Taking into account the stage of the tumor, surgical treatment, radiotherapy (remote or interstitial), chemotherapy can be undertaken. The use of different approaches is primarily due to the prevalence of prostate cancer.
Minimally invasive methods. Includes HiFu therapy, prostate brachytherapy, cryoablation. They can be used in patients with low oncological risk or in those patients who cannot perform prostate removal for medical reasons. However, when these techniques are used, the likelihood of relapse is higher than with a radical approach.
Radical prostatectomy. The main type of surgical intervention for prostate neoplasm is radical prostatectomy, during which the gland, seminal vesicles, prostatic urethra and bladder neck are completely removed; lymphadenectomy is performed. Radical prostatectomy may be accompanied by subsequent urinary incontinence and impotence. Modern surgery is gradually moving away from open surgery. Laparoscopic and robotic-assisted prostatectomy is becoming increasingly common practice.
Androgenic blockade. In order to induce androgenic blockade in prostate cancer, testicular enucleation (bilateral orchiectomy) can be performed. This operation leads to the termination of the production of endogenous testosterone and a decrease in the rate of growth and dissemination of the tumor. In recent years, instead of surgical castration, drug suppression of testosterone production by LHRH hormone agonists (goserelin, buserelin, triptorelin) has been used more often.
Drug therapy. Hormone and chemotherapy can be used after prostate removal and in patients who cannot be operated on
The scope of examination required to detect prostate cancer includes digital examination of the gland, determination of PSA in the blood, ultrasound and ultrasound of the prostate, and prostate biopsy. Digital examination of the prostate through the rectal wall determines the density and size of the gland, the presence of palpable nodes and infiltrates, and the localization of changes (in one of both lobes). However, only with the help of palpation it is impossible to distinguish organ cancer from chronic prostatitis, tuberculosis, hyperplasia, prostate stones, therefore, additional verification studies are required:
PSA study. A common screening test for suspected prostate cancer is the PSA level in the blood. Urology oncology specialists are guided by the following indicators: at a PSA level of 4-10 ng / ml, the probability of cancer is about 5%; 10-20 ng / ml – 20-30%; 20-30 ng / ml – 50-70%, above 30 ng / ml – 100%. It should be borne in mind that an increase in prostate-specific antigen values is also observed in prostatitis and benign prostatic hyperplasia.
Ultrasound of the prostate. It can be performed from a transabdominal or transrectal approach: the latter allows even small tumor nodes to be detected.
Transrectal prostate biopsy. It is performed under ultrasound control. The material is usually taken from 12 points (6 from each lobe of the gland). It is carried out through the rectum, usually under local anesthesia.
Saturation biopsy. It is performed with a transverse approach under spinal anesthesia. During the procedure, more than 12 tissue samples are taken.
Fusion biopsy of the prostate. A special computer program processes the MRI data of the prostate, which allows you to target tissue sampling from a suspicious area. It is done both through the perineum (spinal anesthesia) and transrectally (local anesthesia).
Additionally, testosterone levels can be determined, abdominal ultrasound, skeletal scintigraphy, lung radiography.
Forecast and prevention
The outlook for survival depends on the stage of the oncological process and tumor differentiation. A low degree of differentiation is accompanied by a worsening prognosis and a decrease in the survival rate. At stages T1-T2 NOM0, radical prostatectomy promotes 5-year survival in 74-84% of patients and 10-year survival in 55-56%. After radiation therapy, 72-80% of men have a favorable 5-year prognosis, 48% – 10-year. In patients after orchiectomy and undergoing hormone therapy, the 5-year survival rate does not exceed 55%.
It is not possible to completely exclude the development of prostate cancer. Men over 45 years of age need to undergo an annual examination by a urologist for early detection of neoplasms. Recommended screening for men includes rectal digital examination of the gland, TRUS of the prostate, determination of PSA in the blood.