In this article you will find what is prostate cancer, which are the risk factors, what type of symptoms a person suffer when prostate cancer shows up, diagnosis and classification for this type of cancer, people who should to try the test to detect this disease early, the stages of this disease, among other things.
What is the prostate?
It is a gland of the male reproductive tract located in the lower urinary tract, below the bladder, which surrounds the urethra (conduit through which urine leaves).
The prostate is responsible for producing part of the fluid that makes the semen, contains smooth muscle that contracts to expel the semen during ejaculation.
A normal prostate is the size of a grape, has an approximate volume of 15-25 cc and grows as the men grow older, this can hinder the exit of urine from the bladder causing urinary symptoms. The medical term given to a prostate that has increased in size is Benign Prostatic Hyperplasia (BPH).
It is very different to have hyperplasia than having a prostate cancer, just as different are the tests and treatments for each disease.
What is prostate cancer?
It is a malignant tumor of the prostate. Tumors develop when some cells begin to grow faster than normal. The growth of these cells is related to androgens, these hormones are produced almost exclusively in the testicles. Testosterone is the most important androgen, there is a very important association between prostate and tumors of prostatic origin.
Prostate cancer is the most common cancer in men after skin cancer, 1 in 6 men will have this type of cancer. There are several types of tumors, depending on how aggressive, the treatment changes. These tumors can be detected in time if you regularly attend the general checkup with the urologist.
Risk Factors Causing Prostate Cancer
The most important risk factor is age. The older you are, the more likely you are to have it. Other risk factors include having a first-degree relative as a parent or siblings with prostate cancer and Afro-descendant patients. It seems that high consumption of meat and dairy products may increase the risk of prostate cancer, but this association is still under investigation.
WHAT SYMPTOMS CAN BE GENERATED?
Most prostate tumors grow very slowly and usually do not cause any symptoms detectable by the patient. There are some less common types that grow quickly and can generate some symptoms caused by prostate growth or infection such as:
• Increased urinary frequency
• Decreased caliber of the urinary stream
• Blood in the urine
• Erection problems
• Urinary incontinence
• When the cancer has spread through the body it can lead to more severe symptoms such as bone pain and leg weakness.
Diagnosis and classification of prostate cancer
In most cases these tumors are detected with a blood test indicating the level of prostate specific antigen (PSA). If the PSA is elevated, it means that there is some problem in the prostate like cancer, inflammation, infection or this level can simply rise because of an enlarged prostate.
Depending on antigen levels, the urologist will recommend additional tests to determine what factor is causing these levels to rise, and according to that will be defined if the patient requires to take a prostate biopsy.
There is another very important test that is always used and is rectal examination. The goal is to directly feel the characteristics of the prostate through the rectum and to determine if there is any abnormality in size, consistency or shape, if there are nodules or any suspected cancer findings.
WHO SHOULD TAKE TESTS TO EARLY DETECT A PROSTATE CANCER?
It is very important to do a regular urological checkup, the main advantage of doing it is that you can find a prostate tumor early, improving the chance of being able to cure it. The checkup should be started early in men over 40 years old who have a first-degree relative with prostate cancer or men of African descent.
The age of onset of prostate cancer screening may vary in special cases where the patient has any suspected prostate cancer symptoms or depending on the urologist's experience or patient's preferences.
It is very important that all men over the age of 40 be evaluated by a urologist to determine what studies the person needs, whether to look for prostate cancer or not and to determine the best time to start exams.
WHEN THE SEARCH FOR THE PROSTATE CANCER CAN BE SUSPENDED?
When a person has a life expectancy of less than 10 years, then the active search for prostate cancer is suspended because the patient will probably not reach the consequences of the disease, rendering the diagnosis useless since the patient could be subjected to unnecessary procedures.
There is no age limit to stop looking for prostate cancer, the important thing is not the age but the state of health of the person.
TROPISTAL BIOPSY OF PROSTATE
When there is any indication of prostate cancer, such as elevated PSA or abnormal rectal examination in addition to other considerations of the urologist, a prostate biopsy is indicated. In preparation for this, antibiotics are formulated, a preparation of the colon is made and anticoagulants or aspirin-like medicines are suspended.
The biopsy is performed under sedation, inserting an ultrasound probe into the rectum to properly visualize the prostate and show where the tumor is.
Cells are removed from the prostate through a needle and sent to the laboratory for a pathologist to examine this sample and determine if there is any tumor. At the moment there is no better method to make the diagnosis of a prostate cancer than the biopsy.
Prognosis: After the diagnosis of prostate cancer, the prognosis of the disease is defined depending on the interpretation of the biopsy, the level of PSA, the finding in the rectal examination and the images obtained. According to this it is also defined what will be the best treatment for each patient.
Prostate Cancer Stages
There are several stages of prostate cancer:
LOCALIZED: The tumor is confined to the prostate and has not reached other parts of the body.
LOCALLY ADVANCED: The tumor has left the prostate to the surrounding tissues (seminal vesicles, urinary bladder neck, or lymph nodes)
METASTASIC: Cancer has reached lymph nodes distant from the prostate or other organs such as bone.
Treatment: There are several factors that are taken into account to determine the best treatment for the patient suffering from prostate cancer, for example: the state of the cancer will be very important to determine if the patient benefits from therapy with Curative purposes such as radical prostatectomy or radiotherapy; Or on the contrary requires targeted therapies to control cancer without a cure option such as hormone therapy.
Age, associated diseases and life expectancy are also taken into account, as a balance is made between the risks and adverse effects of the different treatments versus the benefits thereof.
When life expectancy is short, it means that the patient will probably not be able to suffer the discomfort of prostate cancer and therefore the therapy is directed to maintain a good quality life. Equally important to the factors mentioned above is the patient's preference for deciding on different therapeutic modalities.
LOCALIZED PROSTATE CANCER: When the cancer has not left the prostate, there is a high chance of cure through surgery (radical prostatectomy) or radiotherapy. There are some special cases where you simply follow up and intervene only to improve the symptoms and there are other cases where you can do an active monitoring. These therapeutic modalities are explained below.
Follow-up: In some cases when patients have other important diseases, when elderly and the life expectancy is short, the patient's treatments are focused on the other diseases.
The individual is monitored and if any treatment is needed to improve their quality of life, this is done, otherwise there are no surgeries or procedures that impair the patient's comfort.
Monitoring and active surveillance
The main objective of active surveillance is to avoid the complications of surgery or radiation in tumors that are considered indolent or of very low aggressiveness. This modality consists of a close monitoring of the patient to monitor the evolution of the cancer by periodic clinical follow-up through medical evaluation, prostate biopsies, rectal strokes and PSA.
This is only done in patients who have tumors with a low probability of progression. If during the evaluations there are signs that the disease has progressed, the patient is taken to treatment such as surgery or radiotherapy to avoid the spread of the tumor in time.
There are some special cases of patients who have other major illnesses or a short life expectancy in which they are thought not to be able to suffer the consequences of prostate cancer and therefore no specific treatment is done or no further tests are requested.
Surgery: surgery is called radical prostatectomy, the procedure is to completely remove the prostate, surrounding tissue and seminal vesicles with the aim of curing the disease. It is a different operation than surgery for prostatic hyperplasia in which there is no complete extraction of the prostate.
It can be done openly or by laparoscopy (minimally invasive), in this second one there is less blood loss, less convalescence and less pain than in open procedures. It is important to remember that not all patients are candidates for minimally invasive surgeries. The decision of what type of surgery will be carried out is taken jointly by the Urologist and the patient.
Radiation therapy: involves damaging and eliminating cancer cells through radiation. This can be done by external radiation therapy or brachytherapy (seeds placed inside the prostate). Prostate cancer cells usually respond to radiation. Due to advances in technologies, it is an effective method in the treatment of prostate cancer.
Experimental therapies for treating prostate cancer: New modalities are being studied in the world for the treatment of prostate cancer and used in very special cases.
They are not yet available in some countries because of their high costs and they have not shown to be better than conventional therapies available such as surgery or radiotherapy.
These are the cryotherapy that consists of freezing the tumor and the high intensity focal ultrasound or HIFU that consists of destroying the tumor with heat generated by ultrasonic waves. There is also focal therapy in which only the tumor is intended to damage and not the rest of the prostate.
HOW TO FIND THE DIAGNOSIS INITIALLY?
The diagnosis of prostate cancer has a big impact on people's lives, this can make you feel weak, anxious, angry or depressed. It is also common to have the sensation of an impending death when talking about cancer, but it is important to take into account that medicine has advanced very important in the field of prostate cancer, making it in many cases not a deadly disease but a chronic disease, which can be treated and to a large extent, cure.
Cancer and treatment can affect your quality of life, social, family life and sexual activity. It is very important to ask your doctor any questions you may have and ask for additional sources of reading in order to understand your illness, to understand what is happening and what may happen in the future.
All psychological support, family and other patients with the same diagnosis is welcome, as this will facilitate the understanding of the disease.
PREPARE FOR CONSULTATION WITH YOUR DOCTOR
After reading this instruction write down all the doubts you would like to ask your urologist. Always attend the medical visit with a family member who spends the most time with you to help you remember information or instructions provided during the consultation. If your doctor tells you something you do not understand, always ask for an explanation.
Keep in mind that there is a lot of bad information on the Internet or in the people around it, as popular myths abound, it is often the case that people can take advantage of the vulnerable state of the patient and his family to offer "Miraculous Medicines" without any scientific evidence of its functioning.
Always tell your doctor if you are about to start any other treatment and ask whether it is right for you or not. If in spite of the query you have doubts, ask for an extension of the information or ask a second opinion to another specialist.
Prostate cancer is a curable disease if detected early, and still manageable in advanced stages. It is important to be alert to urinary symptoms and should be in controls with Urologist to look for warning signs of different diseases of the urinary tract.