Prostate cancer

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I. The etiology and prevalence

  • Morbidity.

The increase in morbidity due mainly to improved diagnosis, primarily due to the definition of PSA and transrectal ultrasound use. With age, the incidence rises sharply  

  • Etiology. The reason prostate cancer is unknown, a number of established risk factors.
    • Demographic factors. The incidence is maximal in Sweden, an intermediate in the rest of Europe, the U.S. and the Japanese who emigrated to the United States, and minimal in Japan and Taiwan. In blacks it is 30% higher than that of whites. In addition, the amendment to the stage, the survival rate among the Negroes is probably lower than that of whites.
    • Family history. Prostate cancer in father or brother before age 50 years increases the risk of his 7-fold compared with the male population as a whole (if they get sick after 70 years - to 4-fold)
    • Hormonal factors. Pathogenesis of prostate cancer is associated with altered levels of estrogens and androgens.
    • Other factors, whose role has not been proved, include an increased content of vitamin A in the diet, reduced levels of vitamin D and work with cadmium.

II. Pathologic anatomy and flow

  • Morphology. Almost all cases are adenocarcinoma, occasionally there perehodnokletochny, small cell and squamous cell carcinoma. Sarcomas are also rare. Metastases in prostate cancer are the bladder, colon and lung, melanoma, lymphoma and other tumors.
  • Localization. The tumor in 70% of the proceeds from the peripheral regions of the gland and is often multitsentricheskoy. As a consequence, transurethral resection of the prostate is not suitable for radical treatment.
  • Dissemination. The aggressiveness of the tumor is highly dependent on differeniirovki. Vysokodiffsrentsirovannye tumors remain localized for a long time. Tumor spread and perineural spaces, lymphatic and blood vessels. Distant metastases are possible in the absence of metastasis to lymph nodes, but with the defeat of the latter they are almost always the case.
  • Metastases occur most often in the bones and almost always osteoplastic, although sometimes there are osteolytic foci. Possible liver metastases, but damage to the brain, lungs and soft tissues is unusual.

III. Diagnosis

The clinical picture

  • Complaints
    • Initially, the tumor usually grows asymptomatically detected and to improve the PSA, digital rectal examination during or after transurethral resection of the adenoma. The presence of complaints - a sign of advanced tumor. There may be difficulty in beginning urination, urgency, nocturia, sluggish stream, urine drop by drop, terminal hematuria.
    • The sudden appearance and rapid increase in urinary tract obstruction in elderly men is most often caused by prostate cancer.
    • The first symptom of distant metastases is usually a pain in the back, pelvis or in several parts of the skeleton.
    • Sudden neurological disorders (paraplegia incontinence) caused by compression of the spinal cord metastasis can be the first manifestation of the disease or develop later.
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