Prostate cancer

What is it

The prostate is a gland of the male reproductive system located in front of the rectum and under the bladder. The prostate surrounds the urethra, the tube that carries urine.

Under normal conditions it is the size of a walnut. Among its functions is to produce part of the sperm fluid.

When the prostate increases its size, two situations can occur: one benign (prostatic hypertrophy) and the other malignant (prostate cancer).

Prostate cancer cells can leak out of the gland and travel through blood or lymphatic vessels. In this way they reach other parts of the body and can generate metastases.

One of the parts of the body most affected by prostate cancer metastases is the bone apparatus.

Types of cancer

Through a biopsy, a small part of the tumor tissue of the prostate is taken. The examination is used to define “how much” the tumor tissue is different from the normal one.

Prostate tumors with a high degree of differentiation tend to grow fast and metastasize with high probability. Depending on the grade of the tumor, there are different treatment options.

The most used system to measure the grade of the tumor is the Gleason scale, which ranges from a value of 2 to 10, the highest value.

The stage of the tumor instead indicates the extent of the prostate neoplasm and quantifies the metastases.

Diagnosis

• Psa: it is measured with a simple blood sample. The abbreviation indicates the specific prostate antigen, a molecule produced only by prostate cells. By themselves, high values of this marker do not necessarily mean the presence of a tumor. In fact, PSA can grow as a result of inflammatory processes, frequent sports or even sexual activity. What is generally considered most important in the evaluation of PSA is the trend over time of its value.

To determine the stage of the tumor, the following tests are used:

• Rectal exploration: the urologist, with his hand covered by a lubricated glove, introduces a finger into the patient’s rectum, through the anus. In this way it can assess the volume and consistency of the prostate, as well as the possible presence of suspicious nodules. In some cases, a transrectal prostate ultrasound may be appropriate, using a thin probe introduced into the rectum.
• Bone scintigraphy: it is a very sensitive diagnostic imaging technique. It is used to detect the presence of cancer cells in the bones. It is performed by injecting a radiopharmaceutical into a vein in the arm and, after about three hours, the examination is carried out.
• Computed tomography (CT): it is a diagnostic imaging technique that allows to detect the presence of a tumor and metastases in most organs of the body.
• Magnetic resonance imaging: it is a diagnostic procedure similar to CT. It differs in the use of magnetic fields instead of X-rays to create a series of images of the organ being examined. Like transrectal ultrasound, it is performed by inserting a probe through the anus.

Stages of cancer

They are indicated by Roman numerals, from I to IV. The stage of the tumor may depend on these factors:

• metastatic invasion of nearby tissues (rectum, bladder, etc.)
• metastatic invasion of lymph nodes or other parts of the body (bones)
• value of the Gleason scale
• Psa level

Therapies

There are several approaches to treating prostate cancer:

• Active surveillance
• surgery
• radiotherapy
• hormone therapy
• chemotherapy
• immunotherapy

The choice of treatment depends on several factors:

• Age of the patient
• value of the Gleason scale
• stage of prostate cancer
• symptoms
• General health conditions