Prostate cancer

Content

Introduction

Introduction

Prostate cancer is the most common male cancer in Italy and in industrialized countries. It is estimated that 37,000 new cases were ascertained (diagnosed) in Italy in 2019. In the "span of his life, one in 9 men in our country has the theoretical probability of getting prostate cancer.

The prostate is a small gland present only in men and is part of the male genital system. It is positioned inside the pelvis (pelvis), below the bladder, in front of the rectum and surrounds the initial portion of the urethra. Under normal conditions, it is the size of a walnut, but with the passing of the years or due to some diseases it can swell up to give disturbances, especially of the urinary type. The prostate has the function of producing part of the seminal fluid released during ejaculation and is essential for maintaining fertility. Among the components of the seminal fluid there is also a protein called prostate specific antigen or PSA which is present and measurable in the blood.

Prostate cancer usually grows slowly and remains asymptomatic for many years; moreover, the disorders (symptoms) it causes are not specific to cancer, but are the same as those of benign prostatic hyperplasia, the most common form of prostate enlargement.

Symptoms

Symptoms

Prostate cancer usually does not cause disturbances (asymptomatic) for many years, until the prostate becomes large enough to put pressure on the urethra and, consequently, to cause disturbances in urinating (urination).

The most common are:

  • need to urinate more often, both day and night
  • irrepressible urge to urinate
  • weakening of the urine stream
  • possible pain while urinating
  • feeling of not being able to urinate completely (empty the bladder completely)
  • presence of blood in the urine or semen (on some occasions)

If you experience one or more of these disorders (symptoms) it is important to consult the treating doctor, remembering, however, that in most cases the enlargement of the prostate is of a benign nature and does not constitute a health hazard.

Causes

Causes

The causes of prostate cancer are not yet known, however, some risk factors have been identified that can contribute to the development of this form of cancer. Some are preventable and modifiable; others, however, such as age or familiarity, do not.

The main ones include:

  • age, the disease is more frequent in over 50s and its onset increases with age
  • family history, men with a close relative (father, brother, uncle) who became ill with this tumor before the age of 60 are more likely to be affected too
  • ethnicity, the disease is more common among men who have an ethnic origin of African (black) origin than those of Caucasian (white) or Asian origin
  • obesity
  • exposure to environmental pollutants
  • cigarette smoking habit
  • diet rich in dairy and fat of animal origin and low in fruit and vegetables
  • raising the level of male hormones
Diagnosis

Diagnosis

It is advisable to consult the attending physician if urinating problems appear which could be caused by prostate cancer. The doctor will be able to recommend the necessary tests to ascertain the causes (read the Bufala).

Prescribed investigations usually include:

  • urinalysis, to rule out the presence of urinary tract infections
  • PSA test, a test that measures the values ​​of prostate-specific antigen, a protein secreted by the prostate that is normally present in the blood in minimal quantities. Its level tends to increase with age, in the presence of urinary tract infections, benign prostatic hyperplasia or prostate cancer. The PSA test, however, is not a specific test to ascertain (diagnose) the presence of prostate cancer: most sick men do not have high PSA levels. Furthermore, 65% of men with high PSA values ​​do not have prostate cancer because this protein naturally increases with increasing age
  • digital rectal examination, the examination is performed by the urologist who, after wearing a lubricated glove, inserts a finger in the anus to palpate the prostate, assess its size and consistency and check for any suspicious nodules. Usually, in the presence of a tumor, the prostate is hardened and lumpy, while in the case of benign prostatic hyperplasia it is enlarged but is firm and smooth on palpation
  • ultrasound, an examination that allows to detect any abnormalities in the structure of the prostate and allows the doctor to evaluate the need, or not, to perform a biopsy (or fine needle aspiration). This examination consists in the sampling, under ultrasound guidance, of a small amount of prostate tissue through a needle passed into the rectum or into the perineum (anatomical region located between the anus and the scrotum)
  • other tests to ascertain prostate cancer and evaluate its spread are transrectal ultrasound (TRUS), bone scan, computed tomography (CT), nuclear magnetic resonance (MRI), positron emission tomography (PET-CT)

Most prostate cancers are ascertained (diagnosed) at an early stage (early diagnosis), before the development of the disorders, through the PSA dosage and digital rectal examination.

