Is it worthwhile to diagnose and treat prostate cancer?

The diagnosis of prostate cancer has been varying and not all health professionals agree with prostate cancer screening and the PSA study. Dr. Pablo Juarez del Dago Anaya, expert in Urology and awarded a scholarship by the Spanish Association of Urology to study in a foreign center, explains the different views on the diagnosis of prostate cancer.

Prostate cancer is the second cause of death by cancer in men, more than two million men live with it in Europe, many of them without knowing it. Every year, more than 92,000 men die of the disease on the continent.

In the 1970s, Dr. Richard J Ablin discovered the PSA (Prostate Specific Antigen) protein and its relationship with prostate cancer was established.

In fact, PSA is not a specific marker of cancer, it is only a protein that serves to dissolve the seminal clot and is released by the prostate glands, which is why it can be increased in different situations (due to prostatitis, benign growth, after sexual intercourse, just because…) but also in the context of prostate cancer. The job of the physician and above all of the urologist is to discern between the different causes of increased PSA and to rule out life-threatening causes.

It is relevant to highlight the trend in medicine advocated by some studies, many of them in prestigious urology journals, where articles have recently been published that advise against studying PSA in men, using the Screening technique, to find prostate cancer. The study argues that according to statistics the different treatments currently in force for radical prostatectomy and radiotherapy only slightly increase the life span of the patient, who must cope with the side effects to a greater or lesser extent (incontinence and/or erectile dysfunction).

This idea is not new. In 2011, the USPSTF (United States Preventive Service Task Force), a body that functions as the United States Social Security, issued a statement advising against prostate cancer screening and PSA testing.
This document was issued by internists, pediatricians, family practitioners, gynecologists and nurses without any urology specialist or oncologist as a participant, who are currently the specialists in charge of the treatment of this pathology that they share.

As might be expected, the statement caused a stir in the healthcare sector and in 2013 it was officially refuted at the international meeting of the PCWC (Prostate Cancer World Congress Consensus States). At the congress, professionals claimed that abandoning the PSA study would increase the number of advanced prostate cancers, setting back three decades of research.

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Recently, one of the most prestigious scientific journals in the world has once again defended this idea with data that, although not false, may be misinterpreted. The return to this refusal to study PSA is a concern for specialists, who fear that general practitioners, primary care physicians and other professionals will stop requesting it in check-ups.

Prostate cancer is a very variable disease; there are very aggressive cancers that kill patients in a short time and others that are indolent and therefore live with the patient without shortening his life.

It is true, and this is the basis of these “fashions”, that in the past the fear of the disease meant that it was dealt with in a more radical way, with more side effects and with the consequent worsening of the patients’ quality of life.
Today, technology and science have advanced towards a much more precise diagnosis and a more accurate prediction that allows a personalized treatment to be decided for each patient. This “medicine a la carte” has much higher quality, more effective and more precise treatments, both in terms of radiotherapy and surgery, which, thanks to laparoscopy and robotics, minimize side effects. New techniques, such as focal therapies, which would further reduce side effects and improve life expectancy, are already being developed and are gaining momentum.

Adequately treating this disease improves the survival and quality of life of patients, a fact that is reflected in the data and medical experience. On the other hand, it is the patient’s responsibility to go to a good specialist, to get information from different sources and to ask for second opinions if necessary, after all, he/she is the main person involved. The wide range of variables in this disease makes it difficult to choose the optimal treatment for each case, more or less invasive depending on the cancer.

Just as it is the patient’s responsibility to be treated by expert and experienced hands, it is the responsibility of medical professionals to be committed to training, investment in knowledge, adaptation to technology and even recycling, in order to deal with a pathology as transcendental as prostate cancer, guaranteeing a treatment that ensures the best possible results from the health sector.