What is prostate cancer
The tumor develops from the glandular cells of the prostate, most often in the peripheral zone - that part of the gland that is located closer to the rectum and further from the urethra. This explains the absence of early symptoms: the tumor does not compress the urethra for a long time and does not interfere with urination.
Prostate cancer usually grows slowly. A significant proportion of tumors develop so slowly that in older men with underlying medical conditions, active surveillance may be chosen instead of immediate treatment. But there are also aggressive forms that require quick intervention.
It is important to understand the difference between prostate cancer and prostate adenoma. Adenoma is a benign growth of the central part of the gland; it does not degenerate into cancer. But both diseases occur at the same age and can exist simultaneously, which means that the presence of an adenoma does not exclude cancer.
Symptoms: why they are not present at an early stage
At the stage when the tumor is limited to the gland and is completely curable, there are usually no symptoms at all. The appearance of complaints usually means either a concomitant adenoma or the spread of the process.
- Difficulty urinating, weak stream, frequent urges at night - more often associated with concomitant adenoma
- Blood in urine or semen
- Painful ejaculation
- Feeling of incomplete emptying of the bladder
- Pain in the bones of the pelvis, spine, ribs - a sign of bone metastases
- Swelling of the legs due to damage to the lymph nodes
- Weakness, weight loss, anemia with a common process
Risk factors
- Age is a major factor; the incidence increases sharply after 50 years
- Heredity: prostate cancer in a father or brother increases the risk several times
- Mutations of the BRCA1 and BRCA2 genes, family history of breast and ovarian cancer in relatives
- Ethnic characteristics
- Obesity and metabolic syndrome
- Diet with a predominance of animal fats and a lack of vegetables
- Smoking is associated with a more aggressive course
If close relatives have had prostate cancer, regular PSA monitoring begins earlier than usual - the specific age is determined by the urologist.
PSA: what does this analysis mean?
PSA is prostate-specific antigen, a protein produced by prostate tissue. It is specific to the organ, but not to the tumor: it can increase for various reasons.
- Prostate cancer
- Prostate adenoma - the more iron, the higher the baseline level
- Prostatitis and any inflammation
- Recent catheterization, cystoscopy, biopsy
- Prostate massage, cycling, ejaculation the night before the test
- Urinary retention
Therefore, a one-time elevated PSA is not a diagnosis, but a reason for clarification. The urologist assesses the level, adjusted for age and volume of the gland, looks at the dynamics, uses the ratio of free and total PSA, prescribes an MRI, and only then makes a decision on a biopsy.
Diagnostics
- Digital rectal examination of the prostate
- Blood test for total and free PSA
- TRUS - transrectal ultrasound examination
- Multiparametric MRI of the pelvis - allows you to identify suspicious areas and plan a targeted biopsy
- Prostate biopsy with histological examination is the only method to confirm the diagnosis
- Determination of Gleason score and risk group based on biopsy results
- CT scan of the abdominal cavity and pelvis, osteoscintigraphy - to assess the prevalence
- PET-CT - in certain clinical situations
Treatment methods
Tactics are determined by the stage, Gleason aggressiveness of the tumor, PSA level, age and concomitant diseases. The decision is usually made jointly by the urologist, oncologist and radiation therapist.
- Active surveillance - for low-risk tumors in some patients; involves regular PSA monitoring, MRI and repeat biopsies, rather than refusal of treatment
- Radical prostatectomy - removal of the prostate gland; performed openly, laparoscopically or robotically
- External beam radiotherapy
- Brachytherapy - injection of radiation sources directly into the gland
- Hormone therapy - reducing the level of androgens that stimulate tumor growth
- Chemotherapy and modern drugs for a common process
- TUR of the prostate in a palliative mode - to restore urination during obstruction by a tumor
- Cystostomy - when it is impossible to urinate independently
- Drugs to protect bone tissue during bone metastases
Early detection: what a man should do
- После 45–50 лет — ежегодный визит к урологу с определением ПСА и пальцевым исследованием, даже без жалоб
- При раке простаты у отца или брата — начинать раньше и обсуждать с врачом индивидуальный график
- Не сдавать ПСА в течение нескольких дней после эякуляции, езды на велосипеде, массажа простаты, катетеризации или на фоне обострения простатита
- Сохранять результаты анализов: динамика ПСА за годы информативнее одного значения
- При повышенном ПСА не паниковать и не отказываться от дообследования — примерно в большинстве случаев причина оказывается доброкачественной
Prevention
- Maintaining a normal weight and regular physical activity
- Eating a diet with sufficient amounts of vegetables, fruits and fiber, moderation in animal fats
- Quitting smoking
- Monitoring blood pressure and glucose levels
- Regular urological surveillance is the only truly proven early detection measure.
There are no dietary supplements or herbs proven to prevent prostate cancer. The only approach that works is timely examination.
Where to be examined and treated in Tashkent
For a full diagnosis, you need a laboratory with PSA determination, TRUS, access to MRI and the ability to perform a prostate biopsy with histological examination.
In Tashkent, examination for suspected prostate cancer, including prostate biopsy, is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic. Further tactics for a confirmed diagnosis are determined together with the oncology service.
Take all previous PSA results to your appointment, if available: the dynamics of the indicator over several years is often more important than a single value. Clinic contacts and online registration are below.
