What is it?
Prostate cancer originates from cells within the prostate gland, growing uncontrollably. The prostate, found only in men, is positioned in front of the rectum and produces a portion of the seminal fluid released during ejaculation. Under normal conditions, it is the size of a walnut, but with age or due to certain conditions, it may enlarge, causing primarily urinary disturbances.
This gland is highly sensitive to hormone action, especially male hormones like testosterone, influencing its growth.
How common is it?
Prostate cancer is the most common cancer in males, representing 18.5% of all diagnosed cancers in men. Estimates for 2020 report 36,074 new cases nationwide. Despite its high incidence, the risk of an unfavorable outcome is low, especially with timely intervention. Compared to 2015, there has been a 15.6% reduction in mortality rates by 2020.
This is evident in the data on the percentage of people still alive five years after diagnosis — an average of 92%, one of the highest rates for cancer, considering the advanced age of patients.
Incidence, the number of new cases in a given period, has increased in the last decade with the widespread use of tests aiding early diagnosis, such as the Prostate-Specific Antigen (PSA) test.
The prostate contains various cell types, with almost all diagnosed prostate cancers originating from gland cells, classified as adenocarcinomas. Besides adenocarcinomas, there are rare cases of sarcomas, small-cell carcinomas, and transitional cell carcinomas in the prostate.
More common than carcinomas are benign conditions affecting the prostate, especially after the age of 50, sometimes causing symptoms that may be confused with those of cancer. Benign Prostatic Hyperplasia (BPH) involves the central part of the prostate enlarging and excessive tissue growth compressing the urethra, creating difficulties in urine passage.
In the early stages, prostate cancer is asymptomatic. It is usually diagnosed through a urological examination, including a digital rectal examination and PSA blood test.
As the tumor mass grows, it leads to urinary symptoms: difficulty in urination (especially initiation), frequent urination, pain during urination, blood in urine or semen, and a feeling of incomplete urination.
Often, urinary symptoms may be related to benign prostatic issues such as hypertrophy; in any case, consulting a doctor or urology specialist is advisable for further examinations.
The number of prostate cancer diagnoses has progressively increased since the approval of the PSA test in the 1990s. However, the debate continues regarding its actual value for cancer diagnosis, as values are often altered due to benign hyperplasia or infection. In recent years, there has been a reduction in the use of this test. PSA levels should be carefully evaluated based on the patient’s age, family history, exposure to risk factors, and clinical history.
Urinary symptoms of prostate cancer only appear in advanced stages and may indicate other conditions. Therefore, a specialist’s diagnosis, considering various factors, is crucial.
For prostate assessment, the doctor may choose to perform a PSA test and digital rectal examination. The latter is conducted in the general practitioner’s or urologist’s office and sometimes helps identify nodules in the prostate.
The only test capable of definitively identifying cancer cells in prostate tissue is the prostate biopsy. Multiparametric magnetic resonance imaging has become crucial in deciding whether and how to perform this biopsy, which is usually done under local anesthesia, as an outpatient procedure or in a day hospital, and lasts a few minutes. Approximately 12 samples are taken through a transrectal or transperineal route (the region between the rectum and scrotum) with a special needle, which are then examined under a microscope by a pathologist for potential cancer cells. The biopsy can also be targeted under the guidance of previously performed multiparametric magnetic resonance imaging.
There is no specific primary prevention for prostate cancer, but some behavioral rules can be easily followed: increase consumption of fruits, vegetables, whole grains, and reduce red meat intake, especially if fatty or overcooked, and foods rich in saturated fats.
Maintaining a healthy weight and staying fit with regular physical activity, even just half an hour a day of brisk walking, is also advisable.
Secondary prevention involves consulting a doctor and possibly undergoing a urological examination every year, especially for those with a family history of the disease or experiencing urinary discomfort.