Everything you need to know about prostate cancer

According to the American Cancer Society, one in eight men will be diagnosed with prostate cancer in his lifetime.

Prostate cancer occurs as a result of mutations in the DNA of normal prostate cells. This leads to an alteration in the normal functioning of these cells leading to an abnormal growth of tumor cells in the prostate gland.

Its incidence increases with age, being more frequent after 65 years of age. On the other hand, family history and ethnic origin are associated with a higher incidence of prostate cancer, suggesting a genetic predisposition.

Other environmental factors have also been associated with the incidence and prognosis of prostate cancer.

Initially, prostate cancer is asymptomatic. Symptoms occur when the disease is already in an advanced stage.

The most frequent symptoms in this state are bone pain, the presence of blood in the urine, difficulty in urinating, etc.

Its growth is slow, so diagnosis is usually early and treatments can be curative.

There are several factors that increase the risk of prostate cancer. The most prominent are advanced age, race and genetic factors. The latter are fundamentally in those patients with a first-degree family history who have been diagnosed before the age of 65, being very infrequent in those under 40 years of age.

Other family histories that may predispose to an increased risk of prostate cancer include breast or ovarian cancer.

More than 90% of malignant tumors originating in the prostate are adenocarcinomas, but other subtypes can 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 of close to 100%.

For this reason, medical attention by a specialist in urology is recommended for a check-up starting at age 50, or at age 45 when there is a history of prostate cancer in direct line.

This screening consists of a physical examination and the determination of PSA (prostate specific antigen) in a blood test.

The prostate biopsy is the one that 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 Imaging 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(Prostate biopsy guided by image fusion).

The prostate biopsy informs us about the degree of aggressiveness of the tumor (Gleason scale) and, depending on this, an extension study is performed (CT, bone scan, PET-CT Choline or PET-PSMA) to rule out possible metastasis (tumor locations 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 by open, laparoscopic or Da Vinci Robot-assisted surgery techniques.
• Conformal and intensity-modulated radiation therapy: external radiation of the prostate, seminal vesicles and regional ganglion chains with preservation of neighboring organs.
• Brachytherapy: implantation of radioactive seeds in a single session in small prostates with a less 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 of the evolution of the tumor without treatment, in very selected low-risk cases and always in agreement with the patient.
• Hormone therapy: blockade of male hormones by means of biannual injections. Indicated in metastatic tumors with implants in the rest of the body.