Metastasis to the prostate

Prostate cancer is one of the most common oncological diseases among men. Today, this disease is "getting younger" and is increasingly common in men under 50. There are many reasons for the development of prostate cancer, but the main ones are genetic predisposition, age-related hormonal changes, cadmium intoxication of the body (occurs during welding, rubber production), and the presence of prostate adenoma. The most important and, perhaps, the most dangerous feature of this disease is that prostate cancer is characterized by a very long latent (hidden) course of the disease.

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Prostate cancer and bone metastases

When it comes to stage I and II cancer, the patient has significant chances of recovery, since these stages of cancer mostly do not have metastases and the affected cells do not spread throughout the body. But when cancer reaches late stages - III and IV, then in this case the chances of saving a person's life are extremely small. In this case, the process of metastasis has already begun in the tumor and no surgeon will undertake the removal of prostate metastases that have already spread throughout the body and have begun to develop in other organs. Actually, for stage III and IV prostate cancer, the appearance of metastases in bone tissue is most typical; according to statistics, they appear in 54-85% of all cases.

Metastases enter the bones with the blood flow and most often they appear in the femur, spine, pelvic bones and are characterized by pain in a specific area. The frequency of bone tissue metastases is as follows:

• lumbar region – 59%
• thoracic region – 57%
• pelvis – 49%
• femur – 24%
• other bones – 3%

A distinction is made between osteolytic and osteoblastic metastases of prostate cancer to the bones. Osteolytic ones wash out minerals from the bones, which leads to their weakening and the risk of fractures, while osteoblastic ones, on the contrary, strengthen the mineral component.

Radioisotope scanning is used to diagnose metastases. It is not possible to cure prostate cancer metastases to the bones in 80-90 percent of cases, but it is still necessary to slow the progression of the disease, relieve pain, and maintain stable and appropriate levels of calcium and vitamin D.

Prostate cancer and lung metastases

As the tumor progresses, metastases begin to affect the body more and more extensively. They appear in the retroperitoneal lymph nodes, liver, lungs and pleura. Prostate cancer metastases enter the lungs through the bloodstream or lymph, and in most cases their appearance is characterized by a constant cough, shortness of breath, cough with bloody discharge, pain and pressure in the chest. In some cases, lung metastases can be diagnosed earlier than the cancer itself due to the fact that prostate cancer is often asymptomatic.

To diagnose metastases, computed tomography, chest X-ray, MRI, and biopsy are used. Therapy and treatment of metastases in the lungs in this situation will be aimed at alleviating negative symptoms and slowing down the progress of the disease. Chemotherapy and hormonal therapy allow you to control and stop the growth of prostate cancer metastases, radiation therapy and radiosurgery make it possible to alleviate the symptoms of the disease, in rare cases, when there is only one metastasis in the lungs and it has a clear localization and membrane, surgical intervention is used.

Symptoms of prostate metastases

Symptoms of prostate metastases vary and depend on their location.

The main and most important symptom of bone metastases is pain in any bone, it can have different intensity, depending on the complexity of the disease. Another indicator of bone metastases is hypercalcemia (increased calcium levels in the blood). The reason for this is the leaching of calcium ions from the bones. Hypercalcemia accordingly entails a chain of other symptoms, these are: general and muscle weakness, depressive states, nausea, vomiting, lack of appetite, low blood pressure, sometimes swelling of the lower extremities. It is not relevant to consider these symptoms characteristic of hypercalcemia in all cases, but they can suggest an increase in the calcium level in the blood. When prostate metastases appear in the lymph nodes, the main symptom is their enlargement and soreness. Most often, prostate metastases affect the inguinal lymph nodes. We can palpate the lymph nodes located close to the skin (normally they are not palpable and not enlarged). The situation is more complicated with the intrathoracic and intra-abdominal lymph nodes, which cannot be palpated.

