Symptoms, Diagnosis and Treatment of Prostate Cancer

Prostate cancer is the most common cancer among men and therefore, knowing its symptoms is one of their main concerns. Those who suffer from it usually present difficulty in urinating and a reduction in the time between urination. However, it is important to note that these are symptoms of prostate enlargement, not cancer.

What is the prostate?

The prostate is a gland of the male sexual apparatus that is located at the exit of the bladder and surrounds the urethra like a kind of necklace. The prostate tends to grow with age and as it grows it will compress the urethra making it difficult to pass urine. This disease is called benign prostatic hyperplasia and is due to the natural growth of the central part of the prostate. Apart from this disease, the prostate can have in the peripheral zone, in the most glandular zone, malignant transformations that develop the so-called prostate cancer, which is the most frequent cancer in men.

What are the symptoms of prostate cancer?

Prostate cancer itself has no symptoms, the symptoms derived from prostatic growth are difficulty in urinating, getting up more often at night, a reduction in the time between urination, but prostate cancer, as it starts in the most peripheral part of the gland, only produces these symptoms when it is already very large. For this reason, it is essential to carry out periodic check-ups for early diagnosis.

What diagnostic systems are available for prostate cancer?

For the diagnosis of prostate cancer we first make a diagnosis of suspicion by means of digital rectal examination and blood determination of prostate-specific antigen, the famous PSA. Lately we have also included urine determination of PCA3 and genetic sequencing of the BCRA2 gene. All these data give us a diagnosis of suspicion that we have to endorse by performing a prostate biopsy. The problem we have with prostate biopsy is that almost 30% of ultrasound-guided biopsies give false negatives, i.e., they do not diagnose patients with tumor present. To improve this, although MRI or Pet-Colin has been used, it is still not absolutely definitive. The best option to improve the cost-effectiveness of biopsies is to perform histoscanning analysis. Histoscanning is a new diagnostic method in which we perform an ultrasound scan and by means of software we locate the areas most suspicious of having a tumor. These areas are colored, they appear in a color code, which allows us with the transrectal ultrasound to merge both images and take samples of the suspicious areas. Thanks to this method we reduce the uncertainty from the 30% we had mentioned to only 5%, thus improving early diagnosis.

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What surgical techniques are available to combat prostate cancer?

From the surgical point of view we currently have 2 fundamental techniques, on the one hand cryotherapy or freezing of the prostate, which makes sense, above all, in those patients in whom previous radiotherapy or brachytherapy has failed. With respect to the standard technique, radical prostatectomy, which consists of removing the entire prostate and making a junction between the bladder and the urethra, performing this technique by means of a laparoscopic or robotic approach allows us to better preserve sexual potency and continence. In cases where we perform the surgery with a previous histoscanning we improve even more this preservation since we can adapt the safety margin necessary for the patient’s cure to the characteristics of the patient and his tumor.