What are the early signs of prostate cancer. How is prostate cancer diagnosed in its early stages. What treatment options are available for early-stage prostate cancer. Can prostate cancer be cured if caught early. How does PSA testing factor into early prostate cancer detection. What is the prognosis for early-stage prostate cancer. Are there ways to prevent prostate cancer from developing.

Understanding Malignant Neoplasm of the Prostate

A malignant neoplasm of the prostate, more commonly known as prostate cancer, is a serious condition that develops when normal prostate cells begin to grow and divide uncontrollably, forming a tumor. Unlike benign prostate conditions, malignant tumors have the potential to spread to other parts of the body if left untreated.

The prostate gland is a walnut-sized organ located below the bladder in men. Its primary function is to produce seminal fluid, which nourishes and transports sperm. As men age, the prostate often enlarges naturally, but this benign growth (benign prostatic hyperplasia or BPH) is distinct from cancerous growth.

Key Characteristics of Prostate Cancer

• Originates in the prostate gland
• Can grow slowly or aggressively
• May spread to other parts of the body (metastasis)
• Often detectable through PSA testing and other screening methods
• Treatable, especially when caught early

Is prostate cancer always life-threatening? Not necessarily. Many prostate cancers grow slowly and may not cause significant problems for years, if ever. However, some forms can be aggressive and require immediate treatment.

Early Signs and Symptoms of Prostate Cancer

In its early stages, prostate cancer often does not cause noticeable symptoms. This is why regular screening is crucial, especially for men over 50 or those with risk factors. However, as the disease progresses, some men may experience the following:

• Difficulty urinating or weak urine flow
• Frequent urination, especially at night
• Blood in urine or semen
• Erectile dysfunction
• Discomfort in the pelvic area
• Bone pain (in advanced cases)

Do all men with these symptoms have prostate cancer? No, these symptoms can also be caused by other prostate conditions like BPH. However, experiencing any of these signs warrants a visit to a healthcare provider for proper evaluation.

Diagnostic Approaches for Early-Stage Prostate Cancer

Early detection of prostate cancer significantly improves treatment outcomes. Doctors employ several methods to diagnose the condition:

Prostate-Specific Antigen (PSA) Test

The PSA test measures the level of prostate-specific antigen in the blood. Elevated PSA levels can indicate prostate cancer, but they can also be caused by other conditions. How accurate is PSA testing for prostate cancer detection? While PSA testing is a valuable screening tool, it’s not definitive. Approximately 75% of men with elevated PSA levels do not have prostate cancer, highlighting the need for additional diagnostic procedures.

Digital Rectal Examination (DRE)

During a DRE, a doctor manually examines the prostate through the rectum, feeling for any abnormalities in size, shape, or texture.

Prostate Biopsy

If initial tests suggest the possibility of cancer, a prostate biopsy is typically performed. This involves taking small samples of prostate tissue for microscopic examination.

Imaging Studies

Various imaging techniques, such as transrectal ultrasound, MRI, or CT scans, may be used to visualize the prostate and detect potential tumors.

How long does it take to diagnose prostate cancer? The diagnostic process can vary, but it typically takes several weeks from initial screening to a definitive diagnosis, as multiple tests and consultations are often required.

Treatment Options for Early-Stage Prostate Cancer

When prostate cancer is detected in its early stages, several treatment options are available. The choice of treatment depends on factors such as the cancer’s aggressiveness, the patient’s age and overall health, and personal preferences.

Active Surveillance

For low-risk, slow-growing prostate cancers, active surveillance may be recommended. This involves regular monitoring through PSA tests, DREs, and periodic biopsies, with active treatment initiated only if the cancer shows signs of progression.

Radical Prostatectomy

This surgical procedure involves the complete removal of the prostate gland and some surrounding tissue. It can be performed through traditional open surgery or minimally invasive techniques like laparoscopic or robotic-assisted surgery.

Radiation Therapy

Radiation therapy uses high-energy beams to kill cancer cells. It can be delivered externally (external beam radiation) or internally through radioactive seed implants (brachytherapy).

Hormone Therapy

While typically used for more advanced cases, hormone therapy may sometimes be recommended for early-stage prostate cancer, especially in combination with other treatments.

