What are the key symptoms of early-stage prostate cancer. How is prostate cancer diagnosed in its early stages. What treatment options are available for early-stage prostate cancer. Why is PSA testing important for prostate cancer screening.

What is a Malignant Neoplasm of the Prostate?

A malignant neoplasm of the prostate, more commonly known as prostate cancer, is a type of cancer that develops in the prostate gland. The prostate is a small, walnut-sized organ located below the bladder in men. It plays a crucial role in the male reproductive system by producing seminal fluid that nourishes and transports sperm.

When cells in the prostate begin to grow and divide uncontrollably, they can form a tumor. If this tumor is cancerous (malignant), it has the potential to spread to other parts of the body. This is what distinguishes a malignant neoplasm from a benign tumor, which does not spread beyond its original location.

Key Characteristics of Prostate Cancer

• Originates in the prostate gland
• Can grow slowly or aggressively
• May spread to other parts of the body if left untreated
• Often detected through PSA testing and digital rectal exams
• One of the most common cancers in men

Early Signs and Symptoms of Prostate Cancer

In its early stages, prostate cancer often doesn’t cause noticeable symptoms. This is why regular screenings are crucial for early detection. However, as the cancer progresses, some men may experience certain symptoms.

Do early-stage prostate cancers always cause symptoms? No, many men with early-stage prostate cancer are asymptomatic, which underscores the importance of regular screenings.

Potential Early Warning Signs

• Frequent urination, especially at night
• Difficulty starting or stopping urination
• Weak or interrupted urine flow
• Painful or burning sensation during urination
• Blood in urine or semen
• Pain or discomfort in the pelvic area
• Erectile dysfunction

It’s important to note that these symptoms can also be caused by non-cancerous conditions, such as benign prostatic hyperplasia (BPH) or prostatitis. However, if you experience any of these symptoms, it’s crucial to consult with a healthcare professional for proper evaluation.

The Role of PSA Testing in Prostate Cancer Detection

Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland. PSA levels in the blood can be measured through a simple blood test, which has become a crucial tool in the early detection of prostate cancer.

Is PSA testing a definitive diagnostic tool for prostate cancer? While PSA testing is an important screening tool, it’s not definitive on its own. Elevated PSA levels can be caused by various factors, including non-cancerous conditions like BPH or prostatitis. Therefore, additional tests are usually required to confirm a prostate cancer diagnosis.

Understanding PSA Levels

• Normal PSA levels typically range from 0 to 4 nanograms per milliliter (ng/mL) of blood
• Levels between 4 and 10 ng/mL indicate a 25% chance of prostate cancer
• Levels above 10 ng/mL suggest a 50% chance of prostate cancer
• PSA levels can also be affected by age, prostate size, and other factors

It’s important to discuss the pros and cons of PSA testing with your healthcare provider, as there are ongoing debates about its effectiveness and potential for overdiagnosis.

Diagnostic Procedures for Early-Stage Prostate Cancer

When a PSA test or digital rectal exam (DRE) raises suspicion of prostate cancer, several diagnostic procedures may be employed to confirm the diagnosis and determine the extent of the disease.

Common Diagnostic Tests

1. Prostate Biopsy: Small tissue samples are taken from the prostate and examined under a microscope for cancer cells.
2. Transrectal Ultrasound (TRUS): Sound waves create images of the prostate, guiding the biopsy procedure.
3. MRI Fusion Biopsy: Combines MRI imaging with ultrasound for more precise targeting of suspicious areas.
4. Bone Scan: Used to check if cancer has spread to the bones.
5. CT or MRI Scan: These imaging tests help determine if cancer has spread beyond the prostate.

How accurate is a prostate biopsy in diagnosing cancer? While prostate biopsies are generally reliable, they can sometimes miss cancer if the samples are taken from non-cancerous areas of the prostate. This is why newer techniques like MRI fusion biopsies are becoming more common, as they increase the accuracy of sampling.

Staging and Grading of Prostate Cancer

Once prostate cancer is diagnosed, it’s crucial to determine its stage and grade. This information helps guide treatment decisions and provides insight into the prognosis.

