Prostate cancer

. Indeed, according to recent studies and medical statistics, almost all men over the age of 80 have a small outbreak of prostate cancer.

The good news is that many tumors are not very aggressive, remain confined to the prostate and have a rather slow course; this means that patients can live with cancer for years without undergoing specific treatments and without suffering negative consequences for their health. Furthermore, when necessary, the therapeutic options are multiple and quite effective. Unfortunately, alongside the very slow-growing forms, there are also more aggressive prostate cancers, with a tendency to metastasize. These types of cancer grow rapidly and can spread to other parts of the body (through the blood or the lymphatic system), where cancer cells can form secondary tumors (metastasize). In such circumstances, the chances of curing the disease are very low.

Data in hand, it is estimated that every Italian over 65 has about 3% chance of dying from prostate cancer. For this reason, it is good not to let your guard down: intervening in time means greater chances of eradicating or containing the disease.

(lower abdomen), just below the bladder and in front of the rectum, surrounding the first portion of the urethra. The parenchyma consists of a cluster of tubuloalveolar glands, surrounded by a rather thick layer of smooth muscle fibers.

The main function of the prostate is to help produce sperm, as it secretes part of the seminal fluid released during ejaculation (note: seminal fluid together with sperm constitutes sperm).

Symptoms Prostate cancer

In the early stages, prostate cancer is often asymptomatic; this means that the patient does not experience any symptoms, remaining unaware of the condition. In recent years, thanks to the growing awareness of the dangers of the disease, most prostate cancers are diagnosed in these early stages. A urological examination accompanied by a check of the PSA (prostate specific antigen), by means of a blood test, allows to identify the subjects at risk in which to carry out further tests.

If the tumor is ignored, the increase in its size is associated with problems associated with urination, as the organ surrounds the prostatic urethra. The changes within the gland therefore directly affect urinary function. Symptoms of prostate cancer can include:

  • Difficulty urinating (hesitation);
  • Frequent urge to urinate, especially at night (nocturia);
  • Difficulty maintaining a steady stream of urine (the flow is weak, intermittent, or a feeling of not being able to empty your bladder completely)
  • Pain or burning when urinating
  • Blood in the urine or semen
  • Erectile dysfunction (impotence);
  • Painful ejaculation;
  • Discomfort in the pelvic area;
  • Fatigue, loss of appetite and general malaise
  • Generalized pain in the back, hips or pelvis.

PLEASE NOTE: The urinary symptoms described are manifested in a similar way to other benign prostatic problems, such as prostatic hyperplasia (BPH). For this reason, if one or more of these manifestations occur, it is advisable to undergo specific medical examinations without panicking, it could in fact be a "simple" benign enlargement of the prostate. Again, the appearance of these symptoms in an acute form could indicate a "generally bacterial" inflammation of the prostate: prostatitis.
Malignant prostate cancer can metastasize to the lymph nodes in the pelvis and progressively spread to other parts of the body. Prostate cancer tends to metastasize mainly to the bones of the spine, pelvis, ribs and femur. Bone pain, therefore, can be a symptom of advanced prostate cancer. If the metastasis compresses the spinal cord, it can cause weakness or numbness in the lower limbs, urinary and fecal incontinence.

Benign prostatic problems

Benign prostatic pathologies are more common than neoplasms, especially after the age of 50; often, these conditions cause symptoms that could be confused with those of the tumor.

Under normal conditions, the prostate is approximately the size of a walnut, but due to advancing age, or due to certain pathologies, it can enlarge and cause problems, especially urinary ones.

Enlarged prostate (benign prostatic hyperplasia). The prostate is very sensitive to the action of hormones, such as testosterone. Over the years, an enlargement of the gland occurs spontaneously, following the hormonal changes that occur in the testicle (the production of androgens decreases and the release of small amounts of estrogen hormones.) Benign prostatic hyperplasia can compress the urethra and cause problems in passing urine.

Inflammation (prostatitis). Prostatitis is an "inflammation of the prostate. Usually, the main cause is a" bacterial infection, but it can also arise in the absence of pathogens. Symptoms consist of pain in the lower abdomen, often accompanied by dysuria, and loss of mucous secretions.

