Description of prostate cancer
Prostate cancer accounts for about 4% of all cancers. In the Czech Republic, its incidence is about 60 cases per 100,000 men. In the male population of this therefore represents 10% of all cancer tumors, like in other countries of Western Europe. The occurrence of latent disease (ie. Underlying disease, which still had no effect and therefore does not bring the patient to the doctor can not therefore be part of or epidemiological studies) it is much higher.
With this cancer physicians are faced with increasing frequency. In the Czech Republic increased incidence of up to 70% compared to the early nineties. Most patients are aged between 70th-80th year, is increasing as well as younger patients, therefore, are being considered for screening, which could capture the tumor must be at sixty patient. The downside would be quite unnecessary burden on elderly patients who already have other, perhaps also cancer, a disease more serious character, and prostate cancer so they recedes into the background.
Etiology, risk factors and prevention of prostate cancer
The risk of prostate cancer increases with age. Younger men (under age 45) form only a single case per 100,000 men but men over 80 years already represent 735 cases per 100,000 men. This means that prostate cancer is for older men absolutely normal, and if live to 90 years, tumor will most likely be, although they need not have any effect and they are therefore not know it.
Another risk factor is race. Prostate cancer is nearly twice as common in blacks and there is also a greater tendency towards the occurrence of a younger age.
Of course, the role of genetic factors. The direct relationship of First Instance of prostate cancer patients (ie son sick father) is somewhat higher risk than the general population.
It is believed that diet with high fat and cadmium contained in cigarette smoke can be related to the etiology (etiology = origin of the disease) of this cancer. The most important prevention is, therefore, a healthy lifestyle -Suitable preparation of meat, reduce animal fats, plenty of fruits, vegetables, and therefore vitamins that have an antioxidant effect (vit. C, E) and smoking.
Part of a healthy life should also be a daily exercise and limit excessive alcohol consumption.
This comprehensive prevention, not only do you prevent prostate cancer, but other more serious cancers and other diseases. For example, when you quit smoking and eating fatty foods, very soon by up to much reduce the risk of cardiovascular disease present (ie. Myocardial infarction).
Excess alcohol is harmful to your liver (cirrhosis) and also contributes significantly to the formation of certain tumors (primarily in the throat, mouth and tongue). Appropriate composition of food affect the incidence of tumors of the gastrointestinal tract, nekuřáctvím reduces the incidence of lung cancer, although there is this beneficial effect occurs until a few years after they quit smoking. It will be appreciated that cigarettes contains several tens or even hundreds of carcinogenic substances that can cause tumor growth and also destroy the lining of the vessel wall, which is formed on the substrate atherosclerosis all possible consequences (myocardial infarction, angina, stroke, ischemic disease of the lower limbs, etc.).
Among ambiguous risk factors include sexually transmitted infection and the associated rate of sexual activity. Although testosterone – the male sex hormone – has no direct relationship to tumor formation may contribute to the development of clinical manifestations. It has been found that the incidence of prostate cancer is much lower in eunuchs – those lacking testosterone.
Discussed mandatory prevention is the above-mentioned screening. Could relate far only high-risk groups, which are not yet clearly defined. Investigated would be a blood marker – prostate specific antigen (PSA) – which is characteristic for prostate cancer (secreted into the blood due to prostate cancer cells) in sera of healthy individuals or patients other than prostate cancer find him. We’ll see if, in the future we will see.
In addition, it is recommended that a rectal examination annually in men over forty years.
Symptoms and course of prostate cancer
Early stages of prostate cancer are usually asymptomatic (ie. Without symptoms) and can be received in some cases, during the operation of the urethra for other reasons.
Locally advanced tumors (that are those that have spread to the surroundings – to the bladder, the urethra, but still has not metastasized to distant organs) are the main symptoms of patients, variousproblems with urination. Patients go to the toilet more frequently and more often at night or vice versa may retain urine and urination is difficult for them.
Total Rare is the appearance of blood in the urine and kidney disease (renal insufficiency, respectively. Renal failure).
A sign of very advanced tumors are often the most pain from bone metastatic process, especially back, hips and legs. Metastasis in the bones can sometimes oppress the spinal cord and causing trouble with momentum.
General symptoms as with other cancers are loss of appetite, weight loss, fatigue and generalweakness.
Prostate tumors can be histologically differ among themselves, some grow very slowly and metastasize, so you can have a fairly good prognosis, although it should be cause local problems with urination.
