What does malignant neoplasm of prostate mean. Malignant Neoplasm of Prostate: Early-Stage Prostate Cancer Symptoms, Diagnosis & Treatment
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. Why is PSA testing controversial for prostate cancer screening. How does prostate cancer differ from benign prostatic hyperplasia.
Understanding Prostate Cancer: An Overview
Prostate cancer is a malignant neoplasm that develops in the prostate gland, a walnut-sized organ located below the bladder in men. This type of cancer occurs when healthy prostate cells undergo changes and begin to grow uncontrollably, forming a tumor. While prostate cancer can be a serious condition, it often grows slowly compared to other cancers, allowing for effective management in many cases.
Is prostate cancer always life-threatening? Not necessarily. Many prostate tumors grow slowly and may not cause symptoms or health problems for years, if ever. However, some types can be aggressive and spread quickly to other parts of the body. The key to managing prostate cancer lies in careful monitoring and timely intervention when necessary.
The Anatomy and Function of the Prostate Gland
To understand prostate cancer, it’s crucial to know the anatomy and function of the prostate gland:
- Location: Behind the base of the penis, in front of the rectum, and below the bladder
- Size: Approximately walnut-sized in healthy adults
- Function: Produces seminal fluid, which nourishes and transports sperm
- Structure: Surrounds the urethra, the tube that carries urine and semen out of the body
How does the prostate change with age? As men grow older, the prostate tends to enlarge naturally. This condition, known as benign prostatic hyperplasia (BPH), can cause urinary symptoms but is not cancerous and does not increase the risk of developing prostate cancer.
Early Signs and Symptoms of Prostate Cancer
Recognizing the early signs of prostate cancer is crucial for timely diagnosis and treatment. However, it’s important to note that early-stage prostate cancer often doesn’t cause noticeable symptoms. When symptoms do occur, they may include:
- Frequent urination, especially at night
- Difficulty starting or stopping urination
- Weak or interrupted urine flow
- Blood in urine or semen
- Erectile dysfunction
- Pain or discomfort in the pelvic area
Are these symptoms specific to prostate cancer? No, these symptoms can also be caused by non-cancerous conditions like BPH or prostatitis. Therefore, it’s essential to consult a healthcare provider for proper evaluation if you experience any of these signs.
Diagnosing Early-Stage Prostate Cancer
Early detection of prostate cancer is crucial for successful treatment. The diagnostic process typically involves several steps:
- Prostate-Specific Antigen (PSA) Test: A blood test measuring PSA levels
- Digital Rectal Exam (DRE): Physical examination of the prostate
- Imaging Tests: MRI or transrectal ultrasound to visualize the prostate
- Prostate Biopsy: Removal of tissue samples for microscopic examination
What is the significance of PSA levels in prostate cancer diagnosis? Elevated PSA levels can indicate prostate cancer, but they can also be caused by non-cancerous conditions. Therefore, PSA testing is used in conjunction with other diagnostic tools for a more accurate assessment.
The Role of PSA Testing in Prostate Cancer Screening
Prostate-Specific Antigen (PSA) testing plays a crucial role in prostate cancer screening, but its use is not without controversy. PSA is a protein produced by cells in the prostate gland and released into the bloodstream. While higher PSA levels can indicate prostate cancer, they can also be elevated due to non-cancerous conditions like BPH or prostatitis.
Why is PSA testing controversial? The controversy surrounding PSA testing stems from several factors:
- False positives: Elevated PSA levels don’t always indicate cancer, leading to unnecessary biopsies and anxiety
- Overdiagnosis: Detection of slow-growing cancers that may never cause symptoms or require treatment
- Potential overtreatment: Leading to side effects that impact quality of life
- Lack of clear “normal” PSA levels: PSA levels can vary based on age, race, and other factors
Despite these concerns, PSA testing remains an important tool in prostate cancer screening when used appropriately and in conjunction with other diagnostic methods. Men should discuss the pros and cons of PSA testing with their healthcare providers to make informed decisions about screening.
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 overall health, and personal preferences. Common treatment approaches include:
- Active Surveillance: Closely monitoring the cancer without immediate treatment
- Surgery: Radical prostatectomy to remove the entire prostate gland
- Radiation Therapy: Using high-energy rays to destroy cancer cells
- Hormone Therapy: Reducing testosterone levels to slow cancer growth
- Focal Therapies: Targeting specific areas of cancer within the prostate
How is the most appropriate treatment determined? The decision is typically made through a collaborative process involving the patient, urologist, and other specialists, considering the cancer’s characteristics, potential side effects, and the patient’s preferences and overall health.
Active Surveillance: A Conservative Approach
Active surveillance is an increasingly popular management strategy for low-risk, early-stage prostate cancer. This approach involves closely monitoring the cancer without immediate treatment, allowing patients to avoid or delay the potential side effects of more aggressive interventions.
