The prostate along with the seminal vesicles are accessory seminal glands that produce seminal plasma from which sperm is formed. The prostate is located below the bladder and in front of the rectum.
Its size changes with age, in younger men being the size of a nut and weighing 15-20g, but maybe much larger in older men.
Prostate cancer is characterized by the uncontrolled growth of cells in the prostate gland.
Types
Almost all prostate cancers are adenocarcinomas (95%), developing from the cells of the gland.
Other types of prostate cancer include sarcomas, small cell carcinomas, transient cell carcinomas; these types being rare.
Some types of prostate cancer can grow and spread quickly, but most grow slowly.
In fact, autopsy studies show that many older men (and even some young people) who died from other causes also had prostate cancer that never affected them in their lifetime.
Precancerous disorders of the prostate
Some urologist in Noida suggests that prostate cancer starts as a precancerous condition, although this is not yet known. These conditions are sometimes discovered during a biopsy.
1. Intraepithelial prostatic neoplasia: there are changes in the way the prostate cells look under the microscope; based on the abnormal appearance of the cell types, they are classified as:
A. Low-grade: patterns of prostate cells that appear almost normal;
B. High-grade: abnormal cell models.
2. Proliferative inflammatory atrophy: the cells look smaller than normal, coexisting with signs of inflammation in the area.
Symptoms
Clinical:
- Anamnesis: dysuria, pollakiuria, pelvic pain.
- Clinical examination – local: assessment of the volume of the prostate by rectal cough; general examination.
Laboratory findings:
- Endorectal prostatic ultrasound; urography iv; Blood PSA (men without prostatic neoplasm have PSA <4ng / ml); prostate biopsy; CT; MRI; lymph node biopsy; the degree of prostate cancer.
The degree of cancer is based on how abnormal the cells look under the microscope. The Gleason score assigns degrees based on how much the tumor resembles normal prostate tissue.
If the tumor closely resembles normal prostate tissue, it is assigned grade 1. If the tumor has abnormal cells it has a grade 5. Grades 2 and 4 have characteristics between these two extremes.
Because prostate cancers often have areas of varying degrees, one degree is attributed to the two areas that make up most of cancer.
These two classes are added to get the Gleason score (also called the Gleason amount). Theoretically, the Gleason score can be between 2 and 10, but scores below 6 are rarely used.
Prostate cancer is often divided into 3 groups, based on the Gleason score:
- Cancer with Gleason score 6 or lower is called well-differentiated;
- Cancer with a Gleason score of 7 is called moderately differentiated;
- Cancer with a Gleason score of 8 to 10 is called poorly differentiated.
Risk factors
- Age: Prostate cancer is rarely found in men under the age of 40, the risk of developing it increases rapidly after age 50.
- Ethnicity: Prostate cancer occurs more frequently in African-American men and less frequently in Asian-American and Hispanic / Latino men than in non-Hispanic whites. The reasons for these ethnic-racial differences are unclear.
- Family history: having a father or brother with prostate cancer, the risk of having this disease is greater than double.
- Genetic changes: Inherited mutations of BRCA1 or BRCA2 genes increase the risk of breast or ovarian cancer. Mutations in these genes (especially BRCA2) may also increase the risk of prostatic neoplasm in some men.
Staging
A staging system is a standard way for the cancer care team to describe how far cancer has spread.
The most commonly used prostate cancer staging system is the American Joint Committee on Cancer (TNMS) system, which was most recently updated in January 2018.
The TNM system for prostate cancer is based on 5 key elements:
- The size of the main tumor (category T);
- If it has spread in the nearby lymph nodes (category N);
- If it has spread (metastasized) to other parts of the body (category M);
- PSA level at the time of diagnosis;
- The grade group (based on the Gleason score), which represents a measure of the probability of rapid growth and spread of cancer. This is determined by the results of a prostate biopsy (or surgery).
Treatment
It is important to discuss all options of prostate cancer treatment in Delhi, including goals and possible side effects. Depending on the age, the stage of cancer and its degree, comorbidities, there are the following treatment options: surgical treatment, radiotherapy, hormone therapy, and chemotherapy.
Surveillance
After radiotherapy and/or radical surgery: general clinical examination: urinary signs, rectal cough; PSA; bone scintigraphy;
Rhythm: At 2-6 months, in the first 3 years;
After hormone therapy: clinical supervision: general condition, urinary signs, rectal cough; biological monitoring: PSA, testosterone, alkaline phosphatase; radiological and/or scintigraphic tracking.