Prostate cancer: what it is, types of tumors and how they are detected

Prostate cancer is a malignant tumor arising from the cells of the prostate gland, a small gland beneath the bladder that produces part of the seminal fluid. In some men such a tumor grows for years and hardly interferes with life, while in others it behaves aggressively. Below: what exactly is found in the gland, how it differs from adenoma, and which examinations confirm the diagnosis.

What prostate cancer is

The gland lies beneath the bladder and surrounds the urethra. Cancer starts in its cells: they stop obeying control and divide without stopping.

The exact cause is unknown. The disease is associated with changes in the DNA of cells: some of these changes are inherited, some arise during life. More than 400,000 new cases of prostate cancer are detected worldwide each year.

The course varies. Often the tumor grows very slowly and, until it has spread through the body, does not cause serious problems. Sometimes it grows quickly and produces metastases — such cancer is dangerous. A separate problem is late detection: in Russia and the CIS countries the tumor is often found at stage III–IV.

How prostate cancer manifests and when to see a doctor

There are no symptoms that occur only with cancer. In the early stages there are usually no complaints at all. Later there appear a weak stream that is difficult to start, intermittent urination, sudden urges, frequent urination at night, pain or burning during urination, blood in the urine or semen, persistent pain in the lower back, hips or pelvis, and painful ejaculation.

You should see a doctor if such symptoms appear, if the risk of prostate cancer is high due to age or family history, and also if the result of a screening test is concerning. Talking about the rectum and prostate embarrasses many men. Embarrassment is normal here, and a digital rectal examination is the standard first step.

Prostate cancer by itself is not a reason to call an ambulance. 103/112 — for a sudden severe deterioration of the condition that threatens life.

Adenocarcinoma and other prostate tumors

Tumors are distinguished by the structure of their cells. About 95% of cases are acinar adenocarcinoma, a cancer of the glandular epithelium. Other types of adenocarcinoma — ductal, mucinous, small cell, transitional cell — account for no more than 5%.

Besides adenocarcinoma, there occur squamous cell, tubular and alveolar cancer, as well as poorly differentiated forms. The disease often passes through a precancerous stage: atypical hyperplasia and intraepithelial neoplasia are considered precursors of adenocarcinoma. In 60–70% of cases the tumor arises in the peripheral zone of the gland, in 5–10% — in the central zone, and the rest falls to the transitional zone.

How prostate adenoma differs from a malignant tumor

Adenoma, or benign hyperplasia, is an overgrowth of the gland's tissue, not cancer. It compresses the urethra and causes similar complaints: frequent urges, a feeling of incomplete emptying, a thin stream, the need to strain. A malignant tumor is a cancer of the gland's epithelium and can spread to other parts of the body.

There is no difference in the sensations. Many of these complaints are explained precisely by an enlarged but benign prostate. Therefore symptoms by themselves do not indicate cancer — examinations are needed.

Who is at risk

• Age: more than 75% of cases are detected in men over 65, while men under 60 account for only 7%. In Russia, in men over 60 this is the most common malignant neoplasm.
• Family history: the risk is higher if prostate cancer occurred in a parent, brother or child; with three affected relatives it increases approximately 10-fold.
• Origin: in African Americans prostate cancer occurs three times more often than in white Americans, and more often at a young age; in immigrants from Asia — rarely.
• Diet: in men who eat a lot of fatty food, the risk is twice as high.
• External factors: work with cadmium, in the rubber industry, ultraviolet radiation.

How a prostate tumor is diagnosed

First, a digital rectal examination: the doctor inserts a lubricated finger into the rectum and feels for indurations. Then a blood test for prostate-specific antigen, PSA. A high level occurs in cancer, but many other causes raise it too.

Next — ultrasound or MRI of the prostate. If the picture is concerning, a biopsy is ordered. The diagnosis can only be confirmed this way: a piece of the gland's tissue is taken with a hollow needle and studied under a microscope, looking for cancer cells.

This is reference text, not a diagnosis: it does not replace a doctor's consultation and does not cancel an examination.

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