Staging System

The TNM system is commonly used for staging prostate cancer:

• T (Tumor): Describes the size and extent of the main tumor
• N (Nodes): Indicates whether cancer has spread to nearby lymph nodes
• M (Metastasis): Shows if cancer has spread to other parts of the body

Gleason Score and Grade Groups

The Gleason score is a grading system used to evaluate the aggressiveness of prostate cancer. It ranges from 6 to 10, with higher scores indicating more aggressive cancer. Recently, Grade Groups have been introduced to simplify the Gleason system:

• Grade Group 1 (Gleason 6): Least aggressive
• Grade Group 2 (Gleason 3+4=7)
• Grade Group 3 (Gleason 4+3=7)
• Grade Group 4 (Gleason 8)
• Grade Group 5 (Gleason 9-10): Most aggressive

What impact does the Gleason score have on treatment decisions? The Gleason score plays a crucial role in determining the most appropriate treatment approach. Lower scores may allow for more conservative treatments or active surveillance, while higher scores often necessitate more aggressive interventions.

Treatment Options for Early-Stage Prostate Cancer

Early-stage prostate cancer, typically defined as cancer that is confined to the prostate gland, offers several treatment options. The choice of treatment depends on various factors, including the cancer’s aggressiveness, the patient’s age and overall health, and personal preferences.

Common Treatment Approaches

1. Active Surveillance: Closely monitoring the cancer with regular PSA tests, DREs, and biopsies, without immediate treatment.
2. Radical Prostatectomy: Surgical removal of the entire prostate gland and surrounding tissues.
3. Radiation Therapy: Using high-energy rays to kill cancer cells, either externally (EBRT) or internally (brachytherapy).
4. Focal Therapies: Targeted treatments that aim to destroy specific areas of cancer within the prostate while sparing healthy tissue.

Is active surveillance a safe option for all early-stage prostate cancers? Active surveillance is generally considered safe for men with low-risk, slow-growing prostate cancer. However, it requires careful patient selection and diligent follow-up to ensure the cancer doesn’t progress undetected.

Factors Influencing Treatment Choice

• Cancer stage and grade
• PSA level and its rate of change over time
• Patient’s age and life expectancy
• Overall health and existing medical conditions
• Potential side effects of treatments
• Patient’s personal preferences and values

It’s crucial for patients to have thorough discussions with their healthcare team to understand the pros and cons of each treatment option and make an informed decision.

Managing Side Effects of Prostate Cancer Treatment

While treatments for early-stage prostate cancer can be highly effective, they may also come with side effects that can impact a patient’s quality of life. Understanding and managing these side effects is an important aspect of prostate cancer care.

Common Side Effects

• Urinary Incontinence: Loss of bladder control, often temporary but sometimes persistent.
• Erectile Dysfunction: Difficulty achieving or maintaining an erection.
• Bowel Problems: Changes in bowel habits, sometimes including rectal bleeding or diarrhea.
• Fatigue: Especially common during and after radiation therapy.
• Hot Flashes: Can occur with hormone therapy.
• Loss of Fertility: Most treatments for prostate cancer can affect fertility.

How long do side effects typically last after prostate cancer treatment? The duration of side effects can vary greatly depending on the treatment type and individual factors. Some side effects, like fatigue, may resolve within weeks or months, while others, such as erectile dysfunction, may persist longer or even be permanent in some cases.

Management Strategies

1. Pelvic Floor Exercises: Can help improve urinary control.
2. Medications: Various drugs are available to treat erectile dysfunction.
3. Dietary Changes: Can help manage bowel issues.
4. Physical Therapy: May improve urinary and sexual function.
5. Psychological Support: Counseling can help patients cope with the emotional impact of side effects.

It’s important for patients to communicate openly with their healthcare team about any side effects they experience. Many side effects can be effectively managed or mitigated with proper care and support.

The Importance of Follow-Up Care and Monitoring

After initial treatment for early-stage prostate cancer, ongoing follow-up care is crucial. This involves regular check-ups and tests to monitor for cancer recurrence, manage side effects, and ensure overall health.

