Contents
It is the most commonly diagnosed male neoplasm. A challenge for today and tomorrow. Fortunately, prostate cancer doesn’t have to be a sentence. It is prophylaxis that allows us to take control of it. We explain what the diagnostic path looks like step by step …
It lurks in hiding
Prostate cancer is the most commonly recognized male cancer today. Early detection has a good prognosis – it gives a chance of survival for 98,8%. men. Unfortunately, according to statistics, 15 percent. cases of prostate cancer are detected in our country only in stage IV.
Why is this happening? First of all, Polish men forget that the urologist is their best friend and avoid preventive examinations. Second: prostate cancer is a cunning opponent – for a long time it causes only slight symptoms resembling the symptoms typical of benign prostatic hyperplasia: frequent urination (pollakiuria), the need to stop sleeping to urinate (nocturia), the urgent urgency to urinate that is difficult to control (urgency to urinate), feeling of incomplete bowel movement after urinating, passing urine in a narrow stream.
It happens that a growing tumor develops asymptomatically, and its diagnosis is prompted by symptoms related to the infiltration of the surrounding tissues or metastasis of cancer to the bones (pain, pathological fractures, anemia) and the hip lymph nodes. That is why prevention plays such an important role …
We start with a PSA
The determination of the serum PSA (Prostate Specific Antigen) concentration is essential for the diagnosis of the disease. It should be emphasized, however, that this marker is not specific for prostate cancer – its concentration also increases as a result of benign hyperplasia and prostatitis. In addition, in all men, the antigen level increases with age, but in general the result should not exceed 4 ng / ml.
The PSA test is simple, cheap and generally available – it is offered by most laboratories in Poland. It consists in collecting a small amount of blood from the patient into a vacuum tube. The material is usually taken from the most visible veins located at the ulnar fossa. The resulting sample is sent for analysis.
It is assumed that the PSA test should be performed by every man over the age of 45, while men who carry the BRCA2 mutation, which increases the risk of prostate cancer, and who have a family history of prostate cancer, should perform the first PSA test after the age of 40 . The test should be repeated once a year.
Per rectum – don’t be afraid!
The next step in diagnosis is an examination that is worrisome, embarrassing and resistant, but has important clinical significance. Digital rectal examination, which is a finger examination of the anus, allows to assess both the prostate gland and detect its possible enlargement (which is important both in the diagnosis of benign prostatic hyperplasia and prostate cancer). Importantly, the procedure is quick, painless and can save our lives.
If the PSA level results are above the norm and the rectal examiner finds any abnormalities, the patient is referred for a prostate biopsy.
Stop: biopsy
It is one of the most popular diagnostic procedures for prostate cancer. It consists in taking a fragment of prostate tissue with a needle. The sample is subjected to a histopathological analysis which enables the detection of neoplastic changes. To increase the precision, the biopsy is performed under transrectal ultrasound (TRUS) guidance. The needle, with which the prostate samples will be collected, can be inserted transrectally or transoperinally. The procedure is performed under local anesthesia and usually takes 20-30 minutes. With the biopsy result, for which we will wait about 2/3 weeks, we should go to a specialist urologist who will determine the further diagnostic path or possibly decide to start treatment if prostate cancer is detected.
A novelty in the diagnosis of prostate cancer is the so-called prostate fusion biopsy, combining the traditional form of core-needle biopsy performed as standard under the ultrasound image with magnetic resonance imaging, which clearly better visualizes clinically significant neoplastic changes. It also allows you to reduce the number of clippings taken. In addition, thanks to it, we avoid unnecessary, additional non-targeted biopsies, which are burdensome for the patient and burden him with certain complications. Therefore, if the first examination does not bring the expected results, the European Society of Urology recommends performing another biopsy under the so-called fusion. Although this study is becoming more and more popular and very useful, unfortunately it is still available only in a few centers in Poland.
I have cancer and what’s next?
Above all, don’t panic! Depending on the severity of the disease, general health and age of the patient, modern medicine offers various therapeutic options. Thus, in the case of low-risk prostate cancers, one can adopt the so-called active observation. It is a procedure based on monitoring of clinical, biochemical and histopathological advancement in order to avoid or delay treatment.
In the case of prostate cancers with medium or high risk, surgical treatment (radical prostatectomy, i.e. removal of the prostate gland) or radiotherapy is used. The surgical procedure involves the excision of the prostate with seminal vesicles and a fragment of the vas deferens, as well as the fusion of the urethra with the neck of the bladder. In clinically justified cases, depending on the stage of the disease, the lymph nodes are also excised to the appropriate extent (lymphadenectomy). Unfortunately, radical prostatectomy is associated with complications such as erectile dysfunction and urinary incontinence. The risk of side effects can be minimized by using modern endoscopic treatment, i.e. treatment with the assistance of a surgical robot, allowing for greater precision and limiting the invasiveness of the operation. However, robotic systems are practically unavailable in general healthcare in Poland.
An alternative to surgical treatment is radiotherapy in the form of brachytherapy, i.e. intra-tissue irradiation (the radiation source is inserted directly into the tissues affected by cancer) or teleradiotherapy, i.e. irradiation from external fields. Irradiation treatment may also lead to side effects such as diarrhea, potency disorders, urinary incontinence, and rectal ulcers.
In adjuvant treatment, the so-called hormone therapy, which is designed to lower the level of testosterone or block its action.
Europe lives longer
Unfortunately, although the quality of services and access to the most modern methods of treatment is systematically improving, we remain at the tail end of Europe. This is evidenced by the results of the analysis of the university center in Milan, which appeared in the “Annals of Oncology”, a magazine published by the European Society for Medical Oncology. With a further decrease in mortality from prostate cancer (observed since 2020) forecast in Europe in 2015 – we are expected to increase once again.
This is mainly due to the limited access to new therapies, including modern androgens, which can delay the development of the disease by up to 2 years or more. In Poland, such treatment is available only under drug programs. This makes the fight against prostate cancer much more difficult …