they are characterized by small alterations in shape and size, which make them anomalous. Many men may have mild dysplasia (PIN1, low grade) even at a young age, but they will not necessarily develop prostate cancer. A high-grade intraepithelial prostatic neoplasm, on the other hand, correlates with a significantly higher risk. For this reason, physicians must carefully monitor each patient in which it is found and possibly perform another "biopsy of the prostate."
  • Proliferative inflammatory atrophy (PIA): Prostate cells appear smaller than normal and there are no signs of inflammation in the area. Researchers believe the lesion may evolve to high-grade PIN or directly to tumor.
  • Atypical microacinate proliferation (ASAP): in this case, the outcome of the biopsy is uncertain, ie the prognostic significance is not related to a specific nature of benignity or malignancy; for this reason, the patient is advised to repeat the biopsy after three months .
  • ).
    An adenocarcinoma arises when the normal cells, making up one of the secretory glands, become cancerous. During the initial stages, the lesions remain confined. Over time, the cancer cells begin to multiply and spread into the surrounding tissue (stroma), forming a tumor mass. This causes a swelling of the surface of the prostate, which can be seen during palpation of the gland through the rectal wall. In the later stages, the tumor can increase in size and invade neighboring organs, such as the seminal vesicles or the rectum. Cancer cells can develop the ability to migrate from the site of origin to another part of the body, through the bloodstream and the lymphatic system. These can proliferate and form secondary tumors. Prostate cancer metastasizes more frequently to the bones, lymph nodes and can invade the rectum, bladder and ureters by means of a local diffusion mechanism.

    Benign tumors

    Malignant tumors (prostate cancer)

    • They do not invade neighboring tissues;
    • They do not metastasize to other parts of the body;
    • They can be treated and usually do not tend to come back.
    • They can invade nearby organs and tissues (such as the bladder or rectum);
    • They can give rise to metastases in other parts of the organism;
    • They can be treated, but they can come back.

    Adenocarcinoma is the most frequent histotype among prostate neoplasms (it represents about 95% of malignant tumors).
    However, there are other cancers, which differ in clinical presentation and course, including:

    • Small cell carcinoma (originates from neuroendocrine cells);
    • Ductal adenocarcinoma (originates from the cells of the prostatic ducts);
    • Mucinous carcinoma (characterized by the production of mucus);
    • Adenosquamous or squamous carcinoma;
    • Mesenchymal neoplasms (such as sarcomas or liposarcomas);
    • Primary lymphoma of the prostate.

    Once the type of cancer has been diagnosed, the doctor will also need to consider:

    • The grade of the tumor (how the abnormal cancer cells behave);
    • The stage of the cancer, including whether it has spread (metastasized) and where it has spread
    • Prognostic factors (particular characteristics that could influence the course of the disease);
    • Survival statistics for the particular type and stage of cancer.

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    . Prostate cancer is very rare in men under the age of 40, but the chance of developing the disease increases rapidly after age 50. About 6 in 10 cases occur in patients over the age of 65.
  • Ethnicity / Population to which they belong. Prostate cancer is more common in some ethnic and racial groups than others, but the reasons for these differences are unclear. In particular, African-American men have a higher risk of developing the disease and a higher likelihood that it is an aggressive form.
  • Familial predisposition for prostate or breast cancer. Men who have a blood relative (father or brother) suffering from prostate cancer have a 2-3 times greater risk of getting sick than those without familiarity; this risk is further increased if there is more than one affected relative in the family and if the disease was diagnosed before the age of 65the. In addition, the risk appears to be slightly higher for men from families with a "history of breast cancer. In particular, the likelihood of developing prostate cancer is higher in the presence of mutations in certain genes, such as BRCA1 and BRCA2, also involved in the onset of breast and ovarian cancers.
  • Lifestyle. Obesity and lack of exercise can promote the development and growth of prostate cancer. The risk is greater for men who consume foods rich in saturated fat, on a diet low in fruit and vegetables. Most studies found no obvious link between smoking and prostate cancer.
  • Inflammation of the prostate. Some studies have suggested that prostatitis may be linked to an increased risk of prostate cancer, while other research has found no such evidence. The link between the conditions is not yet clear, but is being investigated.
  • urinary. Prostate cancer can lead to problems with bladder control (example: occasional urine leakage, overactive bladder, etc.). Depending on the severity and cause, these problems can be managed with medication, catheterization, or surgery.
  • Erectile dysfunction. Impotence can represent the outcome of the growth of the tumor mass, but also a complication of its treatment through surgery or radiotherapy. The patient may be unable to achieve or maintain a satisfactory erection or to engage in sexual activity. Several medications and medical devices are available to help treat this problem.
  • Metastasis. During the later stages, cancer cells can spread to adjacent organs or migrate through the bloodstream or lymphatic system, then form new tumors elsewhere in the body. The most common metastatic sites of prostate cancer are the lymph nodes and bones, where they can cause bone pain and pathological fractures. Once prostate cancer has spread to other parts of the body, it can still respond to treatment and can be controlled, but it can hardly be cured.
  • CONTINUED: Prostate Cancer - Diagnosis and Treatment
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