the main problem that threatens its detection and a question: to treat or not to treat?

Prostate cancer is the most common tumor in men in Argentina. They are detected almost 12 thousand new cases per year and it is the third type that causes the highest number of deaths in men (almost 3,700 deaths annually). In it Prostate Cancer Daywhich is commemorated today, specialists emphasize the importance of carrying out controls that favor detection and treatment, if necessary.

Because it is a pathology without specific symptoms in the early stages, it is often diagnosed in advanced stages. Given that age is the main risk factor, it is indicated to start the urological control after 50 yearsor a decade earlier for those who have a family history of this type of tumor.

Early detection is a key tool in the decision of whether or not to prescribe treatment to prevent or delay tumor progression, or simply perform active surveillance.

In either case, the objective is to prevent men from coming to the doctor in advanced stages of the disease, when symptoms are already manifesting and the prognosis is more complex.

“In general, men are less inclined than women to undergo routine studies, but it is essential that controls be carried out after the age of 50, since if this pathology is diagnosed early, can be cured“underlined Carlos Silva, medical director and coordinator of the LALCEC Patient Support Program, which within the framework of Prostate Cancer Day makes 100 free check-ups available (see below).

Along the same lines, Norberto Bernardo, head of the Urology Division of the Hospital de Clínicas of the UBA, stated that “one of the main problems that hinder the fight against this disease is related to lack of awareness and education on prostate cancer in the male population.

“A still persistent problem is that some patients do not carry out annual check-ups and opportunity is lost to diagnose cancer early. For this reason it is necessary to emphasize the importance of early detection of prostate cancer,” insisted Bernardo, who is also director of the Argentine Center of Urology (CAU).

“It shouldn’t be a taboo topic. Talking openly about this disease can help raise awareness and eliminate the associated stigma,” said Natalia Gandur, a doctor at the Urological Clinic Functional Unit of the Angel Roffo Cancer Institute, which, like the Clinics, is part of the network of university hospitals. from the UBA.

Gandur maintained that it is key “encourage men to get tested screening and to seek medical help without fear or shame.”

Prostate cancer begins in the cells of the prostate, a gland in the male reproductive system that is located just below the bladder and produces a fluid that is part of semen.

This type of cancer usually grows very slowly. If it does not spread to other parts of the body, it may not cause serious problems. However, there are high-risk tumors that can progress rapidly and spread to other areas.

It is estimated that one in 7 or 8 men you will have prostate cancer throughout your life.

An important fact is that the majority of men diagnosed with prostate cancer will not die from this cause. While the lifetime risk of suffering from the disease reaches one in eight, only 3% will die from this tumor.

However, the high incidence of cases means that, in absolute numbers, the number of deaths is high.

Any man can develop prostate cancer, but certain factors can make it more likely:

Age. Being over 50 years old increases the risk of developing it and that risk increases significantly after 65. Therefore, by having a primary urologist, one can discuss in each consultation what study is most convenient to perform at each opportunity, taking into account the particularities of each case.

Family background. Having or having had a first-degree relative with prostate cancer (father or brother) doubles the risk of developing the disease. People with a history should start checkups earlier, starting at age 40.

A diet high andn saturated fats, obesity and lack of physical activity regularly also increase the risk of developing prostate cancer.

African Americans also have a higher risk of prostate cancer and at younger ages.

Prostate cancer usually does not cause symptoms, at least in the early stages, so an annual urological check-up is suggested starting at age 50 (earlier if there is a history) to detect it early and define the course of action to follow.

However, as the disease progresseswarning signs may appear that should not be underestimated and motivate a consultation:

• Urination disorders (frequent urge to pee, especially at night; weak discharge; pain or burning; blood in urine or semen). “These symptoms are usually the most alarming and the main reason why men go to a doctor,” they say from the Hospital de Clínicas.

• Pain in the back side of the back, hips or pelvis that does not disappear. The pain may be constant or intermittent.

• Erectile dysfunction: difficulty achieving or maintaining an erection.

• Pain during ejaculation.

Some of these symptoms may be due to other common prostate problems that are not cancer, such as an enlarged prostate.

“Early detection can be done through routine tests, such as prostate-specific antigen (PSA) and digital rectal exam (ERD), which is essential for an early diagnosis of prostate cancer, even in the absence of symptoms. Once detected through the biopsy, staging is performed to determine if the tumor is localized or disseminated. For this, bone scintigraphy and computed tomography of the abdomen and pelvis are used,” said Bernardo.