PSA test

PSA test

PSA (Prostatic Specific Antigen, from the English Prostatic Specific Antigen) is a protein secreted by the prostate, naturally present in semen and blood. Increased values ​​of PSA in the blood can be found in the presence of prostate cancer, a " benign prostatic hyperplasia (enlargement), urinary tract infections or in case of recent sexual activity.

The number of diagnosed prostate cancer has progressively increased since the PSA test was approved by health authorities in the 1990s. Screening with PSA testing can identify cancers of the prostate at an early stage, even years before they are detectable with digital exploration or symptoms (symptoms) appear.

On its real value for the purpose of ascertaining (diagnosing) a tumor, however, the debate is still open since very often the values ​​can be altered due to the presence of benign prostatic hyperplasia or an infection. For this reason, in recent years there has been a reduction in the use of this test. In particular, the measurement of PSA in serum (serum is the part of the blood that separates after coagulation) must be carefully evaluated on the basis of the " age of the person, familiarity, exposure to any risk factors and health status over time (clinical history).

Therapy

Therapy

Prostate cancer treatment (therapy) is not the same for everyone but is personalized according to the stage of the disease and the characteristics of the affected person. It will be up to the doctor to share with you the treatment program deemed most appropriate (read the Hoax).

Choice and planning of treatment

When deciding which treatment is most suitable, a group of specialists (oncologist surgeon specialized in prostate cancer, oncologist, radiotherapist, radiologist, pathologist, cancer nurse, nutritionist and psychologist) prepares the therapeutic plan considering:

  • type and size of the tumor
  • general health, age, life expectancy
  • stage of the tumor, that is, if the tumor is localized or extended to other organs

The stages of prostate cancer

  • stage 1: the tumor is very small and localized inside the prostate
  • stage 2: the tumor is confined to the prostate, but larger and detectable on rectal exploration or visible on ultrasound
  • stage 3: the tumor has spread to the fibrous capsule that lines the prostate or to the seminal vesicles
  • stage 4: the tumor has invaded the lymph nodes and / or adjacent tissues

Prostate cancer, if detected in the early stages, has a favorable prognosis: the five-year survival rate of patients with stage 1 and 2 cancers is over 90%.

Observational attitude

This term means the choice not to carry out any treatment but to subject the patient to a specific program of checks and tests:

  • there active surveillance it involves monitoring the progress of the disease over time through PSA tests, digital rectal exploration and biopsies with the possibility of intervening in the event of its progression. This is an approach often proposed to people with a low-risk disease
  • there watchful waiting it is usually an approach proposed to elderly people with other important diseases and with a "life expectancy of less than ten years. The choice is to favor a good quality of life, limiting the unwanted effects (collateral effects) of the therapies." However, it provides for regular checks and the intervention of anti-tumor treatments in case of aggravation of the disorders

Surgery

There radical prostatectomy is the surgical removal of the prostate, seminal vesicles and nearby (regional) lymph nodes. Surgery can be performed in a conventional way (through an "incision" in the abdomen or in the perineum, an area between the scrotum and the anus) or with the so-called laparoscopic technique, in which surgical instruments are introduced into the abdomen through small incisions. . The surgery called "nerve-sparing", If the characteristics of the tumor allow it, it allows to protect the nerve centers that run near the prostate, thus reducing the undesirable effects that accompany radical prostatectomy, in particular erectile dysfunction. Other effects of prostatectomy are the absence of ejaculation, which is inevitable, and urinary incontinence, which is less frequent. Before the surgery, you may want to consider the idea of ​​freezing your semen at a sperm bank, to maintain the possibility of having children in the future.

