Among all prostate diseases, cancer is one of the most dangerous pathologies. This is the most common malignant tumor in men. This disease is more common in economically developed countries. One of the reasons for that is a higher life expectancy. Mostly prostate cancer develops after 65 years of age.
In economically disadvantaged countries, many men simply do not live up to this age. In addition, many cases of prostate cancer in countries with poorly developed medicine remain undiagnosed.
So what is prostate cancer?
Many patients do not know what prostate cancer is. This is a malignant cancer, which primarily develops in the prostate gland. It can develop from different tissues. Most often this is an adenocarcinoma - a tumor of glandular epithelium. Prostate cancer can have a different structure. This includes adenocarcinoma acinar (95% of cases), mucinous, ductal, small cell and transitional cell tumors.
Prostate tumor can have a different degree of differentiation. Adenocarcinoma is one of the types of differentiated tumors. They have a favorable clinical course. This also includes squamous, tubular and alveolar cancer. Polymorphic cell cancer has the worst prognosis, because it has the least degree of differentiation.
A tumor can develop in different parts of the prostate gland. Most often it develops in a peripheral zone - 65% of cases. In 10% of patients, the tumor growth begins in the central zone. This makes diagnosis difficult, because this tumor does not manifest itself clinically any longer (it is not palpable during digital rectal examination). Another 25% of prostate cancer cases develop in the transition zone.
What causes prostate cancer?
So far, science does not know exactly what causes prostate cancer. Doctors cannot determine one specific cause of this disease. However, many risk factors have been identified.
Uncontrolled risk factors
Most of the most crucial factors cannot be controlled. Among them are:
- Age. The older the patient, the higher is the risk of the disease. It is impossible to get prostate cancer at 20 years of age. Up to 40 years, the pathology is almost never found. Morbidity sharply increases after 50 years. 60% of all cases of prostate cancer are diagnosed after 65 years.
- Race. Most often, this disease is diagnosed in people of African origin. US statistics show that among African Americans, mortality from prostate cancer is twice as high as in the Caucasion population. Asians have the lowest risk. So far, doctors have not figured out why prostate cancer occurs with different frequencies in representatives of different ethnic groups.
- Geography. Different prevalence of the disease among residents of different geographical regions indicates that the risk of prostate cancer is influenced by environmental factors and lifestyle. Pathology is most common in the United States, Australia, Western and Northern Europe. Rarely is the disease is diagnosed in Asia, Central and South America.
- Heredity. Genetic predisposition is another cause of prostate cancer. In people with first-line relatives who had prostate cancer, the risk is 2 times higher than in the average population. The risk of cancer is even greater if a relative was younger than 40 years old at the time of diagnosis of prostate cancer, or if the disease was detected in more than one family member.
Controlled risk factors
Controlled risk factors also exist. These are the factors that can cause prostate cancer and which a person can change, thereby reducing the risk of this oncology.
- Diet. It has been established that prostate cancer is more common in men who eat a lot of red meat and dairy products, but consume less fruits and vegetables. There is also the assumption that a large amount of calcium in the diet increases the risk of cancer.
- Obesity. It does not cause prostate cancer. However, it has been established that people with different body mass index develop different histological types of cancer. The greater the weight of a person, the more likely it is that the tumor will be more aggressive. Some studies show obese people have a higher risk of dying from prostate cancer.
- Profession. Firefighters are more likely to develop this oncopathology. This is probably due to the influence of certain chemicals, that cause prostate cancer, develops with greater probability. However, it is not been established what kind of chemicals exactly cause prostate cancer.
Unproven risk factors
Different sources site some other causes of prostate cancer. However, they are not scientifically proven. That is, they are based on assumptions, but not on real evidence.
Most likely, the following are not the factors which cause prostate cancer:
- Prostatitis - often given in various sources as a precancerous condition, although there is no conclusive evidence that it is the cause of prostate cancer
- Sexually transmitted infections
- Vasectomy (surgical sterilization)
- Elevated levels of androgens - accelerates the rate of development of pathology, but is not the cause of the tumor process
Types of prostate cancer
Classification of prostate cancer is based on the TNM system. The letter T is for primary tumor, N - near metastases, and M - distant metastases.
Primary tumor can be characterized as:
- Tx - there is little information to evaluate the neoplasm.
- T0 - undetectable tumor.
- T1 - neoplasm is not clinically detected.
There are three variants of T1:
- T1a - a tumor that is accidentally detected during surgery and is no more than 5% of the removed volume of tissues
- T1b - tumor is detected during surgery and is more than 5% of the resected mass
- T1c-detection of a tumor in a biopsy taken in connection with an increase in the concentration of the prostate-specific antigen
T2 - tumor within the prostate:
- T2a - present in one lobe
- T2b - is detected in two parts
T3 - the tumor has spread beyond the limits of the organ:
- T3a - with spreading to the cellulose
- T3b - with spreading into seminal vesicles
T4 - tumor spread into the bladder, rectum, anterior abdominal wall and other nearby organs.