Using ERD, the doctor feels the prostate for lumps or changes. While PSA is measured through a blood test: a high level of PSA in the blood can be a sign of prostate cancer, but not always: Many benign causes can also elevate it.

“While PSA may be more sensitive, only 30% with abnormal values ​​have prostate cancerwith 20% false negatives and 40% false positives,” Silva reassured.

“If the PSA is higher than expected for age, and other causes of elevation such as prostate inflammation are ruled out, the studies will be expanded and the need for a prostate biopsy will be evaluated, which is the test that confirms the diagnosis. If the PSA It is normal, the frequency of the controls varies depending on the value, recurring in between 1 and 2 years“said Carolina Passarella, medical oncologist at the Genito-Urinary Tumor Clinic of the Austral University Hospital.

Broadly speaking, the different treatment options are the active surveillance (monitoring the evolution of tumors considered low and very low risk without indicating a specific treatment), surgery, radiotherapy, cryotherapy, hormonal therapy, chemotherapy and immunotherapy.

In relation to surgeries, Bernardo said that in recent years “there has been progress in minimally invasive techniques using laparoscopy in its conventional and robot-assisted versions with the aim of achieving a rapid recovery with fewer complications.”

After the diagnosis, the doctor – in dialogue with the patient – will determine the best steps to follow based on the stage of the disease, its evolution, the age and general condition of the patient.

Before, a patient who was diagnosed was treated. Today, that is changing: The aim is to identify more precisely the patient who will actually need to be treated.

Thus, the strategy of active surveillance in prostate cancer is on the rise, which aims to avoid overtreatment, which implies “indicating unnecessary treatments such as radical prostatectomy or radiotherapy, with its possible adverse effects,” Passarella described.

Active surveillance includes active control of tlow and very low aggressive tumors to evaluate its progression and intervene with treatment (surgery, rays, drugs) only if the cancer progresses.

“Active surveillance has been the strategy of choice in many low-risk cases for many years. The urological and oncological guidelines say so. It is absolutely proven. It is not a cause for controversy or discussion,” he told Clarion In a recent note Juan Pablo Sade, head of the Genitourinary Tumors area at the Alexander Fleming Institute (IAF) and at the Austral University Hospital.

One fact: most prostate tumors are low risk (estimated to be between 50% and 60%). “Which means that many patients are candidates for active surveillance,” she stressed.

It is also an option, “discussing case by case”, in favorable intervals. However, there is no unanimity regarding the relevance of its indication in this group of patients.

“Active surveillance in Argentina is very center-dependent“said Gonzalo Vitagliano, head of Uro-Oncology of the Urology service of the German Hospital of Buenos Aires. “In academic and reference centers it is well disseminated, well accepted, well controlled. But we still see patients who are referred for treatment with low-grade tumors and are even indicated for radiotherapy and surgery.”

“To do active surveillance you need a good pathologist, a good imaging specialist, a good urologist and/or oncologist (generally done by urologists) and above all you need a multidisciplinary discussion, a tumor committee,” Sade listed. These conditions are usually met by academic and high-level centers.

Making healthy lifestyle changes can help prevent some types of prostate cancer. These changes include: maintaining a healthy weight, not smoking, exercising regularly, and eating a proper diet.

“Diet plays a fundamental role in prostate health and could contribute to reducing the risk of cancer,” says Vitagliano. Therefore, he maintains that it is advisable to follow a plan that includes the following foods:

• Vegetables from the cruciferous family, such as broccoli, cabbage, and cauliflower

• Vegetables rich in omega-3

• Foods rich in vitamin E such as margarine, vegetable oils, nuts and seeds, wheat germ, and whole grains

• Fiber-rich foods, such as whole grains

• Foods rich in lycopene such as tomatoes, pink grapefruit and watermelon

• Foods rich in selenium such as nuts, seafood, fish, wheat bran, wheat germ, oats and brown rice

• Consume soy: its isoflavones help reduce levels of dihydrotestosterone (DHT), a male hormone that promotes excessive growth of prostate tissue

• Avoid spicy foods, alcohol, caffeine and substances that irritate the urinary tract

• Reduce consumption of red meat and saturated fats

• Drink plenty of water to keep your bladder clean

LALCEC It has availability of 100 consultations with a specialist in urology and PSA studies, free of charge, for those who do not have medical coverage. To get a turn, contact 011-4834-1500.

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