Radiotherapy

Radiotherapy (Video) uses radiation to destroy cancer cells, trying to protect the surrounding tissues as much as possible. It can be used with curative intent, to eliminate all tumor cells present in the prostate and lymph nodes, or after surgery to destroy any residual tumor cells and thus prevent the tumor from reappearing (relapse).

Radiation therapy can cause temporary undesirable effects (side effects) such as, for example, diarrhea, weakness and cystitis or longer-term effects such as erectile dysfunction and urinary incontinence.

Brachytherapy

Brachytherapy is a type of radiotherapy in which small radioactive sources (called "seeds") are inserted directly into the prostate, sparing the surrounding tissues. Brachytherapy is indicated in tumors with a low risk of progression and presents the same side effects (side effects) as external beam radiation therapy.

Hormone therapy

Hormones are substances produced by the body that control the growth and activity of cells. Testosterone, the male hormone produced by the testes, affects the growth of prostate cancer. Hormone therapy aims to reduce the level of testosterone in the bloodstream. to stop the growth of cancer cells, reduce the size of the tumor and control its symptoms (video). The level of testosterone can be reduced through bilateral orchiectomy, i.e. the surgical removal of the testicles which are replaced with prostheses inserted in the scrotum. Alternatively, hormone therapy can be pharmacological: in this case, anti-androgen drugs or gonadotropin-releasing hormone (GnRH) analogues that block androgen production are administered by injection or orally on the part of the testicles Undesirable effects (side effects) of hormone therapy, in addition to erectile dysfunction e to decreased sexual desire, may include flushing, sweating, weight gain, swelling of the breasts (gynaecomastia). Hormone therapy is usually used in combination with radiotherapy.

Chemotherapy

It consists in the use of particular drugs, called antineoplastics, capable of destroying or controlling cancer cells (Video). metastasis and improve quality of life Usually, chemotherapy is used in patients with advanced prostate cancer, in whom hormone therapy has not yielded the desired results.Undesirable effects (side effects) of chemotherapy can be tiredness and weakness, hair loss, diarrhea, nausea and vomiting.

Living with

Living with

Prostate cancer develops slowly and for many years may not cause any disturbances (symptoms) and may not lead to changes in daily activities.

Prostate cancer treatment can cause short and long-term undesirable effects (side effects). The most frequent complications include disturbances in sexual and urinary functions, including:

Erectile dysfunction

The emotional stress of being diagnosed with cancer can cause a decrease in sexual desire (libido) and a loss of interest in sex.

Erectile dysfunction may not be definitive, not being due only to mechanical factors related to the cure but also to emotional factors. It is important to discuss these problems with your doctor who can also suggest appropriate drug aids such as, for example, tadalafil or sildenafil. These drugs increase the flow of blood inside the penis thus allowing an erection to be achieved. If the drugs do not work, it is also possible to resort to an operation to place a prosthesis in the penis or an external device (vacuum device, suction pump) which increases blood supply, allowing you to maintain an erection for about thirty minutes.

Urinary incontinence

Urinary incontinence, that is the loss of bladder control and the inability to hold urine, can be a consequence of the disease itself or of the treatments. Physiotherapy exercises aimed at recovering the ability to hold urine can gradually resolve this problem, in whole or in part. If physiotherapy proves ineffective, it is possible to resort to surgical treatment of urinary incontinence, with the implantation of an artificial sphincter in the urethra.

Infertility

Some prostate cancer treatments can cause infertility. Before undergoing anticancer therapy it is important to talk to your doctor to evaluate the advisability of freezing (cryopreserving) the semen.

Bibliography

Bibliography

Italian Association of Cancer Patients, Relatives and Friends (AIMAC). Prostate cancer

In-depth link

In-depth link

Italian Association for Cancer Research (AIRC). Prostate cancer

Italian Association of Medical Oncology (AIOM). The numbers of cancer in Italy. 2015

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