Last year, 210 cases of prostate cancer were diagnosed at La Paz Hospital alone by biopsy analyzed in the Pathology Laboratory. This is 48% of those indicated by the Urology Service. At La Paz University Hospital in 2023, 53,111 PSA determinations were performed on 32,975 patients, and in only 20%, the PSA values were abnormal. In this same year, 437 biopsies were performed, of which 210 were positive (48%). As a result, 103 patients underwent surgery for prostate cancer and 109 underwent radical treatment with curative intent using various radiotherapy techniques.
The event, held on June 11, was organized jointly by the Madrid Urological Society, the National Association of Prostate Cancer Patients (ANCAP) and the Spanish group of cancer patients (GEPAC). This time, it had the collaboration of the UME, which placed a tent in the central square of the hospital, facilitating access for patients.
In addition, this event featured the voices of professionals as well as patients throughout two training sessions. In the first part, specialists Emilio Ríos González, head of the Uro-Oncology section, and Estefanía Linares, a urologist from the same section, explained the current situation of prostate cancer and explained to the attendees how it is diagnosed and what the treatments are. In the second part, patients from the hospital itself and from the participating patient associations told their experience about the reality of living with prostate cancer.
Prostate cancer
Prostate cancer has become a major concern for men’s health, with around 1.5 million people worldwide diagnosed with prostate cancer in 2022, and the World Health Organization estimates that more than 2.5 million new cases will be diagnosed by 2045. It is estimated that 1 in 9 men will be diagnosed with this type of tumor.
In Spain, according to data from the Observatory of the Spanish Association Against Cancer, prostate cancer is the most common cancer in men and 34,000 new cases are diagnosed each year (4,273 in Madrid), making it the third cause of death from cancer in men. Therefore, it is necessary to raise awareness about risk factors and the importance of early diagnosis. Despite the high prevalence, the survival rate is generally high, provided that it is detected early and its management has a multidisciplinary approach in which Medical Oncology and Radiotherapy Oncology participate, among other services.
Age and family history
This type of cancer develops in the cells that make up the prostate, a gland in the male reproductive system that is normally the size of a walnut and is located below the bladder and in front of the rectum. This is one of the most common types of cancer in older men. 90% of patients are over 65 years old. Diagnosis occurs most frequently between the sixth and seventh decades of life. Age and family history are two of the main risk factors because the possibility of suffering from it increases in these cases.
The importance of prevention
Prevention and regular check-ups are essential because prostate cancer often has no specific symptoms in its early stages. As the cancer progresses, some men may experience certain symptoms that are not unique to cancer, such as benign prostatic hyperplasia or other prostate diseases. These symptoms may include difficulty urinating or weak urine flow; frequent need to urinate, especially at night; pain or burning when urinating; pain in the pelvic, hip or lower back area; or pain during ejaculation.
This lack of clear symptoms in men with localized or early-stage tumors makes diagnosis difficult, which is why men are recommended to have their first Prostate Specific Antigen (PSA) test from the age of 50 and from the age of 45 if they have a family history of prostate cancer. Early diagnosis allows 90% of cases to be detected in time.
Blood test
The PSA test is a blood test, a simple and safe method. At the La Paz University Hospital, around 45,000 PSA determinations are carried out each year, of which 85% have normal values. 15% have values higher than four nanograms per milliliter (4 ng/mL), a reference value considered standard and from which it is necessary to complement with the clinical context and other studies.
Diagnosis
Although the suspected diagnosis is established by the PSA value and the digital rectal exam, in recent years, performing an MRI has become an essential tool when performing a biopsy. La Paz Hospital has incorporated precision biopsy (or fusion biopsy) into its portfolio of services to improve diagnostic accuracy. Also, to determine the extent of the disease after diagnosis, if necessary, new generation imaging techniques such as PET PSMA have been incorporated.
Personalized treatment
Each case is unique and must be evaluated by a multidisciplinary committee to determine the therapeutic management taking into account the characteristics of the patient and the type of cancer. La Paz Hospital has all the available techniques for the treatment of prostate cancer, which allows the treatment to be adapted to each patient and their disease and to offer increasingly personalized medicine.
Treatment may vary depending on the patient’s health, the aggressiveness of the disease, whether or not nearby lymph nodes are affected, or whether or not there is distant metastasis. There are several treatment options, starting with a strategy of close monitoring without immediate intervention in cases of low-risk cancer.
Surgery is an option in cases where it is necessary to remove the prostate. In recent years, La Paz Hospital has incorporated robotic surgery using the Da Vinci platform into its portfolio of services, which allows for greater intraoperative precision and a greater guarantee of early functional recovery of both urinary continence and the patient’s sexual function. In other cases, hormone therapy is used, since prostate cancer is influenced by male hormones, especially testosterone. This therapy blocks the production of these hormones, which can control its growth and help relieve symptoms. In advanced stages or when other treatments do not work, the Medical Oncology specialist may prescribe chemotherapy.
The Radiotherapy Oncology Service currently has the widest range of techniques at a national level, as it offers the option of low and high rate brachytherapy treatment, and external radiotherapy treatment. The great technological advances made in recent years have allowed us to gain precision and accuracy in treatments, as well as reduce their duration. The incorporation of the linac MRI that administers ionizing radiation guided by magnetic resonance imaging, allows a treatment tailored to the patient, the lesions to be treated and the nearby healthy organs.
Prostate cancer has undergone a revolution in its treatment in recent years, allowing our patients to live longer and better, thanks to the results of numerous clinical trials in which urology, medical oncology and radiotherapy services have participated and continue to participate actively.