Prostate cancer

Prostate cancer usually occurs after the age of 50 (often 60 to 70). The relation between cancer of the prostate and the imbalance of sex hormones.
According to histological structure there are adenocarcinoma, solid cancer, sometimes skirr. Squamous cell cancer is very rare. The tumor may grow capsule of the gland and the adjacent organs - the seminal vesicles, the bladder and fiber pelvis.
Clinical course. Prostate cancer may long be asymptomatic; sometimes it is found finger touching through the rectum about another disease or during routine maintenance.
The further growth of the tumor complaints appear at increased frequency of urination difficult and painful urination. There are a pain in the anus, perineum and the sacrum.
For prostate cancer is characterized by metastases in the bones of the pelvis and sacrum, lumbar spine in the neck of the femur, less often at the top of the spine, ribs, skull, only rarely in the tubular bones.
Due to the spread of tumors along the bottom of the bladder advanced close to the Ostia ureters the latter are subjected to compression at the point of confluence into the bladder. As a result of impaired emptying of the upper urinary tract and appears renal failure (pain in the kidneys, dry mouth, thirst, hyposalemia, azotemia).
The diagnosis. In the initial stages of the disease in the prostate gland palpation one or more limited seals cartilage consistency. Further prostate loses shape and is represented in the form of diffuse stationary infiltrate. Quite often it is possible to feel the fibers of infiltration, extending from the top of the prostate towards seed bubbles.
In the early stages of the blood and urine of normal. In blood serum some patients with advanced prostate cancer without metastasis and most with bone metastases increased amount of acid phosphatase.
During cystoscopy in the spread of prostate cancer in the neck of the bladder without germination of the mucous membrane of the last visible tumor rose-pink, situated in the neck, which seems scalloped covered swollen, sometimes damaged mucous membrane. Typical bullous edema in the area of the bladder neck. Cystoscopy detects and spreading of the cancer of the cavity bladder.

prostate cancer
Fig. 1. Prostate cancer.

For prostate cancer characteristic osteopatichesky and mixed forms of bone metastases. On the x-ray osteopaticheskii metastases have a character unstructured mass (Fig. 20), are observed and single osteosclerotic foci on the background of the picture of the bone. Most often, however, there are mixed forms of bone metastases, which are characterized by the diversity of the figure, due to alternating compression and rarefaction of bone tissue. X-ray picture of metastatic prostate cancer is so typical and original, that indicates the primary tumor site, even in cases where there is no local symptoms of prostate cancer.
The essential help in the diagnosis has test with radioactive isotopes.
The most reliable method of detection of prostate cancer is a biopsy of the special trocar (Fig. 21), is inserted through the rectum or crotch under the control of a finger.

Fig. 20. Metastasis of prostate cancer in the bones of the pelvis and femur.
Fig. 21. Trocar for biopsy the prostate.

Treatment. Radical surgery for prostate cancer is to remove the entire prostate, together with its capsule, seed bubbles and neck of the bladder. This operation is possible only in the initial stages, and therefore without prior hormonal therapy may be produced only a small proportion of patients.
The vast majority of patients in all stages of the disease is shown hormone treatment. First you need to make removal of the testicles (castration) or Filumena their parenchyma (enucleation). A few days after this operation, carried out the first course of treatment with large doses of estrogen. Intramuscularly 2% solution sinestrola (or diethylstilbestrol) 3-5 ml (60-100 mg), fosfestrol (similar import honvana or defective) 500-1000 mg daily intravenously during 1,5-2 months. Depending on endurance drug side effects (nausea, loss of appetite, painful breast swelling, edema) and changes coming in the primary lesion and metastases, treatment sinestrola, diethylstilbestrol can be extended in the same dosage for another 2-3 weeks or reduced to 20-40 mg / day.
After clinical effect in the result of the first course of treatment with estrogen patients transferred on supporting therapy. The latter is lower doses of the same hormones (oral or injectable) with short breaks and continues throughout the life of the patient. For maintenance treatment can also be applied pill hlortrianizena, microfollin and injection estradurina.
Upon the occurrence of tumor resistance to estrogen is recommended to combine the treatment with the estrogen exposure of the pituitary gland or the appointment of corticosteroids.