Recaf.net | FEFOC and Cancer of Prostate

GENERALITIES

What is the prostate cancer?

It is the proliferation of malignant cells that originates in the prostate and happens unnoticed for years, progressing subsequently towards the nearby organs and for the blood to other organs especially the bones. It has the peculiarity that affects especially men of advanced age, which has hormonal influence and the valuation of healings it is high. Also, the patients who have already met�stasis in the bones can live through many years (more than 8) with the hormonal treatment.

Which are his causes?

It is considered that it is the accumulation of several causes like familiar precedents, the age, hormonal stimulus, the diet rich in greasy, possible venereal diseases, etc., that the genes of the prostate are injured progressively causing first benign injuries that with the years develop a cancer.

Who is inclined to prostate cancer?

It has been seen that there are racial factors, since the American blacks have more propensity than the white Americans. The age superior to 70 years is a risk factor, but risk begins existing already from the 50. At the age of 90, 80 % of men has prostate cancer, what does not mean that they are going to die of the same one. It is said that these persons die with cancer but not of prostate cancer, since the life prognosis is long and it have time to that die of other illnesses associated at the age. It is more frequent in the northeast of Europe and America of the north and frequent very little in East.

Does exist any way of avoiding it?

It is considered that to avoid predisposing factors reduces the risk of enduring prostate cancer. To avoid diet rich in fats, the ingestion of alcohol and other toxicants, to avoid venereal infections. In spite of that, the age is a fundamental factor and if a man fulfills many years, it will always have risk of cancer of prostate. The best thing a diagnosis is on time to die of this illness since an effective curative treatment exists.

Have I heard that the eunuchs do not have this cancer, the castration prepares it?

It is true that the eunuchs do not endure this one cancer, nevertheless the castration is used only like treatment when prostate cancer is already had but not for prevention. Between other things because it would have to be done when the person is young so that it operates the absence of hormones many years and that produces powerlessness, depression and other not desirable alterations.

Does prevention exist with hormonal treatments?

The same way the administration of hormones antiandrogenic is not used like preventive since it would take the same effects as the castration as a surgery. The Finesteride is a medicine that is administered to prepare the benign hypertrophy of the prostate. Some studies suggest that he might prepare also the cancer. In the next future we will have more information about his utility in cancer prevention.

What can do not to die of prostate cancer?

The best thing there is the precocious diagnosis, which consists of periodic reviews for an urologist or an expert doctor from 50 years (from the 40 if there are familiar cases or other factors of very high risk). It consists of rectal tact with latex glove to touch the surface of the prostate and blood test to see the specific prostate antigen (PSA is the initials in English but the other way round). With that there are had high probabilities of suspecting a tumor if it was or of discarding it if it was not. Only it serves to establish his suspicion since the diagnosis is more complex and not always a bundle in the prostate and elevation of PSA means that cancer exists.
There are in march campaigns of analysis of PSA in men from 50 years without high risk and "without symptoms" to know if with earlier detections the patients will live more years. This is because there is a polemic if diagnosing the cancer in more initial phase he goes to live through more time since often the decision after a precocious diagnosis can be not to treat the cancer and to wait for his spontaneous evolution. In conclusion, the campaigns of precocious diagnosis have not demonstrated yet that the life of the population gets longer with moderate risk of enduring prostate cancer.
In hands of an expert the cancer of initial prostate treats 80 %, but if the cancer is slightly malignant, the patient would live many years without treatment. Nevertheless, with treatment he can live through the same but with worse life quality due to the powerlessness and the due urinal incontinence the treatment.

How is a prostate cancer spread?

Initially it is spread to the rest of the prostate gland that is divided in several parts that are called lobes. Sometimes it originates simultaneously in several lobes and it is said that it is multifocal. From here it invades nearby organs especially the urinal bladder, and the ganglions of the pelvis. Later the retroperitoneo can invade distant ganglions as those of English or those of next to the kidneys. Finally it can go on to the blood and give met�stasis foci, with major frequency to bones and less frequent to lung, adrenal glands, ganglion supraclavicular left (here it comes for route of lymphatic glasses), etc.

DIAGNOSIS

Which are the symptoms of cancer of prostate?

