Today it is “HE” that threatens masculinity! Even before the outbreak of the COVID-19 pandemic, prostate cancer overtook lung cancer and was the most frequently diagnosed malignant neoplasm among Polish men. Unfortunately, the last two years resulted in a delay in diagnosis and treatment, which still differed from European standards …
Number one
Statistics have been saying for a long time that the “small gland” has become a “big male problem” … According to the data of the National Cancer Registry (NCR), we see an increase in not only the number of cases but also deaths due to prostate cancer in Poland. While in 2014, prostate cancer developed about 12 thousand. men, and 4,4 thousand died because of it, in 2018 there were already 16 thousand. cases and 5,6 thous. deaths.
And although the increase in the number of cases is a typical trend for developed countries due to the increasing life expectancy, the increase in the number of deaths applies only to Poland. This is evidenced by the report of the team from Milan presenting the results of research on cancer mortality in EU Member States, published in the “Annals of Oncology” in 2020. According to it, the number of deaths from prostate cancer has decreased by 2015% since 7, thanks to better diagnosis and treatment, including access to new surgical techniques and innovative drugs. Unfortunately, Poland remains a blank spot compared to other EU countries, as since 2015 the observed increase in mortality has been as high as 18%.
The conclusions are obvious: we still have a long way to go in the area of prostate cancer. The more so as the last two years of the pandemic caused long delays in the diagnosis and treatment of patients.
Prophylaxis to be corrected
One of the biggest problems with the prophylaxis of prostate diseases is the low reporting rate for prophylactic and diagnostic tests. Polish men in a urologist’s office rarely appear, usually when they already have disturbing symptoms. This makes many Poles come to the doctor too late, when they experience severe symptoms (severe pain, enlarged lymph nodes, hematuria, urinary retention), which may indicate the advancement of the disease. On the one hand, we can blame the low social awareness and insufficient activities in the field of health education in relation to the needs, on the other hand, the treatment of prostate diseases in the taboo category.
Additionally, as experts say, many men have long-term self-treatment with advertised dietary supplements or are treated only symptomatically. This is a big mistake, because the health of the genitourinary system, including the prostate, should be regularly assessed by the urologist, and in case of any abnormalities, in-depth diagnostics should be ordered.
It is worth remembering that the diagnosis of prostate cancer at an early stage increases the patient’s chances of recovery and a longer life. . It also makes it possible to use modern and less invasive therapies.
Good news for Polish patients is the recently introduced by the Ministry of Health program “PROFILAKTYKA 40 PLUS”, effective from July 1, 2021, under which people over 40 years of age. will be referred for comprehensive preventive examinations. The test package for men included the determination of the prostatic antigen PSA, general urine tests and fecal occult blood tests.
Treatment gaps
In the treatment of prostate cancer, depending on the stage of the disease, the degree of malignancy of the cancer and additional factors (comorbidities or age), the following are used: surgical treatment (radical prostatectomy), radiotherapy, hormone therapy and chemotherapy. In justified cases, you can only actively observe the patient. Half of the men subjected to the so-called Active surveillance will never require any form of radical treatment and thus avoid the complications that come with it.
Patients whose neoplasm is confined to this organ and whose life expectancy is greater than 10 years is most often qualified for complete prostatectomy. Radical prostatectomy is also offered to patients with cancer that infiltrates periosteal tissues. During the procedure, the cancerous prostate gland along with the surrounding tissues and sometimes also the pelvic lymph nodes are carefully removed. All removed structures are sent for histopathological examination, which allows to finally determine the malignancy and stage of the neoplasm. The result of this examination also determines the scheme of further management – termination of treatment or undertaking further, complementary therapeutic steps.
The most common side effects of radical prostatectomy include urinary incontinence and erectile dysfunction. The risk of their occurrence can be reduced by using modern surgical tools such as the Da Vinci robot. Its use reduces the invasiveness of surgical procedures by making smaller incisions and reducing blood loss. It also shortens the recovery time. In the United States, over 89 percent. radical prostatectomy is performed with the assistance of the Da Vinci robot, in Poland innovative surgery is still used to a small extent, mainly due to the lack of adequate funding.
Although the last three years have brought improvements in access to innovative drugs, as evidenced by the favorable changes in the drug program “Treatment of castration-resistant prostate cancer (B56)”, experts emphasize the need to broaden it in line with current medical knowledge. Another need is to provide public funding access to new, already approved drugs in the earlier stages of the disease, when the patient is in good condition and metastases are not yet visible on imaging tests. Undertaking medical intervention when the disease is not yet visible, but signals a relapse, translates into better treatment outcomes and longer survival time. In such patients, the time of PSA doubling is an extremely important prognostic criterion.
Another problem is insufficient access to specialist doctors and clinics as part of outpatient specialist care, in the vicinity of the patient’s place of residence. In addition, as most prostate cancer urology departments are located in clinical or provincial hospitals rather than oncology centers, patients are treated in many different facilities. Hence, experts have been recommending the implementation of comprehensive care centers for patients with prostate cancer, the so-called Prostate Cancer Units (PCU). The implementation of the PCU would also provide access to comprehensive rehabilitation, which would include psychological and nutritional support, pain treatment and physiotherapy. Currently, despite the fact that rehabilitation is considered the next stage of cancer treatment, access to it outside large centers and oncology centers is limited.