The prostate gland is a gland only of men:

  1. Located just below the bladder (an organ that collects urine),
  2. It involves the urethra (the tube that carries urine from the bladder to be expelled).

After the age of 80 most men have prostate cancer, but it is asymptomatic, so the patient does not know if there is this mass.

It usually affects young people or people of 30/40 years.

 

Pathological anatomy of prostate cancer

Prostate cancer develops

  1. Above all on the outside of the gland (75%),
  2. In the transition areas (20%),
  3. In the central area (5%).

It is usually multifocal, that is, it affects the whole prostate and not just a part.

 

Classification of prostate cancer

From the histological point of view, the neoplasia can be classified in:

  1. Unspecified adenocarcinoma (95%),
  2. Adenocarcinoma mucinoso,
  3. Carcinoma ductal,
  4. Neuroendocrine (small cell) carcinoma,
  5. Undifferentiated non-small cell carcinoma
  6. Transitional cell carcinoma,
  7. Carcinossarcoma.

All tissues that make up the prostate can undergo a neoplastic transformation.

 

Causes of prostate cancer

The precise causes are not known.
However, there are some risk factors that can cause cancer.
Age is the most important factor for prostate cancer.

  1. It has been discovered that men aged 65 and older are at a higher risk of having this type of cancer.
  2. Family history is another factor for the formation of prostate cancer.
    A man has a higher risk of contracting the disease if his father suffered from the same illness earlier. The risk increases two to three times on average.
  3. Mortality is highest in black people (about twice). ( Source )

 

Why can milk and dairy products cause prostate cancer?

According to a scientific study published by PubMed , skimmed / low-fat milk increases the risk of aggressive cancer (low-grade or early-stage cancer).
If a person drinks whole milk, it is more likely:

  1. Developing a prostatic carcinoma,
  2. Have a poor evolution.

The ways in which milk can cause prostate cancer are:

1) Low-fat / low-fat milk is the main source of calcium in milk. If a person drinks too much milk, the intracellular concentrations of 1,25-dihydroxycholecalciferol (active form of vitamin D) are reduced and this may stimulate the formation of prostate cancer. Source

2) Another cause may be the content of phytanic acid in dairy products which may increase the expression of the enzyme α-methylacyl CoA racemase.
This substance intervenes in the development of the tumor.

3) According to Newmark et al. the large amount of phosphates contained in dairy products can promote the development of prostate cancer because it increases the concentration of phosphates in the plasma. This excessively increases the concentration of 1,25-dihydroxycholecalciferol.

4) The ability of dairy products to increase concentrations of insulin-like growth factor 1 is another possible explanation for the link between prostate cancer and milk.

5) The link between whole milk and deadly prostate cancer may be due to the effects of milk fat content (especially saturated fat) and other factors (including obesity and excess insulin).
Whole milk has a saturated fat content about 40 times higher than skim milk.

6) Milk and dairy products with a high fat content may increase C – peptideconcentrations . This substance may increase the risk of aggressive prostate cancer ( Source ).

 

How does it manifest itself? Symptoms of prostate cancer

Usually, prostate cancer does not cause symptoms in the early stages.
Signs and symptoms develop as the mass builds up and causes trouble urinating.

Here are some common symptoms:

  • Not being able to urinate
  • Difficulty in starting or maintaining urine flow
  • Need to urinate frequently , especially at night ( Nocturia )
  • Poor urine flow
  • Pain or burning while urinating
  • Urgent need to urinate
  • Urine retention in the bladder

Symptoms of prostate cancer in an advanced stage:

The symptoms of prostate cancer are similar to those of benign prostatic hypertrophy.
In addition, the patient may have both diseases.

 

Evolution of prostate cancer

Prostate carcinoma develops on the outside of the prostate, while adenoma ( benign prostatic hypertrophy ) predominantly affects the central lobes.
The tumor overtakes the prostatic capsule and invades early in the pelvic and pelvic lymph nodes.
Later, it can spread to the bones of:

  1. Skull,
  2. Chest,
  3. Spine .

Here it may cause the formation of osteoblastic bone metastases (with an increase in bone mass).
Typically, dissemination to the lymph nodes precedes the formation of bone metastases within 12-36 months.
Visceral metastases are rare (<10%) and may be:

  1. Liver ,
  2. In the lungs ,
  3. Sometimes brain.

 


Diagnosis of prostate cancer

For the diagnosis the doctor executes:

Rectal exploration – in the case of a tumor, this examination may show an increase in the volume of the gland and a hard nodule.

Transrectal Ultrasonography – If there is a tumor mass, it shows the enlarged prostate and irregularly due to the presence of hypoechoic area (dark gray or black).

In case of cancer, the doctor also recommends the bone scintigraphy to evaluate the presence of metastases in the bones .
This examination is indicated in the case of:

  1. Bone pain ,
  2. High alkaline phosphatase.

With this examination it is possible to control the entire skeleton.

Prostate
biopsy Prostate biopsy is a simple diagnostic test that lasts for 10 to 15 minutes.
The doctor inserts a needle into the prostate through the wall of the rectum to extract the cells to be monitored.
Typically, 12 samples are taken from different parts of the prostate.
This test is performed:

  1. In hospital day,
  2. Under local anesthesia .

Research shows that biopsy may be more effective in the early detection of prostate cancer compared to other traditional tests, such as:

  1. The rectal touch,
  2. A PSA test.

If cancer is confirmed, other tests (including magnetic resonance imaging and computed tomography) are needed to determine the extent of cancer in other parts of the body.

Multiparametric magnetic resonance
The benefits of targeted biopsy have been demonstrated in several studies.
Research shows that the efficacy of multiparametric magnetic resonance imaging, along with PSA, followed by targeted biopsy of the visible lesion on magnetic resonance imaging, is a better alternative to ultrasound guided transrectal biopsy to diagnose prostate cancer.

