Prostate cancer: signs, causes and diagnosis

Prostate cancer is a malignant tumor that begins in the cells of the prostate gland, a small gland of the male reproductive system located below the bladder. The disease often develops slowly and does not make itself known for years, but sometimes it grows quickly and spreads throughout the body. Below — about the signs, risk factors and steps of diagnosis.

Prostate cancer: what kind of disease it is

The gland produces fluid that is part of semen. The tumor arises from its epithelium: about 95% of cases are acinar adenocarcinoma, while other types of adenocarcinoma account for no more than 5%. Prostate cancer is one of the most common malignant neoplasms in men: more than 400 thousand new cases are detected worldwide each year. The disease also has precancerous conditions — atypical hyperplasia and intraepithelial neoplasia; their timely detection helps the doctor assess the prognosis and choose further tactics. In 60–70% of cases the tumor appears in the peripheral zone of the gland, and in the central zone — in only 5–10%.

Signs of prostate cancer in men

There are no symptoms specific to prostate cancer: many of them are the same as in benign hyperplasia. In the early stages the disease is asymptomatic, and complaints often appear only once the tumor has grown.

• frequent urges to urinate, a feeling of incomplete bladder emptying, spasms or pain in the perineum;
• difficulty urinating, a thin or intermittent stream, urinary retention;
• pain or burning during urination, blood in the urine or semen;
• persistent pain in the lower back, hips or pelvis;
• painful ejaculation.

Causes and risk factors

Researchers do not know the exact cause of prostate cancer. It is known that the disease is associated with changes in genetic material (DNA): some of them are inherited, some arise during life, and the origin of many remains unknown. The most notable association is age: the risk increases with age, prostate cancer is rare before 50, more than 75% of cases are diagnosed in men over 65, and men under 60 account for only 7%. The risk is higher if a parent, brother or child had prostate cancer; if three relatives are affected, it increases approximately 10-fold. In African Americans the disease occurs more often, at a younger age and in a more severe form. The role of diet is discussed: an abundance of animal fats increases the risk approximately twofold and impairs the absorption of vitamin A. External factors include ultraviolet radiation and harmful working conditions — work with cadmium, in the rubber industry.

Prostate cancer on ultrasound and gland size

Ultrasound and MRI are imaging examinations: they provide images of the gland, on the basis of which the doctor decides whether further steps, including biopsy, are needed. The size of the prostate itself does not indicate cancer: an enlarged gland occurs in benign hyperplasia, which causes similar complaints. An image does not confirm prostate carcinoma — the diagnosis is made only from tissue obtained by biopsy.

How prostate carcinoma is diagnosed

The examination proceeds in steps. First, a digital rectal examination: the doctor inserts a lubricated finger into the rectum and palpates the gland, looking for indurations. Then a blood test for prostate-specific antigen (PSA): a high level may be a sign of cancer, but many other conditions also raise it. Next is imaging — ultrasound or MRI. If the results indicate possible cancer, the next step is a biopsy: a piece of tissue is taken with a hollow needle and examined under a microscope. This is the only way to confirm the diagnosis.

Metastases and when to see a urologist

As long as the tumor has not spread beyond the gland, it may not cause serious problems; the danger is cancer that grows quickly and spreads throughout the body. Urinary symptoms more often appear in advanced stages, when the tumor grows. In Russia and the CIS countries, prostate cancer is often detected late, at stage III–IV. One should see a urologist for any of the listed symptoms, with a family history of prostate cancer, and also if a screening examination has concerned the doctor.

Suspicion of prostate cancer alone is not a reason to call an ambulance; 103/112 — for a life-threatening condition: sudden severe pain, loss of consciousness, marked deterioration of the condition

A conversation with a urologist and patient communities, where a man and his loved ones receive explanations without false promises, help to go through this path more calmly. This material is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer