It is the most common cancer in men, and it is curable if detected early. It is important to see a urologist annually starting at age 50 for early detection, and at age 40 if there is a family history.
The prostate gland is about the size of a walnut and is located in front of the rectum and below the bladder. It is found only in men. Its function is to produce a certain amount of the fluid that protects and nourishes the sperm in semen. Immediately behind the prostate are the seminal vesicles, which produce the majority of the fluid in semen. The urethra, the tube that carries urine and semen out of the body through the penis, passes through the prostate gland.
The prostate gland begins to develop before birth and continues to grow until a man reaches adulthood. This growth is promoted by male hormones called androgens. The main androgen, testosterone, is produced in the testicles. The enzyme 5-alpha reductase converts testosterone into dihydrotestosterone (DHT), which signals the prostate to grow. In older men, the inner part of the prostate (around the urethra) often continues to grow, causing a common condition called benign prostatic hyperplasia (BPH). When this condition occurs, the enlarged prostate can press on the urethra, causing problems with urination. Although BPH can be a serious health problem, it is not cancer.
Why does prostate cancer occur?
The prostate contains several types of cells, but more than 99% of prostate cancers originate in glandular cells, which contribute to the production of seminal fluid. The medical term for a cancer that develops from glandular cells is adenocarcinoma.
Other types of cancer can also begin in the prostate gland, including sarcomas, small cell carcinomas, and transitional cell carcinomas. However, because other types of prostate cancer are rare, if you have prostate cancer, it is almost certainly an adenocarcinoma.
Some prostate adenocarcinomas can grow and spread rapidly, but most grow slowly. In fact, autopsy studies show that many elderly men (and even some younger men) who died from other diseases also had prostate cancer that never affected them during their lifetimes. In these studies, between 70% and 90% of the men had prostate adenocarcinoma by the age of 80, but in many cases, neither they nor their doctors knew they had it.
Precancerous conditions of the prostate
Many doctors believe that prostate adenocarcinoma begins with a precancerous lesion called prostatic intraepithelial neoplasia (PIN). This lesion typically begins to appear in men between the ages of 20 and 29, and nearly half of all men have PIN by age 50.
If high-grade prostatic intraepithelial neoplasia (HPIN) is found during a prostate biopsy, there is approximately a 20% to 30% chance that cancer is also present in another area of the prostate. For this reason, doctors often closely monitor men with HPIN and may recommend repeating the prostate biopsy, especially if the original biopsy did not sample all parts of the gland.
Another finding that may indicate a prostate biopsy is needed is atypical small acinar proliferation (ASAP), sometimes simply called atypia. In this case, the cells appear cancerous under a microscope, but there are too few of them to be certain they are cancerous. If ASAP is found, there is a 40% to 50% chance that cancer is also present in the prostate, which is why many doctors recommend repeating the biopsy a few months later.
Another finding that can be reported in a prostate biopsy is proliferative inflammatory atrophy (PIA). In PIA, the cells appear abnormal when viewed under a microscope. PIA is not cancer, but researchers believe that some PIA cells can transform into prostate cancer or first change to high-grade PIN.
What do the statistics indicate about prostate cancer?
Prostate cancer is the most common cancer after skin cancer. Approximately one in six men will be diagnosed with prostate cancer during their lifetime. It is the second leading cause of death in men in the United States, after lung cancer. Approximately one in 35 men will die from prostate cancer. In the male population, prostate cancer accounts for approximately 9% of cancer-related deaths.
The five-year survival rate refers to the percentage of patients who live at least five years after their cancer diagnosis. These survival rates are used to provide a standardized way to discuss prognosis. Of course, many of these patients live much longer than five years after their diagnosis.
According to the most recent data, for all men with prostate cancer, the five-year relative survival rate is nearly 100%, while the 10-year relative survival rate is 91%. The 15-year survival rate is 76%. Keep in mind that five-year survival rates are based on patients first diagnosed and treated more than five years ago, and 10-year survival rates are based on patients diagnosed more than 10 years ago. Modern detection and treatment methods mean that many prostate cancers are now found early and can be treated more effectively. If you are diagnosed this year, your prognosis will likely be better than the figures previously reported.
Symptoms of prostate cancer
Prostate cancer, especially in its early stages, often has no symptoms. Symptoms are more likely to appear as the cancer grows.