Key Components of Follow-Up Care

• Regular PSA Testing: To monitor for signs of cancer recurrence.
• Physical Exams: Including digital rectal exams (DREs).
• Imaging Tests: As needed, to check for cancer spread.
• Management of Treatment-Related Side Effects
• Discussions About Overall Health and Wellness

How often should follow-up appointments occur after prostate cancer treatment? The frequency of follow-up appointments can vary based on individual circumstances, but generally, they are more frequent in the first few years after treatment. A typical schedule might involve check-ups every 3-6 months for the first 1-2 years, then every 6-12 months for the next 3-5 years.

Long-Term Survivorship Care

As prostate cancer survivors live longer, attention to long-term health becomes increasingly important. This includes:

1. Monitoring for Late Effects of Treatment: Some side effects may develop years after initial treatment.
2. Screening for Secondary Cancers: Prostate cancer survivors may have an increased risk of other cancers.
3. Managing Chronic Health Conditions: Such as cardiovascular disease or osteoporosis.
4. Promoting Healthy Lifestyle Habits: Including proper nutrition, regular exercise, and stress management.
5. Addressing Psychosocial Needs: Including support for emotional well-being and relationships.

Effective follow-up care requires a collaborative approach between the patient, their oncology team, and primary care physician. Open communication and adherence to follow-up recommendations are key to ensuring the best possible outcomes for prostate cancer survivors.

Prostate Cancer: Introduction | Cancer.Net

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Approved by the Cancer.Net Editorial Board, 12/2022

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Prostate Cancer. Use the menu to see other pages. Think of that menu as a roadmap for this entire guide.

About the prostate

The prostate is a walnut-sized gland located behind the base of the penis, in front of the rectum, and below the bladder. It surrounds the urethra, the tube-like channel that carries urine and semen through the penis. The prostate’s main function is to make seminal fluid, the liquid in semen that protects, supports, and helps transport sperm.

The prostate continues to enlarge as people age. This can lead to a condition called benign prostatic hypertrophy (BPH), which is when the urethra becomes blocked. BPH is a common condition associated with growing older, and it has not been associated with a greater risk of having prostate cancer.

About prostate cancer

Cancer begins when healthy cells in the prostate change and grow out of control, forming a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Prostate cancer is somewhat unusual when compared with other types of cancer. This is because many prostate tumors do not spread quickly to other parts of the body. Some prostate cancers grow very slowly and may not cause symptoms or problems for years or ever. Even when prostate cancer has spread to other parts of the body, it often can be managed with treatment for a long time. So people with prostate cancer, and even those with advanced prostate cancer, may live with good health and quality of life for many years. However, if the cancer cannot be well controlled with existing treatments, it can cause symptoms like pain and fatigue and can sometimes lead to death. An important part of managing prostate cancer is watching for growth over time to find out if it is growing slowly or quickly. Based on the pattern of growth, your doctor can decide the best available treatment options and when to give them.

Histology is how cancer cells look under a microscope. The most common histology found in prostate cancer is called adenocarcinoma. Other, less common histologic types, called variants, include neuroendocrine prostate cancer and small cell prostate cancer. These variants tend to be more aggressive, produce much less prostate-specific antigen (PSA), and spread outside the prostate earlier. Read more about neuroendocrine tumors.

About prostate-specific antigen (PSA)

Prostate-specific antigen (PSA) is a protein produced by cells in the prostate gland and released into the bloodstream. PSA levels are measured using a blood test. Although there is no such thing as a “normal PSA” for anyone at any given age, a higher-than-normal level of PSA can be found in people with prostate cancer. Other non-cancerous prostate conditions, such as BPH (see above) or prostatitis can also lead to an elevated PSA level. Prostatitis is the inflammation or infection of the prostate. In addition, some activities like ejaculation can temporarily increase PSA levels. Ejaculations should be avoided before a PSA test to avoid falsely elevated tests. People should discuss with their primary care doctor the pros and cons of PSA testing before using it to screen for prostate cancer. See the Screening section for more information.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

• ASCO Answers Fact Sheet: Read a 1-page fact sheet that offers an introduction to prostate cancer. This free fact sheet is available as a PDF, so it is easy to print.

• ASCO Answers Guide: Get this free 52-page booklet that helps you better understand the disease and treatment options. The booklet is available as a PDF, so it is easy to print.

• Cancer.Net En Español: Read about prostate cancer in Spanish or read a 1-page ASCO Answers Fact Sheet in Spanish. Infórmase sobre cáncer de próstata en español o una hoja informativa de una página, Respuestas sobre el cáncer.