What does active surveillance entail? The process typically includes:
- Regular PSA tests (usually every 3-6 months)
- Digital rectal exams (DRE) at specified intervals
- Periodic prostate biopsies (often annually)
- MRI scans to assess cancer progression
Active surveillance is most suitable for men with low-risk prostate cancer that is unlikely to spread quickly. If monitoring reveals signs of cancer progression, more active treatment can be initiated promptly.
Differentiating Prostate Cancer from Benign Prostatic Hyperplasia (BPH)
Prostate cancer and benign prostatic hyperplasia (BPH) are two distinct conditions that can affect the prostate gland. While they may share some similar symptoms, understanding their differences is crucial for proper diagnosis and treatment.
How do prostate cancer and BPH differ? Here are the key distinctions:
- Nature of the condition: Prostate cancer is a malignant growth, while BPH is a non-cancerous enlargement of the prostate
- Cause: Cancer results from genetic mutations, while BPH is a natural part of aging
- Progression: Prostate cancer can potentially spread to other parts of the body, whereas BPH remains confined to the prostate
- Treatment approach: Cancer treatment aims to eliminate or control the disease, while BPH treatment focuses on symptom relief
- Long-term outlook: Prostate cancer can be life-threatening if left untreated, while BPH does not directly threaten life
Despite these differences, both conditions can cause similar urinary symptoms, which is why proper medical evaluation is essential for accurate diagnosis and appropriate treatment.
The Importance of Prostate Cancer Awareness and Early Detection
Raising awareness about prostate cancer and promoting early detection are crucial steps in improving outcomes for men affected by this disease. Understanding the risk factors, symptoms, and available screening methods can empower individuals to take proactive steps in managing their prostate health.
Why is early detection so important in prostate cancer? Early detection offers several advantages:
- Increased treatment options: Early-stage cancers often have more treatment choices available
- Better outcomes: Early detection typically leads to more successful treatment and improved survival rates
- Reduced treatment intensity: Early-stage cancers may require less aggressive interventions
- Improved quality of life: Early treatment can help preserve urinary and sexual function
Promoting prostate cancer awareness involves educating men about the importance of regular check-ups, understanding their individual risk factors, and having open discussions with healthcare providers about screening options. By fostering a culture of proactive health management, we can work towards reducing the impact of prostate cancer on individuals and communities.
Advances in Prostate Cancer Research and Treatment
The field of prostate cancer research is rapidly evolving, with new discoveries and treatment approaches continuously emerging. These advancements are improving our understanding of the disease and offering new hope for patients.
What are some of the latest developments in prostate cancer research and treatment? Here are a few notable areas:
- Genomic testing: Identifying specific genetic markers to guide treatment decisions
- Immunotherapy: Harnessing the body’s immune system to fight cancer cells
- Targeted therapies: Developing drugs that specifically target cancer-related molecules
- Improved imaging techniques: Enhancing the accuracy of cancer detection and staging
- Minimally invasive surgical techniques: Reducing side effects and improving recovery times
These advancements are not only improving treatment outcomes but also helping to personalize care based on individual patient characteristics and tumor profiles. As research continues, we can expect further innovations that will enhance our ability to detect, treat, and potentially prevent prostate cancer.
The Promise of Precision Medicine in Prostate Cancer
Precision medicine is an emerging approach that takes into account individual variability in genes, environment, and lifestyle for each person. In the context of prostate cancer, precision medicine holds great promise for tailoring treatments to the specific characteristics of a patient’s tumor.
How does precision medicine benefit prostate cancer patients? The advantages include:
- More accurate prognosis: Genetic profiling can help predict how aggressive a tumor is likely to be
- Targeted treatments: Identifying specific genetic mutations can guide the selection of the most effective therapies
- Reduced overtreatment: Better risk stratification can help avoid unnecessary treatments for low-risk cancers
- Improved drug development: Understanding the molecular basis of prostate cancer can lead to new, more effective therapies
As precision medicine continues to advance, it has the potential to revolutionize prostate cancer care, offering more personalized and effective treatment strategies for each patient.
Prostate Cancer: Introduction | Cancer.Net
Search
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 booklet is available as a PDF, so it is easy to print.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.
‹ Prostate Cancer
up
Prostate Cancer – Statistics ›
Timely. Trusted. Compassionate.
Comprehensive information for people with cancer, families, and caregivers, from the American Society of Clinical Oncology (ASCO), the voice of the world’s oncology professionals.
Find a Cancer Doctor
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
See all (6)
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).
At risk are men whose close relatives had prostate cancer.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.
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.
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
- 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
- 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
- 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
- Schatten H.
