Prostate cancer is diagnosed when there is a proliferation of glandular cells in the prostate gland, which is unique to men. Due to its significant contribution to male sexual function, the prostate is referred to as the “heart” of the male reproductive system – it is responsible for the production of androgens (male sex hormones) and the fluid portion of semen necessary for transporting and nourishing sperm during fertilization.
Like breast, ovarian, and uterine cancers in women, prostate carcinoma is the most common malignant neoplasm in men. Age is a determining risk factor for prostate cancer, as it is detected in only one out of 10,000 men after the age of 35, in every hundred men after the age of 60, and in every eighth man over the age of 75. In light of this situation, WHO experts recommend that all men over the age of 50 should undergo all necessary tests to prevent the exacerbation of the disease.
What is Prostate Cancer?
Prostate cancer is a malignant tumor that develops from the cells of the prostate gland.
Anatomy of the prostate. The prostate is an endocrine gland that is located in the pelvic area of men, with an average size of 3-4 cm. Due to its location around the urethra, an increase in the size of the prostate caused by a cancerous tumor can cause disruptions in urinary function.
The prostate gland is enclosed in a capsule made of connective tissue and contains elastic partitions that separate the prostate glands. It is divided into three parts – right, middle, and left. The prostate gland produces prostatic fluid, which is released during smooth muscle contractions. The prostate gland participates in the production of sperm, increases their activity and viability, and is responsible for the quality and ejaculation of semen. It plays a crucial role in male sexual function.
Functions of the prostate. To better understand the nature of the disease, it is necessary to understand the main functions of the prostate gland. The primary function of the prostate gland is to produce a certain portion of seminal fluid. According to experts, this amounts to more than a third of the total volume. It also plays a role in the process of ejaculation.
Another key function of the prostate gland is its direct relationship to a man’s ability to hold his urine. This is why this gland is of immense importance for men’s health.
How Long Do People Live with Prostate Cancer?
In this, as with any other oncology-related case, early detection is crucial. However, the prognosis is often unfavorable due to late detection and the emergence of a significant number of metastases at an early stage. About 90% of prostate cancer cases are detected at the third or fourth stage.
Therefore, answering the question of how long people can live with prostate cancer depends on the stage at which treatment was initiated. Radical prostatectomy, which was performed in the early stages of cancer in patients under 70, guarantees 10 or even 15 years of survival. Overall, after timely treatment, five-year survival rates for the first or second stage are around 85%, for the third stage, it is 50%, and for the fourth stage, it is no more than 20%.
Prostate cancer metastases can spread to distant areas, due to the spread of cancer cells through the blood and lymphatic vessels. Pain in the pelvis and swelling of the legs in the ankle or foot area with prostate cancer may indicate an increase in the number of metastases and that the cancer has become aggressive.
Causes of Prostate Cancer
Modern research links the causes of prostate cancer with chronic diseases and inflammatory processes that affect the prostate and cause pathological changes in its tissues.
Among the common causes of prostate cancer are:
Hormonal imbalance – since the prostate tumor is hormone-dependent, its onset and growth can be triggered by an increase in the level of dihydrotestosterone and androstenedione (male sex hormones).
Prostatitis – inflammation of the prostate gland, which leads to impaired blood circulation and oxygen exchange in its tissues;
Prostate adenoma – benign neoplasms that contribute to the appearance of cells that do not normally appear in the prostate gland. They are more prone to mutation and malignancy, which triggers the onset of the oncological process;
Bacterial damage to prostate cells and autoimmune processes damage the genetic apparatus of cells, contributing to their uncontrolled division and tumor formation.
Precancerous conditions, such as atypical adenosis and prostate hyperplasia, lead to the formation of a cancerous tumor. Atypical adenosis appears as nodular formations in the center of the gland, whose cells divide rapidly and can mutate into malignant cells under the influence of mutagenic factors. Hyperplasia is the active focal division of cells with subsequent degeneration or malignancy; the risk of developing cancerous tumors is significantly increased in this case.
Risk factors for developing prostate cancer are associated with genetic predisposition and lifestyle. Thus, increased animal fat content in the diet, the entry of carcinogenic substances into the body in tobacco smoke and alcoholic beverages, harmful conditions in the textile, chemical industries, welding workshops, and printing houses can contribute to the development of oncogenic formations. Stagnation of prostatic juice due to a sedentary lifestyle and irregular sexual activity can be a predisposing factor for the development of pathology.
Other risk factors include venereal diseases, old age, retroviral and cytomegalovirus infections, and a suppressed immune system.
Prostate Cancer Symptoms
In the early stages of prostate cancer, there are typically no symptoms, so the presence of cancer can only be detected through specific testing, such as a blood test for prostate-specific antigen (PSA).
The first symptoms of prostate cancer may include difficulty urinating, sexual dysfunction, and the presence of blood in the urine or semen. Patients may associate these symptoms with other conditions, and the appearance of any of them does not necessarily indicate the presence of cancer, but they may be a symptom.
