Prostate Cancer (Part One)

In this informative article, data on prostate cancer, diagnosis, and treatment will be provided, claiming that this data is valuable for recognizing and diagnosing this common disease in the male sex in a timely manner. To realize this information, reliable sources from contemporary foreign and Albanian literature have been utilized.

For individuals affected by this disease as well as for their family members, being informed about this pathology creates a state of shock. The usual way of life changes unexpectedly, combining the state of fear with that of hope.

Prostate cancer also influences the sexual sphere. But every man perceives his state of sexual incapacity in his own way. Some men find it difficult to talk openly about their sexual abilities. However, if problems are not made known and identified, it will be difficult to find proper solutions from the doctor as well as from the partner. For this reason, it is recommended that sexuality issues are discussed with the treating physician before starting therapy.

Today, thanks to the possibilities of early diagnosis and the advances in medicine, treatments have become more effective and less invasive. To find the best treatment for a specific case, close communication with the doctor is necessary.

In many cases today, prostate cancer is curable, in other cases the course of the disease can be slowed down and the quality of life improved.

We hope that this data influences those affected by this disease, their family members, the treatment team, and specialists, to find ways to cope with this disease and its consequences.

According to Albanian doctors, “men die with prostate cancer, but not from prostate cancer. First we say these words to remove the chills caused by this pathology in these patients”. (Ultrasound Assessment in Prostate Diseases. Prostate Cancer. A.Gjokutaj; A.Hoxhaj; E.Enesi; E.Isufi; Sh.Beqiri) 2006.

Incidence and Etiology

In most Western countries, prostate carcinoma is among the most common tumors in the male sex. Recently, an increase in the incidence of prostate carcinoma has been observed, which currently in Western countries occupies the second place among tumors in the male sex. In some countries, such as the United States and in Scandinavian countries, prostate carcinoma is the most common tumor in males. In the European Community countries, the incidence of prostate carcinoma is 55 cases per 100,000 inhabitants and mortality is 22.6 deaths per 100,000 inhabitants.

Genetic factors are responsible for the increased incidences in cases with family history. The incidence of the disease varies among human races. For instance, the incidence is high in the Black population in the United States; conversely, in some countries in South-East Asia, the incidence is very low, 10 times lower than the incidence in North America as well as in many European countries. In 1997, an incidence of 137 per 100,000 African-Americans and 2 per 100,000 Chinese in Shanghai was recorded. (Scientific bases for the definition of clinical guidelines for prostate tumors. Coordinator: Francesco BOCCARDO, Genova. Study Group: Michele BATTAGLIA, Bari et al.) 2004.

Currently, there is no doubt that the etiology of prostatic carcinoma is multifactorial and influenced by genetic and environmental factors as well as by age, for the hormonal situation of subjects at risk.

According to a 10-year study conducted by urologists at the University Hospital Center of Tirana (UHCT) referred in May 2007, out of 299 studied cases, it was observed that 12% of the sick belonged to the age group 50 – 60 years, 48% were in the ages 60 – 70 years, and 40% of the patients studied belonged to the age group over 70 years. (Ultrasound Assessment in Prostate Diseases. Prostate Cancer A.Gjokutaj; A.Hoxhaj; E.Enesi; E.Isufi; Sh.Beqiri).

The factors that can cause prostate tumor are largely unknown. However, the causes that favor the appearance of this pathology are well known: Diet, obesity, and lifestyle play a role in the affliction of the prostate. Elderly men can reduce the risk of being affected by this disease through light physical exercise, even by applying walking in nature for at least 30 to 60 minutes a day. A study published in the “Journal of Urology” shows that people who walked 3 to 6 hours a week, reduced the risk of prostate cancer by 66%. It has been noted that men who used medication (statins) against cholesterol had a lower risk of having prostate carcinoma.

The belief that an enlarged prostate from Benign Prostatic Hyperplasia (BPH) can transform into cancer has no scientific confirmation.

Age and Ethnicity

The incidence of the tumor increases with age; the tumor is very rare below the age of 45, while after this age the incidence increases progressively. Studies have shown that most men affected by prostate tumor are over the age of 60, while the average age of patients at the time of diagnosis is 70 years old. However, many men never become aware that they have this type of tumor.

In the USA, the incidence is higher in men of Afro-American ethnicity.

Family History

It is now verified and accepted that the risk of being affected is higher in individuals who have had close relatives with prostate carcinoma, and it increases proportionally with familial closeness. Men who have a first-degree relative who has had prostate cancer have a 50% higher probability of having it compared to those who do not have cases in the family. Individuals with a family history of prostate tumor should undergo periodic checks (Bostwick 2004).

Dietary Factors

The Western lifestyle, especially a diet rich in fats (especially of animal origin). (Gao 2005).

Hormonal Factors

Androgens play an important role in the development of the normal prostate as well as in the treatment of prostate carcinoma. It is assumed that high levels of testosterone and Dihydro-testosterone over a long time may increase the risk of prostate carcinoma.

Other Factors

Other factors have been accused as triggers, but not fully confirmed, such as: environmental factors, tobacco, alcohol consumption, physical activity, sexual activity, socio-economic factors, etc. (Bostwick 2004).

In 70% of cases, adenocarcinoma originates from the peripheral part of the prostate, usually with posterior localization (backside). For this reason, the digital rectal examination takes on special diagnostic importance because this area is palpable through this examination. In about 20% of cases, adenocarcinoma is localized in the antero-medial position. The central zone is rarely the area where the tumor is localized, with about 5% of cases.

The natural evolution of the disease continues with local spread within the gland itself and then infiltration into the seminal vesicles, the neck of the urinary bladder, and the prostatic urethra, manifested by obstructive phenomena with difficulty in urination, frequent urination (polyuria), and sometimes even blood in the semen (hematospermia).

In advanced stages, there is also infiltration into the pelvic diaphragm, in the rectum, manifested by tenesmus. Metastases can spread through the lymphatic route and through this route infiltrate pelvic and para-aortic lymph nodes, whereas through the hematological (blood) route, metastases usually develop in the lumbar vertebral column and less frequently in the thigh bones, in the pelvis, and in the ribs.

Symptoms

In the early stages, symptoms are like those of Benign Prostatic Hypertrophy with urinary symptoms:

• Frequent urination, especially at night.
• Weak urine flow.
• Intermittent urine flow (difficulty starting urination or interrupted urination).
• Pain or burning during urination.
• Blood in urine or in seminal fluid.
• Difficulty in erection.

Almost all types of prostate cancers are adenocarcinomas.

In advanced stages, there may be additional signs in different parts of the body. The most common sign is bone pain, often localized in the spine, pelvis, or ribs, caused by metastases in these areas.

Prostate carcinoma presents a significant oncological problem for public health; it occupies the third place of deaths from tumors in males. Its incidence is increasing in many countries around the world, but mortality from it has remained stable, this as a result of the dissemination of information about this tumor, which has led to early checks and the disease being diagnosed in the early stages.