Characteristics of a tumor with near metastases:
- Nx - the status is not defined
- N0 - there are no metastases
- N - the near metastases of prostate cancer are present
Characteristics of distant metastases:
Mx - not enough data
M0 - there are no distant metastases
M1 - there are metastases:
- M1a - in the distant lymph nodes
- M1b - in the bones
- M1c - in the organs
In the diagnosis, a person can see something like: prostate cancer T1cNxMx. What does it mean? A person with this diagnosis in a medical record has a tumor. It is small in size and is not detectable clinically. It has been found after a biopsy which was performed on the basis of high PSA in the blood. In-depth diagnostics have not yet been carried out. Therefore, the status of proximal and distant metastases is not yet defined. Most likely, there are no metastases yet. After all, the tumor is small and appeared only recently. This patient was lucky: the cancer was diagnosed during the first stage. Most likely, the treatment will be successful and will lead to complete recovery.
The stages of prostate cancer are determined proceeding from the abovementioned data. There are four stages in all, although sometimes sub-stages are determined as well. In addition, the degree of tumor differentiation is also important for determining the stage.
There are four in total:
- Undifferentiated cancer
Tumor differentiation is denoted by Latin letters G and numbers, where 1 means high differentiation, and 4 - undifferentiated cancer. 4 is the least favorable in terms of prognosis - it grows rapidly and early metastasizes. The designation Gx indicates that the degree of differentiation has not yet been determined or it has not been determined for some reason.
Here are four stages of prostate cancer:
- Stage 1. The size of the primary tumor is no more than T1a. There are no metastases. The degree of differentiation is high.
- Stage 2. The size of the primary tumor is no more than T2. There are no metastases. The degree of differentiation varies.
- Stage 3 of prostate cancer. T3 tumor without metastases. The degree of differentiation varies.
- Stage 4 of prostate cancer. T4 tumor with regional and/or distant metastases.
The earlier the pathology is diagnosed, the better. Prostate cancer of the third degree or 1-2 degrees are well-treatable. However, prostate cancer of the 4th degree is much more difficult to treat. There are three substages in total. They differ significantly in terms of prognosis and therapeutic approach.
- 4a stage. Characterized by the absence of metastases with a large tumor size (T4), which spreads into the surrounding organs.
- 4b stage. There is metastatic damage to the nearest lymph nodes.
- 4c stage. There are distant metastases in the lymph nodes, bone structures or internal organs.
Where prostate cancer metastasizes most often
There are a lot of organs and tissues, where prostate cancer metastasizes. Metastatic tumors first appear in the lymph nodes of the pelvis. Often they become the cause of lymphostasis (impaired lymph circulation). As a consequence, the lower extremities develop swelling.
During the 4th stage of prostate cancer metastases appear in the bone structures, remote lymph nodes and organs. Bones become the first location where prostate cancer metastasizes. This includes the ribs, pelvis and spine. It is accompanied by pain in the bones. Pathological fractures can occur as well. If the vertebrae is damaged, the disease is often complicated by compression of the spinal cord. Paresis and paralysis start to develop. Lungs and liver are the most common internal organs where prostate cancer metastasizes.
It is often difficult to identify locations where prostate cancer metastasizes. This requires high-tech research methods, such as CT, MRI, scintigraphy. It is possible to assume when the tumor will metastasize into the bones on the basis of a biochemical blood test. In 70% of patients in such cases, the level of alkaline phosphatase increases.
Blood test for PSA evaluates how much the tumor process spread. If this index is more than 50 ng / ml, the probability of tumor spreading beyond the capsule of the prostate gland is about 80%. The risk that metastases are in regional lymph nodes is about 65% with such indicators of prostate-specific antigen. If the PSA exceeds 100 ng / ml, there is 100% evidence of the presence of metastases. The analysis does not help to establish the localization of metastases, but it provides an opportunity to understand when additional studies are needed to assess how much the oncological process spread.
Life expectancy in prostate cancer
Prostate cancer is one of the most favorable diseases from the point of clinical course. Following the natural course (without treatment), the life expectancy with prostate cancer is quite high. It can reach 5-10 years. However, one should not label this disease harmless and not severe. Prostate cancer is the most common malignant tumor among men and the second most common in terms of mortality. One in 40 people dies of prostate cancer. That is, this disease causes death of about 2.5% of the male population worldwide. Only lung cancer has a higher fatality among men.
The first thing that a person wishes to know after being diagnosed with prostate cancer is how much longer he will live. Feature films often show a doctor telling the patient with a sad look: "You have 8 months to live". However, in reality it is impossible to give such an accurate prognosis for prostate cancer. There are only average survival figures. They provide information about the disease as a whole, but do not accurately predict the life expectancy for a particular patient.
If a patient is diagnosed with prostate cancer, the life expectancy depends on a large number of different factors:
- The stage of tumor at the time of diagnosis
- The degree of tumor differentiation(the higher the better)
- Age of the patient
- His race, lifestyle, hormonal balance, bad habits
- Presence of other pathology
The average survival rates for prostate cancer often do not include the treatment method which was used. After all, general statistics includes all people: those who did not receive treatment at all, those who underwent radical prostatectomy, those who used only conservative treatment or received only chemotherapy. Life expectancy for prostate cancer also depends on where the patient is being treated. In Western countries, survival rates are much higher than in developing countries with poorly administered medical procedures.
