prostate cancer

Prostate cancer is a malignant change in the prostate gland or prostate.

In Germany, 48,000 men fall ill every year, and thus it is the most common type of malignant tumor in men. Prostate cancer still kills 11,000 men every year. This malignant tumor is a typical cancer of the elderly.

About 90% of all tumors form after 60 years of age. Based on the forecasts of increasing life expectancy, it can be assumed that the number of those affected by this disease will increase.

The frequency of new cases of the disease (incident) is very different in different regions of the world. In general, the disease is less common in developing countries with shorter life expectancy, but there are other trends around the world. Thus, in the United States, the incidence of the disease is 120 cases per 100,000 men per year, and this figure is 10 times higher than in Singapore or Japan.

Differences are also observed in Europe: the risk of the disease for men in the Scandinavian countries, for example, is twice as high as in the countries of southern Europe.

Causes

In recent decades, scientific observations have analyzed a number of possible risk factors for prostate cancer. The following are recognized as real risk factors:

• Ethnic predisposition: the risk of disease for people of Asian descent in the United States, however, increases significantly, but the incidence still lags far behind those among Native Americans.
• family predisposition: men in whose family there were cases of PSA disease in direct relatives (father, grandfather, brother), according to statistics, are at a double, or even 5 times higher risk of getting sick. In this case, it is necessary to start preventive examinations earlier than it is indicated for men without this risk factor.
• Overweight: Evidence is mounting that being overweight leads to low PSA (Prostate Specific Antigen). Therefore, overweight men are not the first to be screened for prostate cancer, but it is these men who often suffer from more aggressive forms of cancer.
• Nutrition: The rise in prostate cancer in people from low-risk countries moving to high-incidence countries suggests that lifestyle plays a role. Nutrition is an important factor in this regard.
• A further risk factor is cadmium toxicosis (chronic cadmium toxicity, usually at work) has been largely eliminated through protective measures.
• Other putative risk factors, sexual activity and smoking, do not play a significant role.

Prevention

Nutrition
Important factors in the prevention of prostate cancer are nutrition and the intake of special medications. With a high degree of probability, it is assumed that if the basis of nutrition is fruits and vegetables (Far Eastern, Mediterranean), then their positive effect on the prevention of prostate cancer and its spread is undoubtedly, however, it is impossible to specifically determine which components of this nutritional basis are responsible for this effect. .

Substances with a high degree of probability of a preventive (preventive) effect on the growth of prostate tumors are called lycopenes (contained in high concentrations, for example, in tomatoes), although recent studies have found some contradictions regarding this observation. Selenium and vitamin E, at least for smokers, are other substances with the ability to protect against prostate cancer. But the final conclusions are expected at the end of the scientific observations that are still ongoing in 2008.

In contrast to this opinion, there is an assumption that saturated fatty acids and increased consumption of dairy products intensify the occurrence and growth of prostate tumors.

Significant dependence on smoking or alcohol consumption has not been recorded.

Medicines
In the so-called Prostate Cancer Prevention Trial (PCPT), prospective clinical trials investigated the preventive effect of the enzyme 5a-reductase Finasteride (Finasterid (Proscar)) with an inhibitory effect on 18882 healthy men over 55 years of age, who were divided into 2 groups.

At the same time, there were 24.1 % fewer cases of prostate cancer in the group treated with this drug. The point of criticism was the discovery among these same treated patients of significantly more aggressive forms of cancerous tumors.

Results of PCPT - studies were subjected to thorough checks in subsequent years. At the same time, it turned out that the observed difference is most likely a consequence of a decrease in the volume of the prostate under the influence of the drug Finasteride. Thus, Finasteride is the first substance with respect to which it has been proven that it has a preventive (warning) effect in prostate cancer.

Other medicines that may have a preventive effect in prostate cancer are non-hormonal anti-inflammatory drugs (NSAIDs), such as, for example, aspirin or so-called cyclooxygenase enzyme inhibitors (depressants, for example, Celecoxib), however, they cause side effects, so they application may cause problems.

Symptoms

Changes in urination.

