Prostate cancer is the most frequent neoplasm in men worldwide, with an estimated 1,600,000 cases per year. Fortunately, about 78% of cases are diagnosed when it is still localized, which is why very high cure rates are achieved.
What causes it and what are its symptoms?
When we want to analyze the risk factors that can lead to this disease we find several, of which some generate more debate than others, such as diet, family history, genetic factors of prostate cancer, ethnicity or hormonal factors among others. But the most determining factor is undoubtedly age; the older we get, the greater the risk of prostate cancer clearly increases.
Regarding symptoms, most cases are diagnosed as asymptomatic due to an abnormality detected in a physical examination by digital rectal examination or due to an elevation in PSA levels. Only a small percentage of cases debut with symptoms, which are usually non-specific for prostate cancer such as dysuria, urinary urgency or hematuria among others.
What is the difference between prostate cancer and castration-resistant prostate cancer?
When we refer to prostate cancer, we are talking about everything that comprises and encompasses this disease; on the other hand, when we refer to castration-resistant prostate cancer (also known as CRPC) we are focusing on a specific moment or situation within this pathology.
Sometimes, due to the progression of this cancer, it is necessary to start an androgen deprivation treatment or more commonly known as “hormonal treatment” with the aim of reducing the levels of testosterone in the patient, causing castration by means of injections every 3 or 6 months. The aim of this treatment is to delay the progression of the disease as much as possible.
Why is it “resistant”?
It is called resistant because, with the passage of time, this neoplasm manages to “evade” the brake that this castration entails and it begins to be observed that the disease begins to progress both at the level of PSA and at the level of the findings in the different radiological tests.
How can this type of cancer be treated?
In recent years there have been many changes and advances in this scenario called castration-resistant prostate cancer, mainly thanks to the appearance of new treatments. Although there are several options, the best known are the so-called second-generation hormonal therapies such as enzalutamide or abiraterone acetate. On the other hand, we also have chemotherapy with docetaxel.
I have prostate cancer, should I have surgery or radiotherapy?
When looking for information on the existing treatments for prostate cancer, we find several options that are very different from one another.
On the one hand, we see that there are surgical options, such as open radical prostatectomy, laparoscopic radical prostatectomy, robotic radical prostatectomy with Da Vinci, etc.
On the other hand, there are options for treatment with radiotherapy to cure prostate cancer. Within radiotherapy we find external radiotherapy applied by means of 3D technique, IMRT, hypofractionation or SBRT. In turn, we can opt for brachytherapy, which can be administered by high rate (HDR) or low rate (LDR); perhaps the latter is more commonly known as “seed brachytherapy”.
Generally speaking, all prostate cancer can be treated with radiotherapy or surgery. But very few patients seek a second opinion with a radiation oncologist after evaluation by a urologist.
Every patient diagnosed with prostate cancer should receive the assessment and opinion of a urologist and a radiation oncologist; each one explaining in detail the best treatment option for his case with its risks and benefits and then the patient being able to choose freely after weighing all the information received.