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with prostate cancer and general survival rates. Use the menu to choose a different section to read in this guide.

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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 cancer in men: symptoms, treatment, prognosis

• General information
• Dimensions and functions of a healthy prostate
• Prostate adenoma
• Prostate cancer
• Causes of prostate cancer
• Symptoms of prostate cancer
• Stages of prostate cancer
• TNM classification
• Prostate cancer, TNM classification
• Gleason scale
• Prostate cancer diagnostics
• Urological examination
• Treatment of prostate cancer
• Da Vinci Radical Robotic Prostatectomy

Prostate cancer is one of the most common oncological diseases. It accounts for more than 14% of all malignant tumors diagnosed in men. The disease develops slowly and can proceed for years without specific symptoms. Often, a neoplasm is detected only at stage 2 or later, when the tumor is already creating pressure on the urethra, and its size can be felt during a urological examination. Early diagnosis allows you to develop an effective treatment plan and prevent dangerous consequences – metastases in bone tissue and internal organs.

Dimensions and functions of a healthy prostate

The prostate is a small organ of glandular and muscular tissue located directly below the bladder. The gland covers the neck of the bladder and the proximal urethra. Its main function is the production of prostatic juice, which contributes to the vitality of the seed.
By the age of 20, the prostate gland reaches its natural size and stops growing. The normal size of the prostate, in which the average man does not have symptoms of adenoma, is 23-25 ​​cm3. An adult male prostate weighs 20 grams.

Prostate adenoma

After 40 years there is a tendency to hyperplasia of prostate tissue. The glandular epithelium begins to grow again due to a decrease in androgen levels. This is a natural process.
Over time, growing prostate tissue can form prostatic hyperplasia (BPH). Benign prostatic hyperplasia (synonymous with prostate adenoma) can compress the urethra and cause urination problems.

Changes in cell structure with age increase the risk of developing prostate cancer. A direct connection between the presence of prostate adenoma and the development of adenoma into prostate cancer has not been found. However, if benign prostatic hyperplasia is detected, it is recommended to regularly undergo an examination by a urologist-andrologist and control the level of the oncomarker PSA (prostate-specific antigen).

Prostate cancer

Prostate cancer (prostate adenocarcinoma) is a malignant neoplasm that develops from cells of the glandular epithelium or connective tissue. In the early stages, the tumor does not go beyond the prostate and practically does not manifest itself.

The first signs of prostate cancer appear as the mass of the tumor increases, when it compresses the urethra and interferes with the normal outflow of urine. Without treatment, the tumor can grow through the prostate capsule and metastasize to other organs.

It is very important to promptly respond to alarming symptoms, establish a diagnosis and start therapy. Prostate cancer belongs to the category of slow-growing tumors and, at undeveloped stages, responds well to treatment.

Causes of prostate cancer

Science has not yet been able to establish with 100% certainty the true causes of prostate cancer. The main risk factors are age, hereditary predisposition, dietary habits (lack of vitamin A and β-carotene), smoking. More than 70% of newly diagnosed prostate cancer cases occur in men over 65 years of age.

In the presence of a hereditary predisposition, men over 45 years of age are at risk. In our experience, we can say that prostate cancer is getting younger. We often see patients over the age of 40. Therefore, the importance of regular urological examinations cannot be underestimated, especially if there are cases of prostate cancer in the family.

Symptoms of prostate cancer

• The urine stream becomes sluggish;
• Prolonged urination;
• Frequent urge to urinate, including at night;
• Small amount of urine when urinating;
• Intermittent urination at the end of urination;
• Sensation of incomplete emptying of the bladder;
• Burning sensation when urinating;
• Uncontrollable urge to urinate, incontinence.

The first signs of prostate cancer are similar to those of benign prostatic hyperplasia (adenoma), urinary tract infection, inflammation of the prostate gland. They should not be underestimated – listen to your body, donate blood for PSA (prostate-specific antigen) and consult a urologist to rule out prostate cancer.

Prostate cancer staging

Prostate tumor classification is determined by TNM system and Gleason Score after prostate biopsy, MRI, CT and other examinations.