Diagnostics

The definition of prostate specific antigen (PSA) has its negative sides: • Not every elevated PSA test indicates a prostate tumor. On the other hand, the report of an elevated PSA test poses a serious psychological problem for all affected individuals. • For men who have an elevated PSA test, further diagnostic measures automatically follow (taking a sample of prostate tissue), but since the tumor is not detected in all cases, then therefore, unnecessary diagnostics are carried out. • Since today it is possible to detect low-aggressive tumors (the so-called "cancer of pets" in Prof. Haketal's terminology), there is, in principle, the possibility of overtreatment. However, the proportion of such harmless tumors known in Germany is very small. • Despite numerous data, it has not been proven that curing prostate cancer increases life expectancy of the entire population. specific patient. Determination of free PSA in the blood serum or the so-called PSA 3 gene of prostate cells in the urine can help in this direction. In case of an increased PSA analysis or a suspicious digital examination, tissue samples are taken (biopsy with a special needle). At the same time, at least 6 samples are taken during the accompanying ultrasonic control. Many urologists are guided by the so-called "Viennese nomogram" when determining the number of samples taken, in which the number of samples depends on the age of the patient and the volume of the prostate gland. In this way, not only excessive, but also insufficient diagnostics can be avoided. A particular diagnostic problem is presented by patients in whom the tumor is not found in the analysis of tissues (negative analysis), but there is a continued increase in the PSA analysis. Unlike most Western countries, PSA determinations in Germany are not paid for by the national health insurance companies. This is due to the fact that the increase in life expectancy with the use of PSA analysis has not been conclusively confirmed. As a criticism, it is worth noting that many other surveys are paid without problems, although the statistics for them are not nearly as reliable as in the case of PSA determination. Payment for the consultation and determination of the analysis is made in accordance with the established prices for doctors (GOÄ = price list for medical services). The price is in the range of 20 - 25 euros. Screening (from the English. Screening - screening) means systematic examinations of people without symptoms, which are selected according to certain rules, parameters. Prostate cancer, based on its parameters, is generally well suited for screening. Although it has not yet been conclusively established whether screening, for example, in men aged 50 to 75 years, increases the life expectancy of the examined. And yet, there is ample evidence that screening does indeed prolong life. Experts are looking forward to the results of scientific screening studies performed in Europe (European Randomized Study of Screening for Prostate Cancer [ERSPC]) and North America (Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial) . In contrast, there is an opinion that the only truly reliable screening tool is the definition of PSA analysis. The so-called "opportunistic screening" is currently the current form of preventive screening in Germany. In men who, for various reasons (changes in urination, reading special literature, information from the Internet, diseases from relatives and friends) are interested in early recognition of prostate cancer, PSA analysis and rectal finger examination are performed. In certain cases, a transrectal (through the rectum) ultrasound examination (transrectal echography) is performed. Diagnosis of the degree of spread of the tumor throughout the body. Of decisive importance for determining the strategy of therapy is the question of how far the tumor has progressed. And in this context, an important role is assigned to the diagnosis of the spread of the tumor: using the information at hand, it is necessary to determine whether the tumor is limited to the prostate, or metastases have already formed. A cure is possible only if the cancer has not spread beyond the prostate. The so-called classification of the stage of the disease occurs according to the TNM system. T (Tumor - tumor) means a primary tumor in the prostate, N (Noduli) regional lymph nodes, M - far spread metastases.

The determination of the T-stage is still carried out by rectal digital examination. But after it became clear over time that the assessment of the degree of tumor spread as a result of a digital examination is many times lower than the real state, nomograms began to be used. The so-called Kattan nomogram, based on the results of a digital examination, the PSA level and the result of a biopsy according to the Gleason classification, calculates the degree of probability that the tumor is limited to the prostate.
One hundred percent definition with accurate diagnosis (transrectal magnetic resonance imaging, positron emission tomography PET with choline) has not yet been developed. Therefore, the use of the described diagnostic methods remains a phenomenon of individual cases.

The Gleason classification gives a definition of the degree of aggressiveness of the tumor, it is the result of a microscopic examination of tissues (biopsy) by a pathologist. The scale of this classification has coefficients from 2 to 10. The higher the coefficient, the more aggressive the stage of the tumor.
If the degree of probability of damage to the lymph nodes and the presence of distant metastases is small, then sometimes there is no need for diagnostics at the N and M stages.
Despite all the successes of modern methods of imaging organs (ultrasound, computed tomography (CT), magnetic resonance imaging), it is impossible to determine with complete certainty the presence of lymph node metastases. Removal of lymph nodes, either as part of a radical removal of the prostate gland, or as a separate operation before irradiation, is today the "gold standard", that is, the optimal type of treatment. Some medical centers offer a method of removing lymph nodes, in which lymph nodes related to the prostate are radioactively marked. In this way, the so-called sentinel lymph nodes can be identified.
Far-spread metastases are manifested mainly in bone tissues. Therefore, bone scintigraphy becomes mandatory if the PSA level exceeds 10 mg / ml or a very aggressive tumor with a high Gleason ratio is detected. X-ray of the lungs and computed tomography (CT) or ultrasound of the liver completes the diagnosis of stage M.