He prostate cancer presents a slow process and may not be perceived by the patient in the initial stages of the disease. Therefore, specialist doctors They recommend going to the urologist and having check-ups starting at 45 years of age. and, if there is a family history, from the age of 40.
According to the Spanish Society of Medical Oncology (SEOM), it is expected that in 2024 the most common tumors be those of colon and rectumwith 44,294 new cases, followed by breast cases (36,395), lung (32,768), prostate (30,316) and urinary bladder (22,097). These are figures that maintain prostate cancer as the cancer with the highest incidence in men in Spain for another year.
Despite the increase in cases of prostate cancer in recent decades, advances in screening programs, new therapies and drugs, and innovative diagnostic techniques have made it possible to “practically make prostate cancer chronic.” placing its cure rate “around 90-94%”As explained by Dr. Juan Casanovahead of the Urology Service of the Valencian Institute of Oncology Foundation (IVO).
The challenge of diagnosing a tumor before it develops
On June 11, the World Prostate Cancer Day. One of the main challenges in the diagnosis of prostate cancer is its detection in early stages, recalls Dr. Casanova. “Typical urinary symptoms, such as nocturia, feeling of urgency to urinate, frequency and incomplete emptying, are non-specific and are not linked to prostate cancer, but rather to prostate hyperplasia or enlargement that all adult men suffer.” He expert also remembers that prostate-specific antigen or PSA“it is a nonspecific marker, and not all patients with elevation of this marker suffer from prostate cancer.”
This is where magnetic resonance imaging (MRI) plays a fundamental roleas highlighted by Dr. Paula Pelechano, Assistant Physician of the IVO Radiodiagnosis Service. MRI, by establishing a category of suspicion (PI-RADS), allows the biopsy to be directed towards suspicious lesions, avoiding unnecessary biopsies and improving diagnostic yield.
To diagnose this type of tumor in its incipient stages, in Spain there are early detection programs aimed at men aged 45 and older. As Dr. Casanova points out, the test allows for differentiated follow-up by risk groups and It consists of a simple examination such as a digital rectal examination and a blood test conventional to detect the PSA level. “This is a test comparable to those carried out for the early detection of breast cancer in women, which is increasingly popular among men.” And he remembers the importance of visiting the urologist once a year “for the interpretation of any symptoms and signs in an adequate and precise way.”
The doctor. Casanova It also highlights that advances in imaging tests such as MRI and PET, combined with PSA, “allow a more precise diagnosis of cancer and avoid many unnecessary biopsies.” It stands out that the IVO has an Opportunistic Early Diagnosis program for Prostate Cancer through a digital rectal examination and a blood test to determine the PSA. “Given a suspicious touch and two PSAs above 4 ng/ml, an MRI is performed and addressed by a Uro-Radiological Committee where outlines the need forbiopsy and, if done, if it is with fusion.”
In this sense, the head of the IVO Urology Service recalls that the fusion biopsy, a procedure to obtain a biopsy that combines magnetic resonance imaging and ultrasound to create detailed three-dimensional images of the prostate, has been one of the main “milestones” in the diagnosis of prostate cancer. “Currently, we are able to ‘navigate’ the prostate andtake samples from suspicious areas according to the resonance. Not only do we diagnose earlier, but we also characterize the tumor better and we can more precisely adjust the appropriate therapeutic option,” says the expert.
In the words of Dr. Ana Calatravahead of the IVO Pathological Anatomy Service, the biopsy is essential to confirm the existence of cancer and determine its histological characteristics. “The joint assessment of the biopsy and the MRI allows us to choose the therapeutic option most appropriate for each patient and at each stage of the disease.” Currently, there are clinical trials that explore the possibility of confirming the existence of cancer immediately using confocal microscopy, allowing treatment in the same surgical procedure as the diagnosis.
Risk factor’s
Most of the more than 30,000 new cases of prostate cancer that will be detected this year will be diagnosed in elderly men, with 90% of patients over 65 years of age and an average age of diagnosis of 75 years.