As almost always in the cancer, there are slightly specific symptoms that the benign tumors can happen in other benign illnesses like the prostate hypertrophy.
It consists of pain on having urinated, I increase of the frequency of the urine, decrease of the force of the jet of urine, not to remain comfortable after having urinated, urinating very much in the nights or residues of any drops of urine on having finished the micturition. They all are unspecific as it has been said.
More rarely it is possible to present like blood loss with the urine. When the prostate cancer is spread to the bones it can give intense and changeable bony pains especially in the night on having been in rest in the bed.

How is the diagnosis done?

It is necessary to do a puncture or a biopsy of the prostate or of some focus of met�stasis if it existed. Simultaneously there have to be done habitual blood tests as hemogram, tests of function of the liver and of the kidney, of salt dissolved in the blood, of the calcium, and specific tests of this cancer like the PSA (specific prostate antigen). It is a fact as so specific as it indicates his name and can be raised in other benign illnesses, therefore it must be interpreted by an expert doctor.
Also there will realize tests of image as the ultrasound scan transrectal, (for the rectum) to see better the existence and extension of the tumor, thorax radiography, and bones tests especially the bony gammagraf�a, which is a radiography of all the bones simultaneously done after injecting a radioactive contrast (of not dangerous low radiation) that accumulates a few hours in the bones and allows to do photos of the same ones. If bones radiographies are done to see met�stasis foci, these can be less dense and sometimes more calcified of the normal thing. Sometimes it is suitable to do other tests of image as the TAC or Resonance (RNM). or abdominal ultrasound scan and in other occasions pulmonary.
Earlier there was done linfograf�a pedal that was the contrast injection in a foot and to continue with radiography the above mentioned contrast that was appearing in the ganglions inguinales or retroperitoneales. Now TAC or RNM is preferred.

So that it serves the blood test?

He informs the doctor about the state of important organs like the kidney or the liver and about if met�stasis suspicion exists in these organs or in the bones for calcium elevation or about fosfatasa alkaline. The PSA serves to watch as the treatment goes and to announce reproductions of the tumor if one has achieved that it is normal after treatment. The prostate acidic fosfatasa is used less since it does the same service of the PSA but it is something less sensitive and more expensive. The principal thing is that it does not contribute any more information about the PSA.
The PSA serves also for the precocious diagnosis in persons without symptoms, since he announces that it is possible to have prostate cancer. Care: a PSA raised not always indicates cancer. It can rise for illnesses or benign alterations.
The PSA should be done from 50 years of age and never from the 80 in persons without symptoms, since it is not clear that it serves to lengthen the life of the persons therefore if the life expectancy is lower than 10 years for age or for other illnesses it means that the person will die of other illnesses but not of the cancer of prostate.

Is it better to use the ultrasensitive PSA?

At present the analysis skills are improved. The ultrasensitive PSA detects minimal changes and it is theoretically better that the standard PSA. The standard PSA is the still useful and the important thing it is not to confuse the units of measurement of one and another PSA since they are not comparable. To consult with the laboratory the values of reference. There exist a few stage of extrapolation of a few and other types of PSA.

After the finished prostatectom�a, does the PSA have to be a zero?

Not always it is zero, since it depends on the skill he can detect some PSA residue. This is due to the fact that some rest of prostate always stays after the operation, especially the one that surrounds the urethra that it is never possible to extirpate, without extracting the urethra. This rest of prostate does that the PSA is not zero, but there exist values of reference to say if the residue is adapted or is superior to the suitable thing and there is suspicion of persistence of tumor.

Why does a prostate cancer serve biopsiar?

To have the certainty that is essential the biopsy for study to the microscope of the cells. Also, it serves to classify prognosis and the treatment to be continued according to the called Gleason classification.
One can classify like Gleason 2 10, depending if the cells seem almost normal, Gleason 2 or if they seem very aggressive and malignant, Gleason 10. The most frequent thing when there are symptoms is to diagnose a cancer with an index of Gleason of 7 or of 8.
If the PSA and the number of Gleason with shallows can be chosen for not doing treatment to hope if they rise or you are not code. If the Gleason is 7 or minor usually talks each other with surgery and external radiotherapy or with implants of radioactive virutas inside the prostate. If the numbers are major, what indicates that probably he will not recover can choose not to do anything to itself or to try to brake the cancer with radiotherapy and treatment with hormones.

How does qualify the extension of a cancer of prostate?