Survival rates depending on the stage
In the first and second stages, the survival rate is approximately the same. Life expectancy for prostate cancer of 2 stage depends largely on the quality of treatment.
Here are the general statistics on prostate cancer in Western countries:
- Five-year relative survival rate - 99%
- 10 years - 98%
- 15 years - 96%
Relative survival rates are different from absolute ones in that they do not take into account deaths from other causes. The need for such differentiation is obvious: often prostate cancer is diagnosed in the elderly, who can die several years later from cardiovascular or other diseases. Similar cases in this statistics are not taken into account.
As we see, prostate cancer prognosis in countries with advanced medicine is more than favorable, since only 4% of men with prostate cancer die within 15 years after the diagnosis. Others live longer or die from causes not related to this cancer.
The prognosis in Western countries is determined not by stages, but by how much the oncological process has spread. This indicator most strongly affects life expectancy.
Patients are divided into the following groups:
- Locally spread cancer. It is diagnosed in 80% of patients in Western countries due to the high quality of diagnostics. Developed countries use a method of screening - regular examination of men, blood tests for PSA. High detection of the disease in the early stages is also associated with the accuracy of the diagnosis. Locally spread cancer includes 1, 2 stages, as well as some patients with stage 3 of prostate cancer. The prognosis is the most favorable for this type of cancer. In locally spread cancer, the relative five-year survival rate is close to 100%.
- Regionally spread cancer. The tumor has spread to nearby organs and tissues. It could spread past the capsule of the prostate and penetrate the bladder, seminal vesicles, or paraprostatic fiber. Or the tumor metastasized into regional lymph nodes but is absent in the remote parts of the lymphatic system. This includes patients with stage 3 and stage 4. Life expectancy remains high, because distant metastases are still absent. Relative five-year survival rate in developed countries reaches 100%.
- Cancer with distant metastases. The last stage of prostate cancer has the worst prognosis. Survival rates depend on the prostate cancer treatment used. Remote metastases appear in stage 4c. Even in developed countries, prostate cancer of this stage is hard to treat. How many survive? The relative 5-year survival rate is 29%. The average life expectancy is about 36 months.
Nevertheless, people should not despair even during stage 4. How many patients will live depends on the quality of the therapy. Today, there are innovative methods of prostate cancer treatment that prolong life expectancy. After all, these 29% of five-year survival rates are statistics that were obtained several years ago. Patients who undergo prostate cancer treatment for stage 4 today have much more favorable prognosis.
Additional prognostic factors also need to be taken into account when determining the prognosis. They can be either favorable or unfavorable. Prostate cancer survival rates in the late stages largely depend on the degree of tumor differentiation. The kind of tissue tumor consists of influences how fast prostate cancer will develop. Undifferentiated tumors grow most rapidly. Highly differentiated tumors have the slowest growth.
Unfortunately, statistics in developing countries are much worse. For example, in the CIS, the relative five-year survival rate for prostate cancer is 95% at stage 1, and 85% at stage 2. Life expectancy is less for stage 3. The overall 10-year survival rate is 35%, the total 15-year survival rate is 42%. How many survive prostate cancer of the 3rd stage depends also on how radical the treatment was. Complete cure the disease is achieved in 20-30% if surgical removal of the prostate and radiation therapy were combined.
Prevention of prostate cancer
By knowing why prostate cancer can develop, you can eliminate the main controlled risk factors for the disease. It will not prevent a pathology with a 100% guarantee. But it will help reduce the risk.
Here's what you can do:
- Reduce the amount of dairy products and red meat in the diet
- Increase consumption of fruits and vegetables
- Control body weight and do not smoke (this will not affect the risk of prostate cancer as a whole, but will reduce the risk of its aggressive forms)
However, the main preventive measure is a regular examination. Prostate cancer spreads slowly. It can be discovered in time and cured quickly. To do this, it is enough to take a PSA test once a year. If a doctor finds an elevated level of cancer marker or a significant increase in dynamics, he/she will conduct an in-depth examination to exclude or detect cancer.
Treatment for prostate cancer in Germany
Regardless of the stage, German clinics can provide you with modern treatment that will improve the quality of your life and increase its duration.
Here, the most modern methods of treating prostate cancer are used:
- Robotic surgical operations
- The newest methods of radiotherapy (brachytherapy, intensity-modulated radiation therapy) that provide the maximum radiation dose for a tumor and minimal radiation for healthy tissues
- New radionuclide methods for prostate cancer treatment if there are distant metastases
To choose a good clinic and get treatment as quickly as possible, contact Booking Health.
We will help:
- Choose a clinic
- Organize treatment
- Issue documents for traveling abroad
- Translate the necessary medical documentation into German
- Save up to 70% on treatment
You will get insurance which will cover all unforeseen expenses in case of complications. This means that the originally agreed cost of treatment is guaranteed not to increase. If it decreases, the excess funds will be returned to you in full. With Booking Health you can fully concentrate on restoring your health while we are engaged in all the organizational issues.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova