Prostate cancer is a malignant neoplasm that arises from the cells of the prostate, the gland responsible for sperm production and secretion of prostatic fluid. This disease is one of the most common types of cancer among men, especially in the age group over 50 years. Prostate cancer can manifest itself in a variety of clinical symptoms and, as a rule, is asymptomatic in the early stages, which complicates its early diagnosis. Histologically, various forms of prostate cancer are distinguished, from well-differentiated to less differentiated, which affects the prognosis of the course of the disease and the choice of therapy. The main goal of modern prostate cancer treatment is not only to increase the patient's life expectancy, but also to improve its quality.
History of the disease and interesting historical facts
Prostate cancer has been known to mankind for many centuries, but its study and understanding of the mechanism of development began only in the 20th century. The first mentions of prostate diseases are found in the works of doctors of Ancient Egypt, Greece and Rome. In 1650, the English anatomist William Harvey described the anatomical structure of the prostate, which opened up new horizons for the study of diseases of this gland. At the beginning of the 20th century, the first systematic studies of prostate cancer began, and in 1941, the famous urologist Charles Harding first proposed castration therapy as a treatment method. Since then, new approaches to diagnosis and treatment have been discovered, including the introduction of biopsy methods and various forms of surgical intervention.
Epidemiology
Prostate cancer is a significant public health problem at the global level. According to statistics, it is the second most common malignant tumor in men worldwide. According to the World Health Organization, about 1.4 million new cases of prostate cancer are registered annually. In Russia, the incidence rate is also high, with an increase in the number of cases detected since 2019, which may be due to both improved diagnostic methods and a real increase in cases. The incidence rate increases significantly with age, peaking in the 70-80 age group, indicating the need for regular health monitoring in men over 50.
Genetic predisposition to this disease
Genetic predisposition plays a significant role in the development of prostate cancer. A family history of the disease indicates an increased risk, especially if close relatives have suffered from this type of cancer. Research shows that certain genes, such as BRCA1 and BRCA2, as well as the HPC1 gene, are associated with an increased risk of prostate cancer. Mutations in these genes can lead to disruption of cell cycle control, which leads to uncontrolled cell growth. According to a study published in the Journal of Urology, men with BRCA2 mutations have a two- to three-fold higher risk of developing prostate cancer compared to men without such mutations.
Risk factors for the development of this disease
There are several known risk factors that contribute to the development of prostate cancer:
- Age: The likelihood of developing the disease increases significantly with age, especially after 50 years.
- Racial and ethnic characteristics: Studies have shown that black men have a higher risk of developing the disease, while Asian men have a lower risk.
- Dietary habits: High fat intake and a lack of vegetables and fruits may increase the risk.
- Obesity: Being overweight is associated with more aggressive forms of cancer.
- Chronic inflammatory diseases of the prostate. For example, chronic prostatitis may be associated with an increased risk.
Diagnosis of this disease
Prostate cancer diagnosis is based on clinical findings, laboratory and radiological examinations. The main symptoms may include:
- Problems with urination (difficulty, frequent urination late at night).
- Pain in the pelvic or lower back area.
- Blood in urine or semen.
- General symptoms such as fatigue or weight loss.
For laboratory diagnosis, the main marker is the level of prostate-specific antigen (PSA) in the blood serum. PSA levels are increased in prostate cancer, but may also be elevated in benign hyperplasia. Radiological examinations such as transrectal ultrasound (TRUS) and MRI are used to visualize the tumor and stage the disease. Prostate biopsy is usually performed when PSA levels are elevated to confirm the diagnosis. Differential diagnosis is necessary to exclude other diseases such as benign prostatic hyperplasia and prostatitis.
Treatment
Treatment for prostate cancer may involve several approaches:
- Observation. In cases of low aggressiveness of cancer, active observation is possible.
- Pharmacological treatment: Hormonal therapy is used to suppress testosterone levels, which can slow tumor growth.
- Surgical treatment: Radical prostatectomy is the main surgical procedure for cancer and involves removing the prostate and surrounding tissue.
- Radiation therapy. It can be either external or internal (brachytherapy) and is used to destroy cancer cells.
- Chemotherapy: Used primarily in advanced stages to slow the progression of the disease.
List of medications used to treat this disease
Medicines used to treat prostate cancer include:
- Bicalutamide (Casodex) is an antiandrogen drug.
- Leuprorelin (Lupron) is a gonadotropin-releasing hormone agonist used for hormonal therapy.
- Docetaxel (Taxotere) is a first-line chemotherapy agent.
- Abiretron (Zitolar) - used to treat metastatic prostate cancer.
- Enzalutamide (Yander) is an antiandrogen for the treatment of metastatic cancer.
Disease monitoring
Monitoring consists of regular PSA testing, clinical examination, and radiological methods. Prognosis depends on the stage of the disease, histological aggressiveness, and the patient's condition. Possible complications include local relapses, metastases to other organs, and pain shock syndrome.
Age-related features of the disease
Prostate cancer often has different characteristics depending on age. In young men (under 60 years old), the disease may be more aggressive, while in older patients, slowly progressive forms are often detected. It is also important to consider that men over 70 years old often have concomitant pathology, which can complicate the management of the disease and the choice of therapy.
Questions and Answers
- What are the main symptoms of prostate cancer? The main symptoms include difficulty and frequency of urination, pelvic pain, blood in the urine or semen, and general symptoms such as fatigue and weight loss.
- What are the risk factors associated with prostate cancer? Major risk factors include age, race, physical activity, diet, and a family history of prostate cancer.
- How is prostate cancer diagnosed? Diagnosis includes clinical symptoms, prostate-specific antigen (PSA) level, transrectal ultrasound, biopsy and differential diagnosis.
- What are the treatments for prostate cancer? Treatment may include observation, hormonal therapy, surgery, radiation therapy, and chemotherapy.
- How often should PSA levels be monitored after treatment? PSA levels are monitored at least once every 3-6 months during the first year after treatment, and then at the discretion of the physician.