This allows:

  1. Avoid unnecessary biopsies
  2. Preventing excess diagnostic errors,
  3. Avoiding useless treatment
  4. Reduce failure to diagnose serious tumors.

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495493

 

PSA and prostate cancer

PSA (prostate specific antigen) is an enzyme produced only by the prostate gland.

PSA helps maintain seminal fluid fluidity.
The PSA in the bloodstream can be found:

  1. Free, is an inactive enzyme,
  2. Linked to enzymatic inhibitors, for example Alpha-1 anti-chymotrypsin (trypsin inhibitor) and α 2 -macroglobulin.

The total PSA is the sum of these two.

Reference values
In blood the level is too low, the normal value is less than 4 ng / ml .
If the level of prostate specific antigen is:

  1. Less than 2.0 ng / mL , the likelihood of prostate cancer in asymptomatic men is low.
  2. Greater than 10.0 ng / ml , the chances of cancer are high, in this case the doctor recommends prostate biopsy.

A total PSA between 4.0 and 10.0 ng / mL is considered medium risk.
In this case, the free PSA / total PSA quotient helps to determine the relative risk of prostate cancer.
In prostate cancer, it occurs:

  1. A reduction in the amount of free PSA,
  2. An increase in total PSA.

If free PSA is greater than 15-20% of the total, the cause is usually a benign disease.
Some urologists advise using this data to understand if the biopsy is indicated.
However, a negative prostate biopsy does not exclude cancer.
Up to 20% of men with negative biopsy have prostate cancer.

PSA levels increase in the case of:

  1. Prostate cancer , if the PSA reaches a value of about 50 ng / ml or higher, is always a sign of neoplasia,
  2. Prostatitis , in this case the values ​​may reach about 15 ng / ml
  3. Other diseases of the prostate, for example, in the case of benign prostatic hypertrophy, there may be an increase in PSA up to 15-20 ng / ml.
  4. Sexual intercourse ,
  5. Car trip in previous days,
  6. Elderly , is a parameter that changes with age, after 50 years can have an increase of about 0.8 ng / ml every 10 years.

For this reason, there are many false positives.

Age PSA – limite superior 
(ng / mL)
< 40 < o = 2.0
40-49 < o =2.5
50-59 < o =3.5
60-69 < o =4.5
70-79 < o =6.5
> o =80 < o =7.2

PSA increases already in the early stages of prostate cancer, this is very important because the prostate tumor grows very slowly, so that it can be diagnosed early.

 


Staging of prostate cancer

In staging, the risk of spreading prostate cancer is identified by PSA and Gleason score.
The objectives are:

  1. The choice of appropriate treatment,
  2. Avoid unnecessary exams.
  • Stage I  – (t1): At this stage, it is usually not possible to detect cancer by ultrasonography or a rectal examination because the tumor is very small. It is detected by chance during surgery for another purpose or during a biopsy performed after the detection of high levels of PSA in the blood.
  • Stage II  – (t2): After the tumor grows in size, it can be detected with a digital rectal examination or ultrasound, but the cancer is still confined in the prostate gland.
  • Stage III – (t3): Cancer cells spread from the original area and invade the seminal vesicles.
  • Stage IV – (t4 or Terminal phase): the cancer leaves the seminal vesicles and invades the lymph nodes . The size and number of tumors increase and cancer spreads to neighboring organs, such as the bladder and rectum.
    In stage IV prostate cancer, metastases are formed particularly in bones and other parts of the body, such as the lungs and liver .

The Gleason classification system  involves the use of the Gleason scale along with other parameters to assess aggressiveness and how much the cancer has spread.
During a biopsy, a cylindrical sample of prostatic tissue is removed through the rectum.
We examined this specimen collected during surgery under a microscope.

 

Degree of prostate cancer

With prostate cancer, the prognosis also depends on histological characteristics (such as cells appear under a microscope).
This is called the degree of cancer.
In prostate cancer, the Gleason scale is used .

  1. Gleason score between 2 and 6 is a low grade cancer. It is likely that growth is very slow.
  2. Gleason 7 value is an average degree, so the tumor grows at a medium rate.
  3. Gleason 8-10 level is a high-grade tumor that threatens to grow faster.

The value of the scale is indicated by two numbers, for example 3 + 4 = 7 or 3 + 3 = 6
Based on the tissue samples examined, the sum of the lowest value obtained from the analysis plus the highest value is made.
If the best sample has a value of 3, while the worst has a value of 4, the score on the scale is 3 + 4 = 7.

 

Treatment for prostate cancer

When prostate cancer is found, doctors may recommend:

  • Prostatectomy ( surgical removal of the prostate )
  • Radiation therapy (radiation therapy)
  • Watchful waiting (cancer monitoring)
  • Hormone therapy
  • Other types of treatment.

To perform a prostatectomy it is necessary to locate the cancer in the early stages.

 


Does Prostate Cancer Cure? Life expectancy in stage IV

Life expectancy in patients who have cancer depends on the stage of cancer and the treatment that the patient does.
Early diagnosis of cancer and rapid care help increase the chances of cure, or the remission of the tumor.

When cancer forms metastases, it is difficult:

  1. Remove the pasta,
  2. Control tumor growth.

Therefore the survival rate and life expectancy for stage IV prostate cancer (late stage) can not be favorable.

Life expectancy table with prostate cancer

Years after diagnosis Survival
5 (localized tumor) Close to 100%
10 (localized tumor) 98 %
Metastatic carcinoma 30 %

FonteAmerican Society of Clinical Oncology

 

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