TNM classification

T (tumor) – tumor; the size of the tumor and how far it has grown into nearby tissues.
N (node) – lymph nodes; whether there is metastasis to the lymph nodes. If yes, how extensive is it?
M (metastase) – metastasis; whether there is metastasis to other organs.

Every type of cancer has its own TNM classification. Each of the three letters is assigned a number to give a more precise description of each of the gradations.
Based on an accurate TNM classification, the attending physician can make a prognosis and determine the correct type of treatment.

Prostate cancer, TNM classification

T (tumor) – tumor

Tx: tumor was not found in the prostate.

T0: no clear evidence of a tumor in the prostate.
T1: tumor is extremely small, not palpable, and not visible on x-rays;

• T1a: less than 5% of biopsy tissue contains cancer cells,
• T1b: more than 5% of biopsy tissue contains cancer cells,
• T1c: biopsy tissue consists of cancer cells.

T2: the tumor is only in the prostate capsule;

• T2a: Tumor occupies less than half of the prostate
• T2b: Tumor occupies more than half of the prostate
• T2c: Tumor occupies both lobes of the prostate.

T3: tumor has grown beyond the prostate capsule;

• T3a: the tumor has grown beyond the prostate capsule and into the bladder,
• T3b: the tumor has grown beyond the prostate capsule and into the seminal vesicles.

T4: the tumor has affected nearby organs: intestines, sphincter, pelvic muscles, pelvic wall, etc.

N: (node) – lymph nodes

Nx: insufficient data to determine the status of the lymph nodes.

N0: no metastasis to regional lymph nodes.

N1: there is metastasis to regional lymph nodes.

M: (metastase) – distant metastasis

• M0: no distant metastases.
• M1: there are distant metastases;
• M1a: metastases to non-regional lymph nodes;
• M1b: there is metastasis to the bones of the skeleton,
• M1c: there is metastasis to other organs.

Example:

T2aN0M0 means that the tumor grows in one lobe of the prostate, the lymph nodes are not affected and there is no metastasis to other organs.

Gleason score

The Gleason score is used to determine the aggressiveness of a prostate tumor. The fewer cancer cells that resemble normal (healthy) cells, the higher the Gleason score and the more aggressive the prostate cancer.

It often happens that not all cancer cells in the tissues of the prostate have the same aggressiveness. The morphologist examines under a microscope the two most characteristic tissue samples taken during a prostate biopsy and evaluates them on a 5-point scale, depending on the degree of differentiation. The most aggressive tumor cells are scored 5 points, the least aggressive receive a minimum score of 1. The Gleason sum obtained by adding these scores varies from 2 (1+1) to 10 (5+5) points. The higher it is, the greater the threat is a poorly differentiated tumor.

Diagnosis of prostate cancer

Timely diagnosis of prostate cancer increases the chances of a cure, improves quality of life and provides a more favorable prognosis for the course of the disease. The average life expectancy for metastasized prostate cancer is 2 years. With timely detection and treatment of prostate cancer, life expectancy in 90% of patients is more than 15 years (all age categories of patients were taken into account).

Urological examination

Have you noticed symptoms of prostate cancer? Donate blood for PSA and sign up for a urological examination.

Learn more about urology

Prostate cancer treatment

The choice of treatment for prostate cancer in men depends on the stage of the disease, general physical condition and characteristics of the individual patient. In the early stages, high-precision radiation therapy (external or internal, brachytherapy) can be used. Radical prostatectomy is considered the gold standard in the treatment of prostate cancer. In some cases, hormone therapy may be needed to slow tumor growth before surgery. Chemotherapy is used for the most severe forms of prostate cancer with metastasis to other organs.

Da Vinci Robotic Radical Prostatectomy

Da Vinci Robotic Radical Prostatectomy (RARP) is a minimally invasive surgical procedure that allows complete removal of tumor tissue without affecting the nerve endings. To date, it is considered the most gentle and effective treatment for prostate cancer. The main advantages of RARP for the patient are rapid recovery, minimal postoperative discomfort, and maximum possible protection against postoperative complications such as potency or urinary incontinence.

