– Cancer diagnosis is always a shock. This information is difficult for everyone to accept, but today we can treat prostate cancer at any stage of diagnosis! The patient is not left alone with the disease, but together with his doctor. It helps… With dr hab. med. Piotr Jarzemski, prof. UMK talks about prostate cancer.
Professor, what warning signals could be that the male prostate needs to be reviewed?
Any urination disorder is a warning sign. Urinating is an activity that we perform several times a day throughout our lives and any syndrome related to urination other than before should be easily noticeable and alarm us. This may be a weaker stream of urine, an intermittent stream of urine, a lingering feeling after voiding, and burning or pain when urinating.
Let’s assume that nothing bad happens – at what age should every man obligatorily see a urologist?
From the age of 45 we should report to a urologist for a prophylactic examination, while men who have family burdens, i.e. if some of their family members from the male line (grandfather, father, brother) suffered from prostate cancer or someone from their family members from the female line (mother , sister) suffered from breast or ovarian cancer should be regularly examined for the diagnosis of early-stage prostate cancer from the age of 40.
What does your experience show, are men aware of the need for regular examinations at the urologist or are they more often referred to a doctor’s office for their disturbing symptoms?
This is an interesting situation, because generally Polish men do not go to the doctors. I think that they still have a stereotypical gender image in their heads, so he is that strong knight riding a white horse, who is not fit to talk about his weaknesses, problems or seek help. From my own experience, I can say that their wives and partners, who often accompany them during the visit, often persuade them to visit the urologist. It seems to me that women can take more care of themselves and have the ability to convince their partners to take care of themselves.
Men should be made aware that taking care of their health is not a sign of weakness, but rather a sign of responsibility for themselves and their own family. Perhaps it is easier for women to “see a doctor”, as most of them regularly visit a gynecologist since they enter adulthood, bearing in mind the need for preventive examinations. Ladies taking care of themselves and their children show greater interest in health and healthy lifestyle issues. And they are often the ones who say to their husbands or partners: “Look, I go to the gynecologist and you should also have a checkup. – To whom? – To the urologist! ” Hence, the urologist becomes a “male gynecologist” in a vague sense.
At the same time, I must say that the situation has improved significantly in the last twenty years. At the beginning of my professional work, the need for preventive examinations in men was not mentioned at all, and the patient came when he was ill. Currently, more and more men who visit my office when asked: “what’s wrong with you?”, Replies: “Doctor, nothing. I just wanted to get tested. ” I think this is the result of promoting health education and social campaigns in which doctors are also involved. This “grain of health awareness” of Poles, however, needs to be watered constantly. Because although it is better, we are still far from the ideal.
What men fear most about the prostate is cancer. What is the diagnosis of prostate cancer?
We start with a PSA test performed on the patient’s blood. PSA (Prostate Specific Antigen) is the only organ-specific antigen known in humans, produced exclusively by prostate glandular epithelial cells. Increased PSA levels are indicative of prostate disorders that may be due to the developing cancer.
However, please remember that an increase in PSA levels is not the same as a diagnosis of cancer. PSA may also rise in the case of mild prostate enlargement, inflammation or even irritation, e.g. after cycling or after sexual intercourse. We recommend that patients always perform blood tests to determine PSA levels “in peace”, ie after a few days of abstinence. The confirmation of an elevated PSA level requires further diagnostics.
That is?
The next stage is a urological consultation, i.e. an interview with the patient, interpretation of the PSA result and physical examination, including per rectum examination, i.e. with a finger through the anus. Finger examination through the anus is by far the least pleasant procedure and disliked by men, it is extremely important. In this way, the urologist can assess the size of the prostate, the soreness associated with inflammation, and above all, sense nodular changes that may correspond to a developing cancer. It should be remembered that some prostate cancers can occur without increasing PSA levels, which is why rectal examination is so important. This examination is not pleasant, but also not painful, it takes only a few seconds and can save us from consequences that can reduce the comfort of our life much more and for a much longer time.
What if PSA is elevated and the rectal examination finds abnormalities?
In such a situation, the next stage of the procedure is to confirm or rule out the neoplastic nature of the lesion. The test for the diagnosis or exclusion of cancer is a biopsy performed under transrectal ultrasound guidance. During the biopsy, we take micro-sections from the prostate for histopathological examination. Only a pathologist, by assessing the specimens under a microscope, gives the answer whether what we suspected in the prostate is cancer or not.
How do men react to the diagnosis: do you have prostate cancer?
The diagnosis of any cancer is always a shock. This information is difficult for every human being to accept, but we, doctors, urologists and oncologists, are properly prepared to pass it on. Today, we can treat prostate cancer at any stage of diagnosis, even at a very advanced stage. So, when we provide the patient with a diagnosis, we inform him about the treatment options and the need for therapy, but we also give him great hope as to the prognosis. I never leave the patient alone with this problem. From the moment of diagnosis, the fight against cancer becomes our common concern, the patient and the doctor. I think that the message “You will not be left alone with the disease, but I will be with you” helps a lot and gives hope.
How many men in Poland are diagnosed with prostate cancer and what are the chances of being cured?
Prostate cancer is the most commonly diagnosed cancer today, accounting for 20 percent. all cancers diagnosed in men. So we can talk about an “epidemic or pandemic” that affects the entire world. It is a serious health, social and economic problem. However, when it comes to prognosis, if cancer is diagnosed at an early stage, we have a 98,8% chance of achieving a good therapeutic result. That is, by far the largest number of men have a chance of being fully healed. That is why we care so much about prevention, good diagnostics and appropriate therapy.
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What is the treatment of early stage prostate cancer?
The standard of conduct in the diagnosis of prostate cancer limited to the organ is radical treatment, i.e. removal of the entire prostate, i.e. radical prostatectomy or radical radiotherapy, i.e. irradiation of the prostate with ionizing rays in various forms: teleradiotherapy, brachytherapy and their combinations. If we remove or destroy the entire prostate, and the histopathological examination confirms that the tumor did not go beyond the prostate gland, and the PSA control test is close to 0,00, we can speak of a successful therapy. Such a patient is only subject to further observation.
And how is the treatment of advanced stage prostate cancer?
If the cancer has gone beyond the prostate and we recognize distant metastases of cancer in diagnostic tests, then such a patient must undergo systemic treatment, i.e. therapy of the whole organism. Fortunately, prostate cancer is a hormone-dependent or hormone-sensitive cancer, so appropriate hormonal treatment can stop the growth of cancer even for many years. Appropriate first-line preparations and innovative second- and third-line drugs have been developed and are mostly available. This type of treatment is performed by both urologists and oncologists. The criteria for including patients in drug programs are strictly defined, which is obvious considering the costs of the therapy. If the patient is disciplined and regularly visits the urologist or oncologist, such therapy brings very good long-term effects.
We know that from April 1, patients will have guaranteed access to surgery using the da Vinci robot – what does this mean for patients with prostate cancer?
This is a very important decision. As a urologist-surgeon, I would like our patients to have the widest possible access to the most modern surgical techniques, giving the best chances of recovery and at the same time maintaining the best quality of life. The da Vinci robot, long awaited by urologists in Poland, is such a device. Until now, treatments assisted by the da Vinci robot have been performed in Poland in a commercial system. The robot gives a much better precision of surgery, which is extremely important during radical prostatectomy. The more precise the tool we use, the better the functional results of the operation will be obtained.
What are, in your opinion, the most urgent needs in the field of prevention, diagnosis and treatment of prostate cancer in Poland?
I will start with education, which is a very important matter and I am glad that by talking we are adding another brick to it. We should talk as much as possible about prostate cancer and inform patients that early diagnosis of prostate cancer gives a chance for a complete cure. This message should be directed to both men and women who have a great influence on the behavior of their husbands and partners. It is equally important to show the support of your partner, the wife of a loved one, throughout the treatment process. Because prostate cancer is a very intimate disease that is difficult to accept. The implemented treatment that saves lives may be associated with complications such as erectile dysfunction or urinary incontinence. In the face of this disease and its consequences, a man often ceases to be a “hard macho” and becomes a fragile man who needs closeness and understanding.
I would like our decision-makers to show more knowledge and imagination in constructing a health care system. I would like everyone to understand that a urologist is also an oncologist. All over the world, urologists treat cancers of the genitourinary system in men and urinary tract cancers in women. It is forgotten in Poland. The National Oncological Strategy was created by oncologists and for oncologists, and after all, the treatment of prostate cancer is done by urologists.
Perhaps one of the decision makers will read our interview and understand that since prostate cancer is the most frequently diagnosed cancer in men, it may also affect him or his family members. When creating a healthcare system today, one should think about the long-term consequences in the future. What will be the surprise of this decision-maker who, when going to an oncologist, will receive information that a urologist deals with the diagnosis and treatment of prostate cancer.
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