Men with a history of prostate cancer should have checkups starting at age 40

He prostate cancerIt is the most common tumor in men. It is estimated that it will affect one in nine men during their lifetime. The good news is that, with the latest advances in treatment, it is possible to cure some types of prostate cancer without the need for surgery or chemotherapy in many cases. The focal therapy It is a pioneering intervention in this sense. Using high-intensity ultrasound or other energy sources, it allows prostate tumors to be selectively eliminated with high precision and without the need to make incisions. This translates into a lower risk of complications and the possibility of avoiding side effects that usually appear with other treatments, such as erectile dysfunction or urinary incontinence. In Galicia, this therapy has recently begun to be incorporated, led by the team led by the urologist. Daro Vzquez-Martul,surgeon specialized in Urology and Robotic Surgery at the San Rafael Hospital in A Corua and urologist at the Urology Service at the University Hospital in A Corua (Chuac).

—How do you see the current panorama of prostate cancer? Is it usually detected early?

—Currently, it is the most common neoplasm in men. Early detection strategies involve carrying out opportunistic screening. It is the general practitioner or family doctor who determines the risk that the patient may have a tumor through a blood test to determine the PSA values, which is a prostate-specific antigen in the blood. From the European Union there is already a recommendation to intensify this screening as in other pathologies, so that it becomes a population screening, so that these controls are systematically carried out on all men. This favors early detection of cancer in early stages and, thereby, increases definitive cure rates, avoiding diagnoses in advanced stages. In this sense, focal therapy is relevant because, by promoting earlier detection of the disease, we can see more localized and less aggressive tumors, to make less invasive treatments that generate fewer side effects in patients. These are the first treatments. carried out in clinical practice in Galician healthcare.

—How is focal therapy performed?

—Focal therapy is a treatment with curative intent that is aimed at the selective ablation of the tumor area within the prostate, preserving the rest of the anatomical structures. In this case, we have performed it using high-intensity ultrasound, although we also have focal treatment using cryotherapy. The selection of the energy source to be used is generally determined by the location and characteristics of the tumor, it is an a la carte treatment.

—What are the advantages of focal therapy for prostate cancer?

—With this, we manage to minimize the side effects that other treatments such as surgery or radiotherapy have. This allows sexual function, that is, erections, to be preserved in more than 70% of cases. In addition, it reduces the risk of urinary incontinence to 2% of cases or less. In other words, we manage to treat the patient by reducing possible side effects that have a high impact on her quality of life. It is a treatment that can be performed even on an outpatient basis. The anesthetic requirement is less than in surgery and the impact on the patient is also minimal. In five days, generally, you can be living your normal life, including playing sports. Incorporating it into your daily routines is really quick. And the treatment does not prevent, if necessary, continuing with any other treatment later.

—In which cases is focal therapy indicated?

—The recommendation is in those patients who, through magnetic resonance tests, we see that they have single or close tumors, of small size, which by biopsy are seen to have an intermediate to low aggressiveness. Also in those patients who, due to surgical risk, are not good candidates for surgery. Focal therapy has another possible indication, which is in rescues from failures of previous treatments. For example, patients who have received external radiotherapy for a prostate tumor and who, after a while, a tumor focus reappears. Focal therapy would also allow this new tumor to be eradicated within the prostate.

—What is the patient’s preparation before focal therapy?

—Generally it does not require specific preparation. They are interventions that are done without any type of incision. The patient will not have any cuts or wounds. They are minimally invasive therapies, anesthesia can even be regional and can be done on an outpatient basis or, in any case, admissions usually do not exceed 24 hours.

—How important is the multidisciplinary approach in the treatment of this cancer?

—In advanced disease, the multidisciplinary approach is essential, although prostate cancer is largely the responsibility of the urologist, who makes the diagnosis, indicates the biopsy and performs most of the treatments. But radiation therapists or, in patients with advanced disease who require chemotherapy, clinical oncologists, are very important.

—What measures can help prevent prostate cancer?

—Today, there are no risk factors beyond genetics that we can detect for prevention. Beyond this, the usual recommendations are to maintain healthy lifestyle habits, including exercise. But there is no direct relationship of any specific environmental factor with prostate cancer. I know that it has been seen that there is a clear genetic and family burden in this type of tumors. Those who have first-degree relatives with prostate cancer have a three-fold increased risk of developing it. Therefore, men who have brothers, fathers or uncles who have suffered from prostate cancer should have their PSA checks done at an earlier age, starting at age 40. The history of breast cancer in the family must also be taken into account, since there are some shared genes that may be related and involved in the development of prostate cancer.

—What symptoms may indicate the possibility of prostate cancer?

—When symptoms appear, generally, the tumor has already evolved. Precisely, early detection is aimed at diagnosis before symptoms appear. It must be clarified that in certain cases, the existence of symptoms may also be due to benign hyperplasia, which is a very common pathology in men and is related to the increase in the size of the prostate gland. But the symptoms that we should be aware of are the presence of blood in the urine or any other urinary symptoms. If they appear, you must consult with the urologist. However, prostate cancer is an indolent tumor until it is very advanced. With early diagnosis, it is rare for the patient to present symptoms. Bleeding in the urine or metastases, bone pain or fractures may appear in very advanced cases. That is why from the age of 45 or earlier if there is a history, PSA checks should be done.

—What advances will we see soon in the treatment of prostate cancer?

—The future will be precision medicine with personalized treatments for each patient, either to achieve a definitive cure with a minor impact or to chronicize the most advanced stages of the disease, increasing life expectancy. Currently, imaging tests are being developed that will allow more reliable and earlier detection of lesions inside and outside the prostate. Drugs are also being developed for the treatment of advanced disease in order to make the disease chronic. In the initial stages, progress is being made to achieve more accurate diagnoses. Progress is also being made in implementing monitoring systems for patients with very low-risk tumors, which we call active surveillance. Avoiding overtreatment in patients who are going to have a very low-risk cancer that will not affect them or impact their life expectancy is key, as is the development of minimally invasive treatments such as focal therapy.