Prostate Cancer

Causes and Risk Factors

Prostate cancer arises from a combination of internal and external factors. The main causes and risk factors include:

• Age – the primary risk factor. The risk increases significantly after age 50, and prostate cancer is especially common after age 65.

• Heredity – having a close relative (father, brother) with prostate cancer increases the risk by two times or more.

• Hormonal levels – high levels of androgens (especially testosterone) can accelerate prostate cell division and trigger carcinogenic processes.

• Lifestyle – excess body weight, sedentary habits, chronic stress, and irregular sexual activity increase stress on the prostate.

• Poor diet – frequent consumption of fatty, fried foods, red meat, and lack of fiber create a background for chronic inflammation and cell mutations.

• Inflammatory conditions – chronic prostatitis and other prostate diseases may serve as a foundation for cancer development.

• Environmental exposure – polluted environments, exposure to toxic substances, and radiation increase cancer risk.

These risk factors are particularly relevant in Russia due to rising life expectancy and low participation in preventive programs.

Symptoms and Early Signs

In its early stages, prostate cancer may be asymptomatic, making it especially dangerous. In most men, tumors are found incidentally during routine check-ups. As it progresses, the malignancy may cause:

• Difficulty urinating, especially at night (nocturia)

• Weak or interrupted urine stream

• Feeling of incomplete bladder emptying

• Frequent urges to urinate

• Blood in urine or semen

• Pelvic, perineal, or lower back pain

• Decreased libido, erectile dysfunction

These symptoms don’t always indicate cancer—they may also result from benign prostatic hyperplasia or prostatitis. Still, any of these signs warrant prompt medical evaluation.

Classification

Classification helps determine disease stage, prognosis, and optimal treatment strategy. Two main systems are used: TNM and the Gleason scale.

TNM Classification

The TNM system includes:

• T (Tumor): ranges from T1 (non-palpable, microscopic) to T4 (tumor spreads beyond the prostate)

• N (Nodes): N0 – no lymph node involvement; N1 – metastases in regional lymph nodes

• M (Metastases): M0 – no distant metastases; M1 – presence of distant metastases (e.g., bones, liver)

TNM staging is the global standard used by physicians, including in Russia.

Gleason Scale

The Gleason scale assesses cancer cell aggressiveness based on histology. Two scores (1–5) are given to the most prevalent tissue patterns, then summed (6–10):

• 6 points – low aggressiveness

• 7 points – moderate (3+4 or 4+3)

• 8–10 points – high aggressiveness and rapid progression

The higher the Gleason score, the more aggressive the disease. Both classification systems complement each other and guide personalized treatment planning.

Diagnosis

Early and accurate diagnosis is crucial. Modern methods allow detection even before clinical symptoms appear. Key diagnostic steps include:

• Digital Rectal Exam (DRE) – detects hardening or asymmetry of the prostate

• TRUS (Transrectal Ultrasound) – visualizes the gland’s structure and size

• PSA Blood Test (Prostate-Specific Antigen) – a screening test

• Pelvic MRI – refines tumor location and extent

• Biopsy – confirms the diagnosis and is mandatory if cancer is suspected

Prostate-Specific Antigen (PSA)

PSA is a protein produced by prostate cells. Elevated levels may indicate cancer, inflammation, or benign hyperplasia. The threshold is 4 ng/mL, but levels below this may still be suspicious depending on age and PSA trends.

Annual PSA testing is recommended for men over 45—especially those with risk factors. In Russia, PSA testing is a widely used screening tool and can detect cancer before symptoms develop.

Treatment Methods

Treatment is chosen based on cancer stage, patient age, comorbidities, and Gleason score. Russia offers the full range of modern therapies:

• Surgical Treatment:
  Radical prostatectomy (complete removal of the prostate) is most effective for localized cancer. Performed via open, laparoscopic, or robotic-assisted (e.g., Da Vinci) surgery. Potential complications include urinary incontinence and erectile dysfunction, though modern techniques minimize these.

• Radiation Therapy:
  An alternative or complement to surgery. Includes external beam radiation and brachytherapy (internal). Destroys cancer cells and is used at various disease stages.

• Hormone Therapy:
  Aims to block testosterone, which fuels cancer growth. Used for advanced or metastatic cases. Involves antiandrogens, LHRH analogs, or surgical castration.

• Chemotherapy:
  Prescribed for hormone-resistant cancer or metastases. Modern drugs slow disease progression and improve quality of life.

A combined approach, including surgery, radiation, and hormone therapy, offers the best outcomes. The Marus medical tourism platform supports patients at every stage—from diagnosis to treatment planning.

Prevention

Prevention focuses on reducing cancer risk and enabling early detection. Key recommendations include:

• Regular screening – from age 45, annual PSA tests and urologist visits are advised

• Healthy lifestyle – physical activity, weight control, and avoiding smoking and alcohol benefit prostate health

• Balanced diet – rich in vegetables, fruits, fish, and plant-based fats helps reduce inflammation

• Sexual activity – regular sex promotes healthy prostate function and reduces stagnation

• Chronic disease management – conditions like hypertension, diabetes, and obesity may indirectly raise cancer risk

Family history is also important. Men with affected relatives should begin screening earlier—around age 40.