As Dr. Jose Antonio López Guerrero explains, head of the Molecular Biology Service of the IVO, in a way there is a certain genetic predisposition to developing this type of cancer, but not all cases have hereditary origin. “There are two scenarios at the family level that increase the risk of suffering from prostate cancer.: the one that occurs in the context of a family in which there is a certain aggregation of cases, which is called familial prostate cancer and occurs in approximately 20% of cases; and on the other hand, we would have hereditary prostate cancer, which is less common and is responsible for Approximately 5% of diagnosed prostate cancers”. And he clarifies: “Compared to sporadic cases, hereditary prostate cancer is characterized by an early onset, a more aggressive behavior of the cancer with a greater risk of relapse after surgery.”
The importance of a comprehensive and multidisciplinary approach
As Dr. Miguel points out Angel Climent, clinical head of the IVO Medical Oncology service, once the diagnosis of prostate cancer is confirmed, “the first step is to determine if the cancer is localized.” To do this, extensive diagnostic tests such as CT, bone scanning and PET are used.
In cases where the tumor is located in the prostate, there are numerous treatment options. treatment, ranging from Active Surveillance and focal therapy (treatment directed exclusively at the intraprostatic tumor) to more radical treatments such as surgery or radiotherapy. The choice of treatment depends on the characteristics of the patient, such as his age and other diseases he may have, as well as the size and location of the tumor.”
In the case of tumors with metastases, Dr. Climent emphasizes that the fundamental treatment continues to be antiandrogenic hormonal therapies (treatments that block the action of androgens, male hormones). For this type of case, treatments with chemotherapy, radioactive isotopes such as Ra223, radioconjugates such as Lutetium-PSMA, or treatments that act when there is the presence of certain genetic alterations in the tumor. “All of these treatments have shown promising results, although we are still determining in what clinical situations obtain the best results”, and adds: “Each patient is unique, and our goal is to offer them the most appropriate treatment according to their characteristics and the specific situation of their disease.”
Radiotherapy in the treatment of prostate cancer
¿What role does radiotherapy play inprostate cancer treatment? As explained by Dr. Leoncio Arribas, head of the IVO Radiation Oncology Service, radiotherapy “It is very effective” in most stages of the disease. In this way, in initial low-risk phases, “Brachytherapy is an alternative to surgery, with results in the 10-year IVO experience above 90%.”
In relation to intermediate risk stages, Dr. Arribas explains that both Brachytherapy and external radiotherapy, alone or combined with each other, or with hormone therapy, continue to constitute the best therapeutic options. For locally advanced cases, the expert highlights the results of combining radiotherapy with hormone therapy. Likewise, Dr. Arribas recalls the role that radiotherapy plays in the treatment of pain caused by bone or brain metastases, etc. “The IVO has extensive experience that allows it to offer each patient the radiotherapy treatment that best suits their needs.both at the level of external radiotherapy and brachytherapy,” highlights the doctor.
The benefits of robotic surgery
Robotic surgery constitutes one of the greatest advances for the radical surgical treatment of prostate cancer. In this sense, Dr. Álvaro Gómez-Ferrer, clinical head of the IVO Urology Service, highlights “pain reduction in the postoperative phase and, in general, a faster functional recovery with shorter hospital stays”, among the main advantages it offers to the patient.
For the surgeon, it provides “surgical precision, augmented 3D vision, and betterergonomics“, which improves the functional results of prostatectomy and minimizes surgical complications, offering excellent oncological results.
Advances and research
Among the advances in treatment, experts place their hopes in immunotherapy: “No We still have important results that allow the generalization of these treatments in this cancer, but there are many clinical trials underway that are expected to have good results and we will be able to have new treatment alternatives for these patients,” explains Dr. Climent.
Likewise, the clinical head of the IVO Medical Oncology service highlights the importance of taking into account the symptoms reported by the patient, the PSA number obtained in a blood test and the degree of histological aggressiveness of the tumor obtained in the biopsy. And he adds: “In recent years, new, more sensitive diagnostic tests have been developed to detect the possible locations of metastases.such as PET choline or PET PSMA, which are indicated depending on the situation of the disease.”