Prostate cancer

Prostate cancer. The frequency of occurrence is one of the first places for men. The most commonly diagnosed is over the age of 60 years. It is an adenocarcinoma of various differentiation. The tumor secretes mucin-containing sialic acid and contains acidic phosphatazuium (-glucuronidase.) The differential diagnosis is performed with adenoma of the prostate, the adenoma has clear contours, a slight density, is characterized by a slow growth.The cancer manifests itself by the development of a dense node infiltrating the adjacent gland tissues, the base of the bladder, Pelvis prostate cancer matastases are found in regional pelvic and retroperitoneal lymph nodes.Distant metastases are determined in the bones, with the primary damage to the pelvic bones.Medastasis is of the osteoblastic type or in combination with osteolytic.Perhaps the appearance of metastases in the lungs and other organs In the early stages of prostate cancer is only locally manifested, metastases can not be detected.

Clinical signs are nonspecific. There are frequent urge to urinate, especially at night; Difficulties in starting urination, blood in the urine, pain, etc.

Diagnosis is established by biopsy. However, the diagnosis can be made on the basis of palpation of the gland with rectal examination and ultrasound tomography.

1. Stage: there are no clinical manifestations, the diagnosis is established accidentally during morphological examination of the removed adenomas.
2. Stage: disturbances of urination and other signs of the disease there; When rectal examination, a dense knot is found in the gland; The diagnosis is made with a biopsy; At this stage, metastases are rare.
3. Stage: frequent urination, hematuria, other symptoms; The tumor germinates the seminal vesicles, the base of the bladder and the lateral walls of the pelvis; A biopsy confirms the diagnosis; In half the cases find metastases in the pelvic and retroperitoneal lymph nodes,
4. Stage: more often a large tumor with severe dysuric disorders; The main characteristic feature of this stage is the presence of metastases in bones and / or other organs. In serum, a high level of acid phosphatase is found in 70% of cases.

Treatment. Cure is possible only with small localized tumors. In other cases, modern treatment provides a reduction or removal of clinical signs of the disease, a temporary objective effect in 60-80% of patients; 5-year survival at the I-II stage is 85%, Stage III -50%, IV stage - 20%. This dictates the need for early detection of the disease, which is promoted by the prophylactic (once a year) rectal examination, which must be performed for every man over 40 years of age. When a tumor is localized, radical prostatectomy is used. When the first stage is detected in a remote adenoma, additional prostatectomy is usually not necessary. Additional hormonal treatment at the I-II stage is not prescribed. At the III-IV stage, orchiectomy is recommended in combination with hormone therapy with or without estrogens. The use of extrogens (synestrol, phosphostrol, diethylstilbestrol, chlortrianizen, etc.), which do not increase survival and at the same time (with high doses and prolonged use) cause an increase in the incidence of cardiovascular complications (cerebral stroke, myocardial infarction, thromboembolism, insufficiency Blood circulation), it is advisable only for pronounced disorders of urination, intense pain in the bones, etc. Diethylstilbestrol is recommended for long-term use at 5 mg / day (chlortrianizin 48-72 mg / day) sometimes in combination with prednisolone -10 mg / day. Palliative care has radiation therapy on the prostate gland, as well as on the areas of metastatic bone damage with a sharp pain syndrome and the threat of compression. As a method of endocrine treatment, pituitary irradiation is used to turn off its function.