PROSTATE CANCER

Prostate cancer is the male reproductive system common malignancy. Prostate below the bladder in a chestnut-shaped gland, in the middle through the urethra. It is the secretion of sperm liquid nutrient solution is a component of semen. Benign prostate enlargement and prostatitis produce similar symptoms and cancer. Prostate cancer mainly primary site for posterior subcapsular gland, was latent slow growth, a tumor hours without any clinical manifestation. Thus the advanced prostate cancer generally only show symptoms. A clinical disease duration and often asymptomatic B, C obstructive symptoms of a period, and D both distant metastasis obstructive symptoms have symptoms.

[Transfer and disseminated]

The higher the degree of malignancy of prostate cancer, early local infiltration will be clear and lymph node metastasis and tumor often violated seminal vesicle and bilateral lesions, few violations of the rectum. Along the lymphatic metastasis to the nearby pelvic lymph nodes, then transferred to the internal iliac, the skeleton, abdominal aortic adjacent mediastinal lymph nodes, and supraclavicular lymph nodes. Prostate cancer can fool to bone metastasis, the most common is the pelvis, lumbar spine, femur and ribs. Blood Road also can be transferred to the lung, liver, kidney, brain and other organs.

A digital rectal examination
Because prostate cancer occur in the prostate gland posterior subcapsular leaves, it digital rectal examination in the diagnosis of prostate cancer accounted for a very important position on prostate cancer diagnosis and staging of vital significance. Checks should pay attention to prostate size, shape, whether irregular nodules, prostate volume expansion of the central sulcus, glandular activity, hardness and seminal vesicle, and so on. If it refers to the seizure, in prostate cancer as well. More patients aged over 50. Generally, prostate cancer nodules in hard as a rock, uneven, central sulcus disappear glands fixed, and even direct violation of the wall. But the difference was significant, infiltration and larger lesions may change as the relatively soft. Checks need attention.
2, laboratory examination and inspection Radioimmunoassay
1. Serum acid phosphatase (ACP), alkaline phosphatase (AKP), both of prostate cancer are increased, particularly in the diagnosis of prostate cancer ACP more sensitive, 65% distant metastasis ACP increased without distant metastasis were 20% of the ACP increased. If using radioimmunoassay ACP, will enhance the early diagnosis of prostate cancer, the positive rate was 73.7%. As the disease and the development of its positive rate also increased. Can be used to monitor the progression of prostate cancer. But ACP determination may have false-negative and false, but not rectal examination and urethral inspection within 24 hours after the inspection. Attention should be.
2. Smear prostatic fluid cytology examination of this high accuracy rate, it is reported up to 86%, but may cause prostate massage proliferation of prostate cancer, should not be used as a clinical method.
3. Benign prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) screening PAP detection sensitivity and specificity than ACP high. But since PSA testing after the application has been replaced. PSA is produced by the prostate epithelial a sugar protease, normal serum PSA less than 5 μ g / L, when more than 10 μ g / L, to consider the possibility of prostate cancer. PSA has become a cancer diagnosis before the sensitive indicators. But not because of their high specificity, clinical use is subject to restrictions. In recent years the percentage of free PSA determination, a sensitivity and specificity of PSA increase.
3, ultrasonic inspection
With the special insert rectal ultrasound probe, the prostate can cut loose screen, reflecting lights up the lesion area. In B-rectal ultrasound probe developed into three-dimensional image-focused, to enhance diagnostic value. Prostate cancer ultrasound examination showed inhomogeneous internal reflection in the light, hypoechoic region or group of Spot. Advanced prostate cancer, not for reflection coated tumor and surrounding tissue boundaries unclear, suggesting that a local infiltration, and the envelope infiltration degree classification for diagnosis. This objective can be increased to the extent that prostate Institute and State. Because of this examination is painless, non-invasive inspection, it can be used for early diagnosis.
4, X-ray inspection
(1) imaging
1. Prostate contrast to the perineal prostatectomy puncture injection B iodine tablets pelvis after perturbation, that the entire prostate, prostate can be found in isolated, less than a finger touch nodule. Method: Local anesthesia after disinfection, the finger guided by the puncture to the perineal prostatectomy, the first injection of Lipiodol 0.2ml B] after pelvic tablets to determine puncture in the prostate after injection of Lipiodol 2 ~ B treatments. Because a majority of only puncture the side of the prostate that, it takes the same approach for prostate screening with the other side.
2. IVP right understanding of the situation is necessary urinary tract, and may provide clues to the spread of prostate cancer. After voiding X-ray can show noninvasive residual urine volume. If a urinary tract showed that the water is suggested that the former has advanced adenocarcinoma, affecting bladder triangle bilateral ureteral orifice urine drainage.
3. Lymphatic angiography in the diagnosis of prostate cancer has some value to speculate on lymph node metastasis of prostate cancer, prognosis and treatment of the development are of great significance. It is reported up to 86% accuracy rate. But the dorsal lymph angiography can show that the earliest obturator lymph node metastasis and internal iliac lymph nodes, angiography showed 1cm when filling defect can be diagnosed over the transfer. The difficulty that small metastases. Therefore methods in clinical application is limited.
(2) the skeletal system and lung X-ray
Because prostate cancer often have bone metastasis and lung metastasis, it chest and bone X-ray examination of the importance of cancer staging. Although the body can transfer any bones, pelvic and lumbar but is the most common site of metastasis early. Skeletal radiography inspection system should include the pelvis, spine, ribs, femur, skull, X-ray showed a bone or osteolytic performance. All right chest X-ray lung metastasis judgment significance of X-ray often shows massive shadow or miliary shadow.
5, CT and MRI
The fault resolution factors and the reasons for the smaller early diagnosis of prostate cancer often do not, but to determine local tumor invasion and lymph node spread of advanced local help. Prostate cancer can be carried out in phases to help the anti-election reasonable treatment and prognosis.
6, radioactive nuclear scan (ECT) Checks
Radionuclide scanning used to diagnose prostate cancer bone metastasis than X-ray found bone metastases as early as six months time around. Recessive bone metastases particularly sensitive. The patients were followed up and prognosis, than for bone scans or X-ray inspection of serum acid phosphatase higher sensitivity.
7, prostate aspiration biopsy
Prostate cancer depend on the final pathological diagnosis. In a partial-proliferation and metastasis, a prostate biopsy within sclerosis, and early diagnosis can be made. The original finger-guided prostate puncture, because sometimes inaccurate puncture position, the positive rate is not high. Application in prostate ultrasound-guided puncture, accuracy greatly enhanced. Transperineal prostate puncture accuracy rate of 86%, transrectal prostate wear up to 80% ~ 95%.