Detailed information about Da Vinci prostatectomy

Prostate cancer – diagnosis and treatment of prostate cancer at the EMC Oncology Center

Prostate cancer is one of the most common cancers in men. Its danger is that in the initial stages there are practically no symptoms. Due to the lack of timely diagnosis, many patients begin treatment late, when the tumor has already spread to other organs and has given distant metastases.

What is prostate cancer

Prostate cancer is a malignant neoplasm that develops from the secretory epithelium of the prostate gland. As with other oncological diseases, the tumor arises from atypical cells that divide pathologically quickly and form a neoplasm.

Prostate cancer is often diagnosed at an advanced stage. Only a small part of men undergo special screening, so it is difficult to detect a tumor at the initial stage.

Causes and risk factors

It is still not known exactly what causes the development of the tumor. But scientists have already identified risk factors that increase the likelihood of getting sick:

• Age. The older the man, the higher the risks.

• Race. The disease is more often diagnosed in representatives of the Negroid race.

• Hereditary predisposition. At risk are men whose close relatives had prostate cancer.

• Harmful working conditions (for example, radiation exposure for pilots or exposure to chemicals in production).

• Smoking, drinking alcohol (especially strong).

• Improper diet (with a large amount of animal fats in the diet).

• History of diseases of the genitourinary system (prostatitis, prostatic hyperplasia).

Most often, the disease is diagnosed in men over 60 years old, but in recent years there has been a tendency to “rejuvenate” the pathology.

Symptoms

Prostate cancer in the early stages has no obvious symptoms. The disease develops rather slowly, so the patient may not be aware of it for several years. As the tumor grows, some noticeable symptoms appear:

• frequent urination, especially at night;

• difficulty urinating;

• urinary incontinence;

• weak or intermittent flow of urine;

• pain or burning during urination;

• blood in urine or semen.

In some cases, prostate cancer can also lead to bone pain, especially in the pelvis, back, chest, or upper limbs. The symptoms are nonspecific, so they can easily be confused with signs of other diseases.

Classification

Prostate cancer is classified into stages according to the international TNM system, which takes into account the size of the primary tumor, lymph node involvement and distant metastases:

• Stage 1. Cancer cells are located in the prostate. There are no symptoms of the disease.

• Stage 2. Cancer cells are also in the prostate. The tumor can be palpated.

• Stage 3. The tumor has spread to adjacent organs and seminal vesicles.

• Stage 4. Cancer spreads rapidly and aggressively to distant organs. Metastases appear in the bones, liver, lungs, brain, etc.

An accurate classification of prostate cancer helps oncologists determine treatment strategies and predict the course of the disease.

Cancer diagnosis

Since prostate cancer does not show itself in the early stages, preventive examinations are of key importance in the diagnosis. Even if the patient does not experience any symptoms, the urologist, based on clinical signs, can already suggest a diagnosis and conduct an examination. The first thing they usually start with is a digital rectal examination of the prostate gland. The prostate is located on the anterior surface of the rectum, so the doctor can feel the lumps.

On palpation, the posterior surface of the prostate is well accessible, but pathological formations in its anterior and upper part are palpated worse. Therefore, on the basis of only this method of diagnosing cancer, a diagnosis is not made. If suspicions arise, the doctor prescribes additional examinations:

• Analysis to determine the level of PSA. Prostate specific antigen is a marker that is elevated due to certain prostate diseases, including cancer.

• Ultrasound. A safe and effective procedure to visualize the prostate using ultrasound waves. Ultrasound is necessary to determine the size, shape and structure of the tissues of the organ.

• Biopsy. A procedure in which a sample of prostate tissue is taken with a special needle for further examination under a microscope. Biopsy is an important method for diagnosing prostate cancer and determining its degree of aggressiveness.

• Radionuclide research. The method uses radioactive substances that are introduced into the body and then detected by special devices. A radionuclide test, such as a scintigraphy or positron emission tomography (PET), can help detect metastases or determine whether prostate cancer has spread beyond the prostate.

• Magnetic resonance imaging (MRI). The method uses magnetic fields and radio waves to create detailed images of internal organs and tissues. MRI allows you to more accurately determine the size and location of the tumor, as well as assess its spread to surrounding structures.