Prostate cancer usually manifests itself when the tumor reaches significant size and puts pressure on the walls of the bladder. As a result, a man may experience frequent urges to urinate, up to 15-20 times a day and more than 2 times at night. Urination is slow, the stream is interrupted, and there is a feeling of bladder fullness. The process becomes painfully difficult, with burning sensations and dribbling. The patient may need to strain their abdominal muscles, as the tone of the bladder is weakened, and in some cases, a catheter may need to be inserted.
- Urinary incontinence and pain in the groin area may also be symptoms of prostate cancer.
- Swelling of the lower limbs, genitals, and scrotum caused by metastases in the lymph nodes.
- Kidney stones and lower back pain – the ureter and renal pelvis become enlarged due to the backward flow of urine caused by the cancerous tumor.
- If the cancerous growth damages the blood vessels of the urethra or seminal vesicles, blood may be present in the urine or semen.
- Impotence can occur when the cancer damages nerve endings.
- Painful dry cough indicates the spread of cancer to the lungs.
- Jaundice and heaviness in the right side are symptoms of secondary tumors in the liver.
- If a person experiences painful sensations during defecation, the tumor may have affected the intestine.
- In later stages of prostate cancer, bone pain may occur when the tumor has spread to bone tissue.
The intensity of all of these symptoms may increase over several years, and they may appear gradually. Any of the above signs is a reason to see a doctor and undergo an examination with a urologist.
Prostate cancer stages
It is important to distinguish between the concepts of stage and grade of prostate cancer. The grade of the disease is the indicator of the clinical type, determining the degree of morphological variations in the cells of the prostate gland. That is, a cell type examination, such as a biopsy, is required. It is this that makes it possible to diagnose the disease literally at the first stage of its formation.
The stage of prostate cancer, on the other hand, determines the increase in the size of the tumor formation and further growth of the lesion focus. Identifying the stage is no less important than the degree of the disease, as it makes it possible to accurately determine what is happening with the tumor and whether there are metastases.
Stages of prostate cancer
First stage
In the first stage, the tumor cannot be felt, and any modifications in the structure of the gland and its individual cells can only be determined through microscopic examination.
Second stage
In the second stage, the growing formation is visible on ultrasound, but its location is still limited only to the capsule of the gland and has no other foci of spread.
Third stage
In the third stage, there is an invasive spread of the tumor beyond the boundaries of the prostate, which is not directly related to the gland or located near it.
Fourth stage
In addition to significant growth of the tumor focus, metastases in the fourth stage of prostate cancer can spread to the liver, lymph nodes, lungs, and skeletal bone tissue.
Diagnosis
Even with minor problems with urination, it is desirable to consult a specialist in urology as early as possible. This may not only be prostate cancer, but also adenoma or inflammation in the prostate area.
The primary method of diagnosis is a digital rectal examination. This method is the simplest and makes it possible to suspect cancer. However, if the formation is already palpable, this indicates that the disease is at one of the final stages. Therefore, even if the formation cannot be palpated, the patient is prescribed additional research: a blood test for prostate-specific antigen (PSA).
To make a more accurate diagnosis, a man may also be prescribed a prostate ultrasound, computed tomography, X-ray, and radioisotope imaging.
The final diagnosis can be made after a biopsy of the prostate – a specific needle is used through the perineum or rectum to take a small part of the gland for examination.
Prostate cancer treatment
The type of treatment for prostate cancer depends on the patient’s age, health status, stage of cancer, and his preferences. Older men with lung, heart, or vascular diseases and severe chronic conditions are recommended to follow a wait-and-see approach since surgery may cause more harm to the body than the cancer itself. In this case, ultrasound of the prostate and PSA analysis should be done every six months to prevent tumor growth.
Surgical treatment
Surgical treatment of prostate cancer is performed by radical prostatectomy – under general anesthesia or epidural anesthesia, the patient’s prostate gland and surrounding tissues are removed if the tumor has spread beyond the prostate. Sometimes, removal of lymph nodes and part of the tumor in nearby organs is required, and chemotherapy is additionally performed, resulting in a less favorable prognosis for recovery. Patients whose tumors have not grown beyond the connective tissue capsule have almost a hundred percent chance of recovery.
The operation lasts from 2 to 4 hours, and it is prescribed for patients under 65 due to possible risks and complications. The incision is made in the groin area or abdominal area. Modern surgical treatment of prostate cancer is carried out using the “Da Vinci” robot, controlled by a doctor. The operation is performed without incisions through small punctures, which speeds up the tissue healing process and reduces the number of postoperative complications, minimizing the risk of impotence and other unpleasant consequences.
Orchiectomy
Another way to combat prostate cancer is orchiectomy – the removal of one or both testicles.
This surgical intervention leads to the cessation of endogenous testosterone production and a decrease in the rate of growth and further development of the malignant formation. The procedure should be performed only based on the diagnosis after a prostate biopsy.
The intervention can be performed not only on an outpatient basis, under local anesthesia but also under general anesthesia. During the operation, such a technique is applied, in which visual changes remain unnoticed (reservation of the cord, insertion of artificial testicles).