What is the most effective treatment for early-stage prostate cancer? The effectiveness of treatment varies depending on individual circumstances. Generally, both surgery and radiation therapy show similar success rates for early-stage prostate cancer, with cure rates of 70-80% or higher.

The Role of PSA Testing in Early Detection

Prostate-specific antigen (PSA) testing plays a crucial role in the early detection of prostate cancer. This simple blood test measures the level of PSA, a protein produced by the prostate gland, in a man’s bloodstream.

PSA Levels and Cancer Risk

• PSA levels under 4 ng/mL are generally considered normal
• Levels between 4-10 ng/mL indicate a 25% chance of prostate cancer
• Levels above 10 ng/mL suggest a 50% chance of prostate cancer

However, it’s important to note that PSA levels can be elevated due to non-cancerous conditions as well, such as prostatitis or BPH.

Controversies Surrounding PSA Testing

While PSA testing has undoubtedly improved early detection rates, it has also been the subject of controversy. Critics argue that it can lead to overdiagnosis and overtreatment of slow-growing cancers that may never cause symptoms.

Should all men undergo regular PSA testing? The decision to undergo PSA testing should be made individually, considering factors such as age, family history, and personal preferences. Current guidelines generally recommend that men discuss the potential benefits and risks of PSA screening with their healthcare providers starting at age 50, or earlier for those at higher risk.

Prognosis and Survival Rates for Early-Stage Prostate Cancer

The prognosis for early-stage prostate cancer is generally very good, with high survival rates compared to many other cancers. This is largely due to improved screening methods, leading to earlier detection and treatment.

5-Year Survival Rates

• Localized prostate cancer (confined to the prostate): Nearly 100%
• Regional prostate cancer (spread to nearby structures): Nearly 100%
• Distant prostate cancer (spread to distant parts of the body): About 30%

What factors influence the prognosis of early-stage prostate cancer? Several factors can affect the outlook, including:

• The stage and grade of the cancer
• PSA levels at diagnosis
• Age and overall health of the patient
• Response to treatment

It’s important to note that these statistics are based on men diagnosed and treated at least five years ago. With ongoing advancements in treatment, current survival rates may be even higher.

Prevention and Risk Reduction Strategies

While it’s not always possible to prevent prostate cancer, there are several strategies that may help reduce the risk or detect it early:

Lifestyle Modifications

• Maintain a healthy diet rich in fruits, vegetables, and whole grains
• Exercise regularly
• Maintain a healthy weight
• Limit alcohol consumption
• Don’t smoke, or quit if you do

Regular Screening

Regular check-ups and discussions with healthcare providers about screening options can lead to early detection and better outcomes.

Know Your Risk Factors

Understanding personal risk factors, such as age, race, and family history, can help inform decisions about screening and preventive measures.

Can prostate cancer be completely prevented? While no method can guarantee prevention, these strategies can significantly reduce risk and improve overall health.

Living with Early-Stage Prostate Cancer

A diagnosis of early-stage prostate cancer, while concerning, often comes with a positive outlook. Many men live long, healthy lives after treatment or even during active surveillance. However, the journey can still present challenges:

Emotional Impact

Coping with a cancer diagnosis can be emotionally taxing. Support groups, counseling, and open communication with loved ones can be beneficial.

Treatment Side Effects

Some treatments may cause side effects such as urinary incontinence or erectile dysfunction. Working closely with healthcare providers can help manage these issues effectively.

Lifestyle Adjustments

Adopting a healthier lifestyle can support recovery and overall well-being. This might include dietary changes, increased physical activity, and stress management techniques.

Regular Follow-ups

Ongoing monitoring is crucial, even after successful treatment, to detect any potential recurrence early.

How can men maintain a good quality of life with early-stage prostate cancer? By staying informed, adhering to treatment plans, maintaining open communication with healthcare providers, and seeking support when needed, many men successfully navigate life with early-stage prostate cancer.

In conclusion, while a diagnosis of malignant neoplasm of the prostate (prostate cancer) can be frightening, early detection and advances in treatment have greatly improved outcomes. Understanding the disease, its symptoms, diagnostic processes, and treatment options empowers patients to make informed decisions about their care. With proper management, many men with early-stage prostate cancer can expect to live long, fulfilling lives.

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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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

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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

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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

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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
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2005 Mar-Apr;28(2):108-18.
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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.