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Everything you need to know about prostate cancer
According to data from the American Cancer Society, one in eight men will be diagnosed with prostate cancer during their lifetime.The prostate is a gland that is part of the male reproductive system and whose function is to produce seminal fluid, which transports sperm during ejaculation. It is located in the pelvis, below the bladder and surrounds the urethra.
Prostate cancer occurs as a result of mutations in the DNA of normal prostate cells. This leads to an alteration in their normal functioning that leads to an abnormal growth of tumor cells in the prostate gland.
Its incidence increases with age, Its appearance is more frequent after 65 years of age. On the other hand, family history and ethnicity are associated with a higher incidence of prostate cancer, suggesting a genetic predisposition.
At the same time, there are other environmental factors that have been associated with the incidence and prognosis of prostate cancer.
Initially, prostate cancer is asymptomatic. The symptoms derived from it appear when the disease is already in an advanced state..
The most frequent symptoms in this state are bone pain, the presence of blood in the urine, difficulty urinating, etc.
Its growth is slow so the diagnosis is usually early and treatments can be curative.
There are several factors that increase the risk of prostate cancer. The most notable are advanced age, race and genetic factors. The latter are mainly in those patients with a first-degree family history who have been diagnosed before the age of 65, their appearance being very rare in those under 40 years of age.
Other family history that may predispose to a higher risk of developing prostate cancer are breast or ovarian cancer.
More than 90% of malignant tumors that originate in the prostate are adenocarcinomas, but other subtypes may appear such as tumors with neuroendocrine differentiation, urothelial carcinoma (transitional cell), sarcomas, lymphomas, ductal adenocarcinomas, etc. Precancerous lesions may also appear.
Early diagnosis and treatment of prostate cancer achieves a cure rate close to 100%.
For this reason, medical attention by a urology specialist is recommended to perform a review from the age of 50, or from the age of 45 when there is a direct history of prostate cancer.
This review consists of a physical examination and PSA determination (prostate-specific antigen) in a blood test.
The prostate biopsy is what provides the definitive diagnosis, but we must try to avoid unnecessary biopsies and “false negatives.” In this sense, we have complementary tests (PCA3, 4K Score, Select MDX, etc.) and Multiparametric Magnetic Resonance of the prostate, which will provide us with very approximate data on the existence and location of a possible carcinoma in order to direct the biopsy to the suspicious area. (Image Fusion Guided Prostate Biopsy).
The prostate biopsy informs us about the degree of aggressiveness of the tumor (Gleason scale) and based on this, an extension study is performed (CT, bone scintigraphy, PET-CT Choline or PET-PSMA) to rule out possible metastases (localizations). tumors in the rest of the body) in cases of prostate carcinomas in advanced stages.
- Radical prostatectomy: removal of the prostate, seminal vesicles and regional lymph nodes in selected cases. In localized tumors it is the option with the highest cure rate and can be performed using open, laparoscopic or Da Vinci Robot-assisted surgery techniques.
- Radiotherapy conformational and intensity-modulated: external radiation of the prostate, seminal vesicles and regional lymph node chains with preservation of neighboring organs.
- Brachytherapy: implantation of radioactive seeds in a single session in small prostates with a non-aggressive tumor.
- Focal therapy: cryotherapy (destruction of tumor tissue by local application of temperature -40°C) or focal application of ultrasound (HIFU).
- active surveillance : monitoring the evolution of the tumor without treatment, in very selected low-risk cases and always in agreement with the patient.
- Hormonotherapy: blocking of male hormones through semiannual injections. Indicated in metastatic tumors with implants in the rest of the body.