Prostate cancer refers to an epithelial malignant tumor that occurs in the prostate. In 2004, WHO's "Pathology and Genetics of Tumors of the Urinary System and Male Reproductive Organs" listed the pathological types of prostate cancer as adenocarcinoma (acinar adenocarcinoma), ductal adenocarcinoma, urothelial carcinoma, squamous cell carcinoma, and adenosquamous carcinoma. Among them, prostate adenocarcinoma accounts for more than 95%, so what we usually call prostate cancer refers to prostate adenocarcinoma.
The occurrence of prostate cancer is related to genetic factors. If the relative risk of no prostate cancer in the family is 1 and the absolute risk is 8; the relative risk of prostate cancer in family members with hereditary prostate cancer is 5 and the absolute risk is 35-45. In addition, the incidence of prostate cancer is related to sexual activity and eating habits. Those with more sexual activity have an increased risk of prostate cancer. A high-fat diet is also related to the incidence. In addition, the incidence of prostate cancer may be related to race, region, and religious beliefs.
Clinical manifestations
Prostate cancer is often asymptomatic in the early stages. As the tumor develops, the symptoms caused by prostate cancer can be summarized into two categories:
- Compression symptoms
The gradually enlarged prostate gland compresses the urethra, which can cause progressive dysuria, manifested as thin urine stream, short range, slow urine flow, interrupted urine flow, dripping after urination, incomplete urination, and labored urination. In addition, there is frequent urination, urgency, increased nocturia, and even urinary incontinence. Tumor compression of the rectum can cause difficulty in defecation or intestinal obstruction, and can also compress the vas deferens to cause lack of ejaculation, compress nerves to cause perineal pain, and can radiate to the sciatic nerve.
- Metastatic symptoms
Prostate cancer can invade the bladder, seminal vesicles, and vascular nerve bundles, causing hematuria, hematospermia, and impotence. Pelvic lymph node metastasis can cause edema of both lower limbs. Prostate cancer is often prone to bone metastasis, causing bone pain or pathological fractures and paraplegia. Prostate cancer can also invade bone marrow and cause anemia or a decrease in the whole blood count.
The incidence of prostate cancer gradually increases after the age of 55. Unfortunately, people's attention to prostate cancer is far from enough. When many men have obvious discomfort, they still simply think it is just benign prostatic hyperplasia and delay it. When prostate cancer is seriously diagnosed, it is too late.
What should men be highly vigilant about the early symptoms of prostate cancer?
- Progressive dysuria, prostate cancer and prostatic hyperplasia can also exist at the same time, which will cause abnormal enlargement of the prostate. The gradually enlarged prostate compresses the urethra and can cause progressive dysuria. Severe patients may have acute urinary retention. Most patients think it is benign prostatic hyperplasia when urinary difficulty occurs, which may be misdiagnosed or missed.
- Increased urine volume at night. Prostate cancer can cause increased urine volume at night. Many male patients have to get up four or five times a night. Many people think there is a kidney problem, but the real problem is the prostate.
- Frequent urination, urgent urination, and urinary incontinence. When the current prostate cancer occurs, due to the pressure of the prostate on the urethra, the patient may experience frequent urination, urgent urination, and even urinary incontinence. Many elderly people have obvious urine odor. It is not that the elderly accidentally urinate in their pants, but prostate cancer caused by urinary incontinence. So when the elderly at home have this situation, don't blame them.
- Naked hematuria. Many prostate cancer patients will have naked hematuria, which is caused by prostate cancer invading the bladder.
- Abnormal bone pain. Prostate cancer is prone to bone metastasis, leading to bone pain or pathological fractures, paraplegia, etc. Many prostate cancer patients may not have obvious discomfort such as dysuria. Only when unexplained bone pain occurs, further examination will find that it is caused by prostate cancer.
So what examinations should be done in the hospital?
- Rectal digital examination to check whether there are hard nodules around the prostate. If abnormalities are found, other examinations are required, such as PSA
- PSA examination is also a prostate cancer specific antigen test. The PSA index is tested by blood draw to assess the risk of prostate cancer. Patients with PSA levels higher than 10.0 ng/ml are highly suspected of prostate cancer.
- MRI (MRI) MRI examination is an important means of diagnosing prostate cancer. It can observe whether the peripheral capsule is intact and whether it invades surrounding fat tissue, bladder and other organs.
- Transrectal ultrasound examination is often used in the diagnosis of prostate cancer in clinical practice. Under ultrasound guidance, puncture biopsy can also be used for pathological analysis. Pathological examination is the gold standard for the diagnosis of prostate cancer.
If you find anything wrong with your body, especially if the condition persists and worsens, you must seek medical treatment as soon as possible. The cure rate for early prostate cancer is very high. We recommend that male friends over 50 years old go to the hospital regularly for prostate cancer screening, and try to achieve early detection and early treatment.
How to treat?
Hormone therapy
Also known as endocrine therapy, it is an important and effective means of treating prostate cancer. The growth of prostate cancer cells depends on androgens. Cutting off the supply of androgens will cause cancer cells to grow slower or die. Hormone therapy mainly includes the following:
Orchiectomy
Bilateral orchiectomy is the most effective and least side-effect method in androgen removal therapy. It can achieve short-term treatment effects without the use of other auxiliary drugs. However, the long-term efficacy depends on the dependence of cancer cells on androgens. That is, the stronger the dependence of cancer cells on androgens, the better the inhibitory effect on cancer cells after orchiectomy.
Anti-androgen drugs
Anti-androgen drugs can prevent the effect of endogenous androgens on prostate cells to achieve the purpose of treatment. Commonly used drugs include bicalutamide, nilutamide and flutamide. In addition, when other hormones fail, enzalutamide can be selected for treatment.
Luteinizing hormone-releasing hormone (LH-RH) agonists
The initial treatment of luteinizing hormone-releasing hormone (LH-RH) agonists will cause a sharp increase in testosterone. For patients with obvious metastasis or possible related symptoms, they should be treated with anti-androgens in the initial stage. Subsequently, testosterone decreases, which can block androgens and inhibit tumor development. Currently used clinically are leuprolide acetate, leuprolide acetate, histrelin, etc.