Tumors that grow rapidly and metastasize, by contrast, are unfavorable. Metastases are most often in the bones, as well as in lung, liver and less in adrenal gland and kidney.
Examination of Prostate Cancer
Doctor will examine overall, see if you have lost, what bothers you and if you do not have enlarged lymph nodes to which the cancer has spread and how to have an enlarged prostate. This can be achieved best examination per rectum, which is a bit annoying, but they are even more unpleasant examinations. The positivity of this test does not necessarily mean not necessarily a tumor, so do not be alarmed.
Also, you Palpating abdomen had been increased by an institution, may be a metastasis. He will ask you for blood tests to determine liver and kidney function, may help detect bone involvement, and above all determine the level of PSA – prostate antigen. This may also occur in benign tumors of the prostate (prostatic hyperplasia – a mere enlargement of the prostate, yet it is not cancer, but may be it under certain circumstances later state) and some inflammatory diseases of the prostate.Values above 10 micrograms per liter means usually has a carcinoma.
Additional examinations are imaging methods such as chest X-ray, ultrasound, renal, bone scintigraphy (nuclear medicine department), CT, MRI (magnetic resonance imaging) of the abdomen and pelvis, in some cases the ultrasound through the lower part of the large intestine (rectum) which urges wall prostate or cystoscopy – the introduction of the tube into the bladder.
For more invasive tests can be done to puncture (aspiration) thin needle (for cytological examination of cancer cells) or needle biopsy again through the large intestine or through the pelvic floor. It is then sent for histological examination.
Prostate Cancer Treatment
The method of treatment depends on the nature of the tumor, the patient’s age, his overall condition and other associated serious illness, especially in older age.
Patients in whom the cancer came by chance during other operations in this area and it is only in its early stages, only watching. Locally advanced stage (tumors had already spread to the lymph nodes and into the urethra) are suitable for surgery.
The most serious complications can be incontinence – the inability to contain urine in the bladder associated with enuresis – and impotence. Today, however, there are improved surgical techniques, so these complications often occur.
Another treatment option is radiation therapy (radiotherapy) prostate region or across the pelvis in places of possible metastatic (especially bones). At some clinics are doing and brachytherapy(radiation “from the inside” when using special instruments introduced into the radiator near the prostate rays do not go through the skin, therefore, have less side effects and the therapeutic effect is higher). The results of irradiation of the tumor are comparable with surgical treatment.
The uniqueness of prostate cancer is that in its treatment can also be used hormone therapy (as with breast cancer in women). Previously taken estrogens (female hormones, having prostate cancer cushioning effect, as they inhibit the release of one pituitary hormone – luteinizing hormone – and thanks to its lack decreases testosterone production and reduces the growth of prostate cells), but after they have proved their side-effects, in particular thromboembolic and cardiovascular complications, to use practically ceased.
Another, preferred nowadays, the possibility of hormonal intervention is testicular surgery –removing them (orchiectomy). This operation is very simple surgery. Stop forming testosterone (produced it is the cells of male sex glands – testes), which affects tumor growth.
The analogy is gonadoliberines administration, respectively. their substitutes (goserelin, leuprolide, and others) that have exactly the opposite effect than natural hormones. There is thus also inhibit the production of testosterone essentially as in estrogen administration with the difference that here we no side effects.
Psychologically, this treatment is better accepted than surgical castration, but it is also significantly more expensive. At the beginning of treatment may lead to temporary deterioration, which may occur, for example, intense pain of bone metastases. Prevention of this phenomenon is the concomitant administration of anti-androgen (a substance that has the opposite effect than testosterone) usually week before the planned start of treatment. A significant reduction in levels of testosterone (the same as if it was performed surgical castration) comes after three weeks of treatment.
Other times antiandrogens are administered simultaneously all the time with gonadoliberinovými analogues, then we are talking about combination therapy. The point is that testosterone is partly in the adrenal glands and, therefore, even after the cessation of his work in the testis may be his, although it was lower, levels continue to cause prostate tumor growth.
Advanced stages of the tumor, if it did not take hormonal therapy can be treated withchemotherapy. But it is always secondary to the procedure after they have tried hormone therapy.Served mitoxantrone, docetaxel and vinorelbine. Estramustine is a special kind of drug, whose effects are not yet evident.
Other names: prostate cancer, prostate cancer, prostatic adenocarcinoma, a malignant tumor of the prostate, cancer of the prostate gland
