoid prostate cancer?

Unfortunately, no one has yet given an answer to this question.