One, Pathogenesis
(1) Causes
The cause of prostate cancer has not yet entirely clear, but sex hormone and prostate cancer relationship is clear. Estimates may be circulating estrogen and the hormone imbalance, in particular the male hormone changes. Puberty that will not happen with testicular prostate cancer. Androgen suppression can be dissipated to prostate cancer. In patients with liver cirrhosis, liver Inactivation of estrogen decline, increased levels of estrogen and thus the incidence of prostate cancer is not high. Prostate cancer is infection with environmental pollution and there is a certain relationship. Excessive use of alcohol and coffee also the incidence of prostate cancer increases. At the same time, there are familial prostate cancer incidence trends.

1) A period of the disease: A period of the lesions were completely confined to the prostate, small volume, no symptoms, only occasionally, in search of discovery. No local or distant spread, and difficult to detect clinically. Only through autopsy by the pathology of prostate hyperplasia or biopsy specimens removed specimens made of the inspection. Lesions limitations and cell differentiation good, growth is slow, DRE examination can not be touched nodules, lesions without metastasis of this period accounted for about 9% of prostate cancer. Prospective and retrospective studies show that a period of generally good prognosis, in the majority of patients do not progress to clinical lifetime cancer or hidden cancer.

Features
All the tumors were malignant prostate, and the overwhelming majority of glands in peripheral adenocarcinoma of the gland. It mainly occurs in men over the age of 50, occasionally occurred in young people and even children.

Autopsy results showed that with the increase of age, the incidence of prostate cancer has increased, but the more extensive histology higher morbidity. Prostate certain regions more vulnerable than other parts of malignant transformation. Implementation of the United States had 208 cases of total prostate cancer early clinical case study, they found that 97% of prostate cancer occurred in peripheral areas or peripheral Center district, which also proved a little past some of prostate cancer in the prostate center of the conclusions.