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Adenocarcinoma Prostatico

The mortality rates have remained almost unchanged in the recent decades with an increase of prostate cancer in recent years, done probably related to a greater efficiency and concern about the diagnosis in stages early and the increase in the half-life of the population.

The cause of prostate cancer is unknown, in the same possibly several factors, such as age, racial – genetic, hormonal and environmental concerns.

The age is without doubt the factor of greater influence in the emergence of prostate cancer, the incidence increases proportionally with age, most of the cases are diagnosed after 50 years, being exceptional before 40 years, increasing its frequency from the 60 years, coming to be present in the 30 % of individuals between 70 and 80 years and in up to 70 % in the age of 80.

The hormonal factors seem to play a role in the development of prostate cancer, was that the same does not occur in individuals castrated by any circumstance before puberty, with low incidence in patients with hiperestrogenismo by liver cirrhosis and in response to the medical treatment of estrógenoterapia.

Adenocarcinoma Infiltrante

It was not shown on a direct with the diet (excess consumption of fat and red meat), venereal diseases, sexual habits, smoking or occupational exposures. There is no convincing evidence of predisposition to prostate cancer by benign prostatic hyperplasia, although both coexist frequently.

It was not shown on a direct with the diet (excess consumption of fat and red meat), venereal diseases, sexual habits, smoking or occupational exposures. The prostate cancer tends to be located predominantly peripheral level glándular (adjacent to straight), region and subsequent posterior-side in a 75 % of the cases, 15 % central area and 10 % 15 % in transitional area.

The localized prostate cancer at peripheral level may be palpable through digital rectal examination as nodule firm or induration woody.

Histologically 95 % of the cancerous prostate adenocarcinomas are derived from acinar cells and tend to be multifocal in a 85 % of the cases.

Patients with prostate cancer to be diagnosed in most of the times develop a clinic obstructive, similar to that produce the prostatitis or prostate hyperplasia benign, the symptoms miccionales are essentially polaquiuria (emission abnormally frequent urine) day and night, decrease of force and caliber of voiding jet, chronic retention incomplete of urine and hematuria (voiding bleeding, more rare). 

Screening – Early Detection or Secondary Prevention of Prostate Cancer

The american association of cancer and the american association of urology believe that the evidence of early diagnosis of prostate cancer can save lives because:

(1) The prostate cancer is a problem of important public health.

2) Is the tumor more frequent.

3) Is the second cause of death.

4) Mortality has remained unchanged in recent decades.

5) 50 % of tumors are extended beyond the prostate when they are diagnosed.

6) The tumors spread (spread) cannot be cured by the ineffectiveness of the treatments in advanced disease.

7) The most tumors diagnosed by evidence of screening are usually located in the body (prostate).

The American Cancer Society suggests:

The men of high risk of prostate cancer as the individual African-Americans and men with relatives of first degree with prostate cancer (father, brother, uncle) at early ages, should initiate the screening from the 45 years.

Procedures for Early Detection of Prostate Cancer Include:

• Rectal

• transrectal ultrasound

• Determination of the antigen prostate specific (PSA) in blood (in several of its forms)

Digital rectal examination

Being the prostate a body part accessible to the exploration digital by their neighborhood anatomical rectum, rectal is one of the methods of choice in the early diagnosis of prostate cancer, carefully made a series of useful parameters to establish the clinical suspicion, sensitivity, size, consistency (nodule or area indurated), glandular limits and mobility.

The sensitivity diagnosed of rectal examination for prostate cancer varies between 50 and 75 %. To be a rectal examination a method practico, efficient and economical diagnostic early prostate cancer, should be carried out on a systematic and regular (annual) to every male that exceeds 50 years. A rectal examination should not be abandoned because it can detect some cancers of the prostate associated with a PSA serica normal.

It is of choice on the abdominal, not eliminating this last. The images ultrasonic transrectales with transducer of high-frequency to obtain the measures glandular, volume, ecoestructura internal, evaluating injuries iso, hiccups and hiperecogenicas, litiasis, cysts, etc, delimitation capsular prostate (Continuity, symmetry, lack of delimitation, broken, tumor permeation capsular) and commitment of seminal vesicle, serving also as a guide for obtaining prostate biopsies transrectales, in patients with PSA serica high or rectal abnormal or both.

The correlation ecografica and pathological studies suggest that approximately 70 – 75 % of the cancerous prostate are hypoechogenic and 25 to 30 % are isoecogenicos.

Determination of the Antigen Prostate specific (PSA) in Blood

The PSA is a protein substance (protease) produced by cells are prostate (acino-ductal) normal and neoplastic. Its function is the dissolution of seminal clot and its production depends on the presence of androgens and the size glandular, is practically a protein synthesis of exclusive prostate, a tiny fraction of the same passes blood circulation, which is dosada for diagnosis, prediction and monitoring of prostate cancer.

Infarto Prostatico

The lifting of the PSA is proportional to the tumor mass this far more advanced than the process tumor will be more frequent find values above the normalcy and these tend to be higher.

Using jointly by the PSA and rectal can discover more than 60 % of the cancerous prostate that still are located within the gland.

Infarto Prostatico

When developing a prostate cancer PSA levels increase above 4 ng/ml, if PSA levels are among 4 and 10 ng/ml the likelihood of having prostate cancer (positive predictive value) is a 20 to 30 %, if PSA levels are older than 10 ng/ml is 42 – 71 % and increases PSA levels increase as well.

If the PSA level this high is recommended biopsies of prostate a prostate cancer.

The PSA can help predict whether the cancer was confined to the gland or outside it, if the PSA level is very high cancer probably exceeded the levels of the gland. The PSA serves to monitor whether the treatment was effective after surgery or radiation, a rise later in the PSA can mean that there are remaining cancer or has recurred. The PSA can indicate the effectiveness or failure of a hormonal treatment.

They know that the PSA this usually higher in older men in the young people, even in the absence of cancer, so that the cutoff point of normal levels are on the increase with age. The reference values normal PSA serico vary according to the various laboratories.

Ranges of Reference According to Age:

30 – 40 Years     ——————    0 to 1.5 ng/ml

40 – 50 Years     ——————    0-2 ng/ml

50 – 60 Years    ——————-   0 to 3 ng/ml

60 – 70 years    ——————-   0 to 4.1 ng/ml

More than 70 years  ————   0 to 4.4 ng/ml

PSA levels range at random in the order of 15 % in an individual.

PSA levels can increase by many factors such as: benign prostatic hypertrophy.

Prostatitis

Infarction prostate

prostate biopsies

urinary tract infections

recent urinary catheterization

Operation recent urinary tract.

A rectal examination does not alter significantly PSA levels.