Less frequently, prostate metastases affect the liver and lungs. Symptoms of liver metastases are pain in the right hypochondrium and upper abdomen, nausea and vomiting; symptoms of lung metastases are a pressing sensation in the chest, shortness of breath, cough.

It is important to remember that all of the above symptoms do not always indicate the presence of metastases; it could be any other disease that is characterized by their inflammation.

Prostate cancer and metastases

In most cases, prostate cancer is not characterized by any symptoms, it progresses very slowly, the patient may begin to feel changes in the body only after several years, and often these complaints are associated with the growth of the tumor, the appearance of prostate metastases and their spread throughout the body. Symptoms of prostate cancer metastases are similar to those of prostate adenoma: frequent urge to urinate, difficulty urinating, urinary incontinence, pain in the perineum. Most often, metastases to the prostate spread to the lymph nodes, adrenal glands, lungs, liver, bone tissue of the pelvis, spine and hips.

Regarding the development of prostate cancer itself, it has 4 stages:

• Stage I – the tumor does not manifest itself in any way and can only be examined using a biopsy
• Stage II - the neoplasm is more pronounced and can be examined using ultrasound
• Stage III – the tumor extends beyond the prostate and spreads to adjacent tissues
• Stage IV – the tumor begins to metastasize, prostate metastases spread to other organs and systems

Until metastases appear, it is still possible to remove the tumor, but if prostate metastases are present, there is practically no chance of recovery. The prognosis for prostate cancer is currently negative, due to the fact that 80% of tumors are diagnosed at stages III and IV, when the metastasis process has already begun. To prevent prostate cancer, men over 40 need to undergo an annual preventive examination by a doctor. The problem is that men do not always seek specialist advice in time, which leads to a negative outcome of the disease.

Diagnosis of prostate metastases

Regarding the diagnosis of metastases in bone tissue, radioisotope scanning is used here - a radioactive substance is injected into the patient intravenously, it accumulates in the cells of the metastatic tissue and then the patient is placed in a special chamber, where an image is taken, which clearly shows the focus of the accumulation of cancer cells. If we talk about the diagnosis of other types of metastases, then very often metastases are detected earlier than prostate cancer itself, since cancer often proceeds asymptomatically. In these cases, they resort to the use of MRI, computed tomography, biopsy, ultrasound, and also do an analysis to determine the level of PSA (prostate-specific antigen).

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Treatment of prostate metastases

Treatment of prostate metastases rarely has a positive outcome, since metastases themselves are very difficult to treat, especially if there are many of them and they are chaotically spreading throughout the body along with the bloodstream. Only those metastases that are single, have a clear localization and clear boundaries can be treated. In other cases, treatment will be aimed at alleviating pain symptoms and stopping the development of the disease.

The most popular treatments for prostate metastases are hormonal therapy, chemotherapy, radioactive drugs, and radiation therapy.

• Hormonal therapy consists of lowering the level of the male sex hormone testosterone in the blood, as it stimulates the growth of prostate cells. Hormonal therapy is often combined with the use of radiation therapy and helps to reduce the size of the cancerous tumor, slow its growth and metastasis.
• Chemotherapy is aimed at the use of drugs by the patient that block the development of a cancerous tumor and slow down the process of metastasis in it. But unfortunately, chemotherapy has many negative consequences such as weakening of the immune system and the body as a whole, hair loss and nail loss, and it is used in cases where cancer cells are very active and divide at a rapid rate (which is not typical for prostate cancer).
• Radioactive drugs tend to accumulate in cancer cells and promote their destruction by releasing dangerous chemical elements – strontium and samarium. In some cases, these drugs are combined with chemotherapy.
• Radiation therapy involves directing a radioactive beam to the area where the metastasis is located. It has the ability to kill cancer cells and, accordingly, reduce pain. This method of therapy is most often used to treat bone metastases.

Do not forget that timely detected metastases to the prostate give high chances for recovery, even the most minor symptoms should not be ignored. Annual preventive examination by a doctor will help diagnose the disease and not give it a chance to develop.