There are several classifications that use numbers or letters, of more down to more high place as the extension is minor or major. The most varied is the classification TNM that there are the inicales of tumor, lymphatic nodules (ganglions) and met�stasis. 1 sums this classification up in simpler others like stadiums (or A), when it is located in the prostate it does not give symptoms; stadium II (or B) when the tumor touches by means of a rectal tact, raises the PSA but without extension evidence out of the prostate; stadium III (or C) when the tumor has spread to nearby organs; stadium IV (or D), when the cancerous cells have spread to the regional ganglions or for the blood to distant organs.

How does it talk each other in located cases?

Most of men prefer the resection for surgery to avoid the subsequent dissemination, 3 or more weeks are taken in recovering.
The radiotherapy on the prostate is used in too aged men to tolerate the surgery. If it trumps the radiotherapy, it is still possible to operate. There is introducing a new technology called three-dimensional radiotherapy with which the radiation goes better against the tumor obtaining better healing result with less toxicity.
The implants of radioactive virutas (call braquiterapia) in the prostate is an ambulatory treatment that in expert hands offers serviceability and high numbers of healing. It consists of introducing across the rectum, a few puntitos, like tops of pencil that are radioactive, inside the prostate guided by ultrasound scan.
From these virutas radioactivity is eliminated inside the prostate and this way cancerous cells are eliminated. Nevertheless, it gives short-term urinal problems. It is a promising treatment for the immediate future.

TREATMENT

Which are the disadvantages of the treatment?

Principally the powerlessness that it affects 60 % of patient for injury of nerve pudendo that is the person in charge of the erection, and the urinal incontinence for affectation of nerves of the urethra that happens in 8 % of the cases. These numbers are similar both with the surgery and with the radiotherapy.
If the nerve being able is not injured completely it can work taking Viagra, but if it is completely disabled it will not work. In this one several types of inflatable devices exist case for manual bomb that can do erections artificially. All of them give problems, but it is necessary to choose between being impotent and being alive or without losing the powerlessness and dying.

When is the hormonal treatment indicated?

It is indicated to brake the progression of the cancer when they exist met�stasis over a distance. It is called also a chemical castration since it reduces and annuls the testosterone secretion and this way the cancer is braked. Also it produces side effects as powerlessness and feminizaci�n of the distribution of the fat and the muscles of the body.

What types of hormonal treatment exist?

Fundamentally two: the androgen blockade (that are the masculine hormones) and the administration of estrogen (that are the feminine hormones).
The androgen blockade is obtained first administering a hormone antiandrogenic, that blocks the effect of the natural androgen in the recipients of the cells where they act. Later the androgen source suppresses by means of the orquiectom�a or castration of the testicles for surgery with laying of one testicle prosthesis done of silicone. Another form is the chemical orquiectom�a, which consists of suppressing the testosterone secretion by means of hormones that block this action in the testicles. This is obtained by the similar hormones to which they are segregated in the hypophysis but that do not have the action to stimulate if not of inhibiting the testicles.
The estrogen uses less nowadays that the androgen blockade because they have major side effects than the first ones, like the feminizaci�n and the powerlessness.

How is it known if the treatment works?

In prostate cancer it is relatively easy, since soon they eliminate the symptoms if they existed and it goes down up to normal levels the PSA in blood. Also, also there can be realized several types of radiographies and ultrasound scans to see images of the evolution of the tumor.

PROGNOSIS

What is the prognosis of the cancer of prostate?

It depends on several factors especially of the stadium, this way the stadiums A live free of illness at the age of 5 of the diagnosis through 70-80 % what is equivalent to say that 70-80 % is treated; the stadiums B, 50-80 %; the stadiums C of 15 to 70 % and the stadiums D with met�stasis of 6 to 30 %. In the latter case is riskier to say that the reproductions are treated so beyond 5 years they are frequent.
Other factors that bear worse prognosis are the tumors that they do not answer to hormones, which had invaded the ganglions of the pelvis, which were invading the seminal vesicles, that tumor stayed in the resection margins for surgery and those who had a classification of Gleason superior to 7.

PURSUIT

What control panel and every?

To criterion of the medical specialist. In general, every 3 or 4 months for 3 years, and every 6 months for two more years. Later, once a year. If they had met�stasis every 3 months although they have disappeared.
The control panel will consist of physical examination, blood test for PSA and other things like fosfatasa alkaline or calcium in the whey, and of some occasions, radiological studies.


	On January 17, 2010 home \| map of the place \| subscribe \| I Contact Us Us \| advice adviser