Orchiectomy makes sense in the following cases:
- The process of treatment with hormonal drugs is impossible due to satellite diseases that are in no way related to the malignant formation.
- When it is impossible to take prescribed hormonal medications or injections every day.
Chemotherapy
Chemotherapy involves the use of drugs containing toxins that affect rapidly dividing cells. Since cancer cells grow and divide rapidly, chemotherapy selectively targets their membranes and nuclei, causing destruction. This treatment is prescribed for the third and fourth stages of cancer when the tumor has metastasized, as the toxic substances are carried throughout the body, destroying abnormal cells. On earlier stages of prostate cancer, chemotherapy is not recommended, as it has many side effects, including nausea, hair loss, rapid fatigue, and weakness.
Radiation therapy
Radiation therapy involves the use of X-ray radiation to target cancer cells, damaging their DNA and disrupting their ability to divide. It is carried out using a linear accelerator, which delivers neutron, gamma, and beta radiation to the area of the tumor and, in some cases, the lymph nodes, to stop its growth and the spread of cancer cells throughout the body.
External beam radiation therapy is administered in a course of five days per week for two months. The procedure itself is painless and takes only fifteen minutes, after which the person is recommended to rest for two hours. It is only prescribed for large tumors with metastases, as radiation can affect healthy cells, causing a number of side effects.
Brachytherapy has fewer side effects due to its selective action – radioactive substances (iridium, iodine) are inserted into the prostate and act directly on the tumor, practically not affecting healthy cells and tissues. This increases the effectiveness of the procedure and minimizes side effects. Needles with the radioactive substance are inserted under anesthesia and are removed either immediately or within a day.
HIFU therapy is another modern radiation therapy method that is used to selectively destroy the tumor without damaging healthy tissues. It involves the use of ultrasound to target the cancerous growth, which destroys the structural proteins of the cancer cells.
Brachytherapy
An alternative method of radiation exposure to the presented gland in the initial stages of the disease formation is brachytherapy. The essence of the method is that iodine-coated pellets with high radioactivity are injected into the gland under ultrasound control. This creates an increased ratio of radiation in the area of the formation, while the tissues located nearby are practically unaffected.
The procedure of inserting the capsules takes no more than an hour and is carried out on an outpatient basis. This is precisely what distinguishes it favorably from other types of radiation treatment.
Prognosis
Prostate Cancer Prognosis The prognosis for patients with prostate cancer depends on the stage at which treatment was conducted. Specialists use the concept of “five-year survival,” which allows them to evaluate the success of treatment. For patients who sought medical attention at the first stage of cancer, the five-year survival rate is over 90% – meaning that more than 90% of people live 5 years or longer after treatment. For the second stage of cancer, this indicator is 80%, for the third and fourth stages, it is 40% and 15%, respectively.
If a patient seeks medical help at the first stage of the disease, then as a result of therapy, they can completely restore control over the function of the bladder, sexual function, remove the tumor, and regain their ability to work. After successful treatment, negative manifestations of prostate cancer are eliminated, and the disease does not reduce life expectancy.
The success of treatment in the second and third stages depends largely on the doctor’s professionalism and the patient’s health, age, and overall well-being. Therapy takes more time, and treatment is more complex, but the chances of success are quite high – the life expectancy of most patients after treatment is 15 years or more.
The prognosis for the fourth stage of prostate cancer is unfavorable – few patients manage to live more than seven years after long-term combined therapy.
Prevention
Medicine cannot offer a hundred percent effective way to prevent cancer, but by following general recommendations for maintaining a healthy lifestyle, the risk of developing cancer can be minimized.
Regular sleep is a necessary condition for maintaining the health of the whole body. During sleep, melatonin is produced, which prevents the development and growth of tumors.
A healthy diet includes more fruits and vegetables, especially cruciferous, legumes, garlic, onions, citrus, leafy green, and yellow vegetables. Consume lean meats, fish, and seafood, prefer plant-based fats and grains that are rich in dietary fiber, easily digestible protein, vitamin E, and phytosterols.
Avoid carcinogens that can cause the development of tumors. Carcinogens can enter the body through food, polluted air or water. Tobacco smoke, products with aromatic and flavor additives contain carcinogenic substances, and their concentration is high in chemical industry enterprises.
Regular preventive check-ups with a specialist are recommended for men over 50 years old to screen for prostate cancer every two years and once a year for men with adenoma, prostatitis, and other pathologies. Screening includes prostate ultrasound and blood tests for prostate-specific antigen.
Physical activity helps to avoid stagnation in the prostate, strengthens the walls of blood vessels, and is a prevention of atherosclerosis and cardiovascular diseases. Morning exercise, an evening jog, or a 40-minute walk neutralizes the harm caused by a sedentary and inactive lifestyle.
Regular sexual activity prevents stagnation and inflammatory processes in the prostate, enhances pelvic blood circulation and metabolic processes in prostate tissues.