Prostate cancer, a symptomless pathology

About 29,000 men suffer from prostate cancer every year in Spain. It is currently one of the most common cancers. It is usually detected through a routine check-up, since it does not usually present signs or symptoms. The advantage of this type of pathology is that, unlike other types of cancer, its evolution is slow and it usually appears in men over 70 years of age.

Symptoms of prostate cancer

In the beginning the detection of prostate cancer can be difficult because it can be asymptomatic, with very unspecific symptoms or similar to benign prostate or bladder diseases. If any signs are present, they will be:

  • Difficulty in urination
  • Frequent urination
  • The need to urinate several times at night.
  • Other voiding symptoms

Diagnosis of prostate cancer

The classification of prostate cancer stages is made according to the detection and extension of the tumor. In cases in which the cancer does not yet present symptoms nor is it palpable, the specialists in Urology establish it as stage T1. If the diagnosis is made by rectal examination, it is stage T2 or T3, depending on the local extension. When the cancer is very advanced and affects nearby organs or structures, it is stage T4.

The two basic screening tests are digital rectal examination and analysis of PSA in the blood, a protein generated by prostate cells. Without PSA, most prostate cancer cannot be diagnosed or suspected. If the result is a risk of prostate cancer, a prostate biopsy is performed, consisting of a few punctures in the prostate under local anesthesia in different areas of the prostate, by means of a transrectal ultrasound. The advantage of this method is that the patient usually tolerates it very well and it gives us the exact diagnosis, thus establishing the level of risk of this cancer.

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Treatment of prostate cancer

Depending on the PSA data, the biopsy results classify prostate cancer as very low or low risk, intermediate risk or high risk. Currently, prostate cancer has a solution, it can be cured with treatment or monitored without major problems. Others require treatment to slow its growth.

Depending on the risk classification and the age or associated diseases, treatments vary between:

  • Surveillance only, with no treatment required. It is carried out in cases of very low risk or low risk, in elderly patients or in associated diseases more important than prostate cancer.
  • Active surveillance. Applied in young patients with low-risk prostate cancer. It can be entered into an active surveillance program, without treatment, with frequent visits with PSA and repeated prostate biopsy to assess if the tumor worsens and then treat it.
  • Radical prostate surgery. Removal of the entire prostate, increasingly by laparoscopy; a technique that offers great advantages such as a good postoperative period, with almost no pain and rapid recovery, with hardly any bleeding, with a better view of the prostate during the operation and better reconstruction to avoid incontinence and, in many cases, to avoid impotence.
  • Prostate radiotherapy. One of the best options for patients with good life expectancy, who cannot or do not want to undergo surgery or those who have locally advanced cancer. Increasingly, surgery in selected locally advanced cases may also be a good option.
  • Hormonal treatment. Many high-risk patients or those with tumor spread outside the pelvic cavity or with metastases require hormonal treatment with an injectable.
  • There are currently many treatments under investigation that are suitable for selected cases, but not yet fully established.
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Prevention of prostate cancer

Although it is believed that obesity and hypertension may increase the risk, there is nothing concrete to say for certain. Despite the great technological advances available to urologists, there is currently no way to prevent prostate cancer, neither with dietary supplements nor with changes in habits. Only early diagnosis in the population at risk and treatment or follow-up under surveillance can be effective. There are large differences between countries, the cause of which is still unknown.

Even so, there are various risk factors that favor its appearance:

  • Age, especially after the age of 50, and with greater risk as the years go by.
  • Heredity: double risk if there is a history of prostate cancer in the first degree family. The possibility increases 5 to 10 times more if there are different first-degree relatives who have suffered it.
  • Race: there is evidence indicating that black men are at higher risk, although the cause is unknown.
  • Diet does not yet have a defined risk, but it is believed that fatty diets increase the risk of prostate cancer, and diets rich in vegetables, fruit and legumes reduce it.