Call your doctor if you experience any of these symptoms:
- Difficulty starting to urinate
- Less force in the urine stream
- Dribbling after finishing urination
- Urinates frequently, especially at night
- Blood or pus in the urine
- blood in semen
- Pain when urinating
- Pain with ejaculation
- Hip or lower back pain that does not go away over time
- Pain in the lower part of your pelvis
- Unintentional weight loss and loss of appetite, or only the latter.
How is it diagnosed early?
Early diagnosis of prostate cancer is based on two fundamental tests: the digital rectal exam and the determination of prostate-specific antigen (PSA).
Your doctor can examine your prostate by performing a digital rectal exam. Normally, the prostate has a soft, elastic consistency (like your cheek). If a lump is felt (with the consistency of your cheekbone), this may raise suspicion of a cancerous nodule in the prostate.
Another way to diagnose prostate cancer early is by measuring serum PSA. PSA stands for prostate-specific antigen. Men with prostate cancer may have elevated PSA levels in their blood. However, PSA levels can also be high due to other, less serious causes, such as infection or an enlarged prostate. The free PSA fraction (PSA circulating in the blood without being bound to transport proteins) can also be measured to determine the free/total PSA ratio, which is useful for assessing whether the elevated PSA is likely due to cancer.
If the digital rectal exam or PSA test is suspicious, the urologist may decide to order further tests, such as MRI with spectroscopy, PCA-3, or a prostate biopsy. Microscopic examination of prostate tissue may reveal the presence of a tumor.
The latest in prostate cancer detection: prostate mapping
At ICUA, we offer prostate cancer diagnosis using the latest technique: prostate mapping. This technique combines two technologies: 3 Tesla Multiparametric Magnetic Resonance Imaging (MRI), which allows for highly sensitive and harmless visualization of lesions suspected of being prostate cancer (without radiation for the patient) and with a very high negative predictive value, which in many cases will prevent unnecessary biopsies; and the BIOPSEE MRI-Ultrasound Fusion System, which performs prostate mapping transperineally (through the skin, not the rectum) on an outpatient basis, projecting the tumor's location onto the three-dimensional MRI image. The combination of these two techniques allows for greater precision when performing the biopsy and guides the needle to the exact location of the lesion.
The incorporation of this cutting-edge diagnostic technique increases the speed of diagnosis, as results are available the day after the test. Mapping offers a higher tumor detection rate by identifying the location of tumors that transrectal biopsies cannot access. Finally, the precision of the results allows for better diagnosis and, therefore, greater effectiveness in treatment and treatment selection.
What are the treatment options for prostate cancer?
If prostate cancer is diagnosed while it is still localized to the prostate and before it has spread to other parts of the body, it can be cured in a very high percentage of cases. If the cancer has spread to other organs (metastasis), it is possible to treat it and manage the disease as a chronic condition, with typically very long survival times.
When diagnosed with prostate cancer, it's important to remain calm and thoroughly understand the treatment options before making a hasty decision. All prostate cancer treatments carry the risk of impacting a patient's quality of life, so it's crucial that the patient understands the potential benefits and risks of each technique before making a choice.
One option in the early stages of prostate cancer, especially in men over 70, is "watchful waiting." Watchful waiting means seeing your doctor regularly so they can monitor the cancer. This may include frequent blood tests and rectal exams to check if the cancer is growing. This can be a good option for those with slow-growing cancer or for older men or those in poor health. At any time during the watchful waiting period, you can choose to switch to another treatment.
It's important to understand that watchful waiting doesn't involve any medication or treatment that will eliminate the cancer. It's simply a period of observation. If the cancer suddenly starts growing more rapidly, or if it begins to cause symptoms, you may need to switch to a more aggressive treatment option.
Current treatment options
Classic options:
- The surgery, which can be open, laparoscopic o robot-assisted.
- La radiotherapy external (classical, 3D conformational, intensity modulated or tomotherapy.
Other more modern options: They attempt to reduce the side effects of classic treatments.
- Radiotherapy using seed implantation (brachytherapy)
- Cryotherapy (freezing of the tumor)
- High-intensity focused ultrasound or HIFU treatment.
- Irreversible electroporation (experimental)
It is highly advisable to schedule a consultation with the specialist, allowing enough time to discuss these treatment options and individually analyze the pros and cons for each patient.