EMC also uses a unique fusion biopsy technique. This is the collection of a tissue sample under visual control using a complex of MRI and ultrasound. In prostate cancer, the pathological focus is difficult to access, so a standard biopsy is not effective enough. Targeted sampling from suspicious areas is much more revealing. This method is 30% more accurate.

Treatment

The EMC clinic uses a comprehensive approach to the treatment of prostate cancer, including various methods depending on the stage of the disease, the patient’s history and personal wishes. There are many strategies: it is expectant tactics, surgery or destruction of the tumor with the help of various influences.

Expectant management is a permanent control without therapeutic interventions. Ultrasound is performed regularly and the level of PSA in the blood is determined. Expectant management is used for slowly growing highly differentiated tumors, in the elderly, in the presence of other diseases.

Surgical treatment is the main method used for prostate cancer. A radical prostatectomy is performed, that is, the removal of the prostate along with the surrounding tissues. The method allows you to maintain the normal functioning of the sphincter of the bladder and sexual function.

In the EMC Urology Clinic, surgeries are performed using the Da Vinci robot-assisted system. Tissue injury and blood loss are minimal. A gentle technique helps to recover quickly after surgery and prevent many postoperative complications.

Radiotherapy . This is the use of high energy beams to kill cancer cells. The EMC clinic uses various types of radiation therapy and radiosurgery.

Cryotherapy. Method for the treatment of prostate cancer based on the effect of low temperatures on the tumor. This procedure is used when other treatments do not bring the desired effect or cannot be used due to the patient’s history.

Hormone therapy . This method aims to reduce the level of male hormones (testosterone) that promote the growth of cancer cells in the prostate. It is used when other treatment strategies are not possible. Hormone therapy can be done with chemical or surgical castration. Methods of 5-alpha reductase inhibition, androgen blockade of target cells, and maximum androgen blockade are also used.

At the EMC clinic, we approach each patient individually, taking into account their condition, cancer stage and preferences, and develop an optimal treatment plan using modern methods and technologies. We use only original medicines approved by international and Russian control organizations. During surgical interventions, we prefer sparing organ-preserving techniques.

Complications

Complications of prostate cancer are characteristic disorders of the functions of the affected organs. Most often these are various problems of urination. If metastases spread to the bones, pain in the extremities is possible. When the tumor squeezes the spinal cord, paralysis and paresthesia develop.

Postoperative complications largely depend on the skill of the surgeon. The EMC clinic uses gentle organ-preserving techniques: laparoscopic, endoscopic and robotic (Da Vinci Si HD) operations. This reduces the risk of complications and speeds up the rehabilitation process after cancer treatment.

Prognosis and prevention

The favorable prognosis directly depends on when the disease was discovered and treatment started. With a tumor localized in the prostate and timely therapy, a complete recovery is possible. However, if the cancer has spread beyond the prostate and there are distant metastases, the prognosis may be less favorable.

In terms of prevention, recommendations include a healthy lifestyle with moderate physical activity, a diet high in fiber, and limiting fatty foods. Regular check-ups with a doctor are important for early detection of possible relapses.

If you are at risk or have troublesome symptoms, make an appointment for a cancer screening. Early detection of the disease significantly affects the prognosis and effectiveness of treatment. In the EMC multidisciplinary clinic, highly qualified specialists conduct appointments, and an integrated approach to the treatment of prostate cancer meets international standards.

References

1. Pasevich KG, Cherenkov VG, Petrov AB, Strozhenkov MM Multi-stage screening for prostate cancer // Bulletin of NovSU. 2012. No. 66. https://cyberleninka.ru/article/n/mnogoetapnyy-screening-raka-predstatelnoy-zhelezy
2. Turina L.I., Nagorny V.M., Alekseeva G.N. Fundamentals of diagnosis and treatment of prostate cancer // TMJ. 2003. No. 3. https://cyberleninka.ru/article/n/osnovy-diagnostiki-i-lecheniya-raka-prostaty
3. Marisov L. V., Vinarov A. Z., Alyaev Yu. G., Martirosyan G. A. Incidental prostate cancer: prevalence and treatment approaches // Medical Bulletin of Bashkortostan. 2013. №3. https://cyberleninka.ru/article/n/intsidentalnyy-rak-prostaty-rasprostranennost-i-podhody-k-lecheniyu
4. Schatten H.