Prostate cancer is the most prevalent form of tumor in men over the age of 50. Statistics from the United States indicate that approximately one in eight men will develop prostate cancer in their lifetime. It is important to highlight that only one in every 41 men affected by this disease will die as a result of it. In Brazil, prostate cancer accounts for about 10% of all cancer-related deaths in male patients, ranking second in incidence, just behind lung cancer.
There are different types of prostate cancer, with adenocarcinoma being the most common. Most diagnosed cases are adenocarcinoma, which originates from glandular cells that secrete fluid, such as prostate cells. In rare cases, prostate cancer can develop from other types of cells.
In addition to adenocarcinoma, there are other less common types of prostate cancer, which include:
- 1. Small cell carcinomas: these are fast-growing and less frequent tumors.
- 2. Transitional cell carcinomas: these tumors originate in the cells that line the urethra and have similar characteristics to the cells found in the bladder. They are most common in the bladder, but can also occur in the prostate.
- 3. Neuroendocrine tumors: these are rare tumors that develop from neuroendocrine cells, responsible for hormone production. They have an aggressive behavior and can grow quickly.
- 4. Sarcomas: these are rare tumors that form in the connective tissues of the prostate, such as muscles, blood vessels or fibrous tissue. Sarcomas are quite uncommon and represent only a small percentage of prostate cancers.
SYMPTOMS
Early-stage prostate cancer usually has no obvious symptoms. However, as the disease progresses, the following problems may occur:
- 1. Frequent and sometimes urgent need to urinate, especially during the night.
- 2. Weak or intermittent stream of urine, with difficulty starting or stopping the stream.
- 4. Loss of bladder control resulting in urinary incontinence.
- 5. Loss of bowel control, leading to fecal incontinence.
- 6. Painful ejaculation or erectile dysfunction.
- 7. Presence of blood in semen (hematospermia) or urine.
- 8. Pain in the lower back, hip or chest.
CAUSES
It is true that the exact cause of prostate cancer is still not fully understood. These factors include:
- 1. Age: The risk of prostate cancer increases as you age.
- 2. Ethnic group: Prostate cancer has a higher incidence in black men compared to Asian men, for example. The prevalence of the disease varies between different ethnic groups, being more frequent in the male population of African origin.
- 3. Family history: Having a family history of prostate cancer, especially if a sibling or parent was diagnosed before age 60, increases your risk. In addition, studies indicate that having a close relative with breast cancer may also increase the risk of prostate cancer.
- 4. Obesity: Recent research suggests a possible link between obesity and prostate cancer.
- 5. Diet: Studies are underway to investigate the relationship between diet and prostate cancer. Some evidence suggests that a diet rich in calcium, especially from dairy products, may be associated with an increased risk of developing the disease.
DIAGNOSIS
The diagnosis of prostate cancer involves carrying out different types of tests, depending on the health condition and the suspected presence of the tumor. The two main tests used are:
- 1. PSA (Prostate Specific Antigen) Test: This test involves taking a blood sample from the patient. PSA is a protein produced by the prostate, and high levels of this substance can indicate the presence of prostate abnormalities, such as cancer. However, it is important to note that an elevated PSA level is not a conclusive diagnosis of prostate cancer, as it can be influenced by other factors such as inflammation or benign prostate enlargement.
- 2. Rectal exam: Despite being a widely known exam, it often causes discomfort or apprehension in some men. The digital rectal examination is performed by the urologist, who inserts a lubricated finger into the rectum to assess the size, texture and surface of the prostate. Although it is a quick and painless test, it can identify changes in the prostate, such as lumps or swelling. If there is any suspicion of cancer, the doctor may recommend a biopsy to obtain a sample of prostate tissue for further analysis.
It is important to note that these tests are used to identify possible signs of prostate cancer, but the definitive diagnosis is made through a biopsy, in which samples of prostate tissue are analyzed by a pathologist to determine the presence of cancer cells. It is essential to consult a doctor to discuss the need and indication of these tests according to your health history and risk factors.
TREATMENT
IN STAGES I AND II of prostate cancer, when the disease is restricted to the prostate and does not invade its capsule, there are three commonly considered treatment options:
- Surgery: Depending on the case, open, laparoscopic or robotic surgery may be performed. Prostate removal aims to eliminate the tumor and may be followed by other therapies such as radiation therapy if needed.
- Radiotherapy: Radiotherapy can be performed in two ways: external or internal (brachytherapy). In external beam radiation therapy, beams of radiation are aimed at the prostate from outside the body, while in brachytherapy, tiny radioactive seeds are implanted directly into the prostate. Both forms are intended to destroy cancer cells.
- Watchful observation (or active surveillance): This approach involves regular and close monitoring of prostate cancer progression without immediate active intervention. During watchful observation, regular tests, such as PSA tests and digital rectal examinations, are performed to monitor the growth of the tumor. This option is generally considered for patients with low-risk tumors where immediate treatment may not be necessary.
IN STAGES III AND IVA of prostate cancer, in which the tumor infiltrates the tissues around the prostate or reaches the pelvic lymph nodes, the indicated treatment usually involves combined approaches. Treatment options include:
- Radiation therapy combined with hormone therapy: Radiation therapy is used to target and destroy cancer cells in the prostate and surrounding tissues, such as the seminal vesicle, rectum, and bladder. Hormone therapy, also known as androgen deprivation therapy, is given to suppress the production of male hormones, which fuel prostate cancer growth. Combining these treatments aims to control the tumor and improve outcomes.
- Surgery followed by postoperative radiotherapy: In some cases, surgery, such as radical prostatectomy, may be performed to remove the prostate and affected tissues. After surgery, post-operative radiation therapy is given to destroy any residual cancer cells that may have been left behind. Hormonal treatment may also be recommended in these cases.
- Advanced anti-hormonal therapy: In more advanced or higher-risk situations, new oral hormone-inhibiting agents can be added in addition to classic injectable anti-hormonal therapy. These drugs aim to further block the action of male hormones, inhibiting the growth of prostate cancer.
PREVENTION
There is no scientifically proven way to specifically prevent prostate cancer.
- 1. Balanced Diet: A diet rich in fruits, vegetables, whole grains, and low-fat foods can be beneficial to your overall health. While there is no definitive evidence that a specific diet can prevent prostate cancer, maintaining a balanced diet can contribute to better health.
- 2. Regular physical exercise: Regular practice of physical activity has been associated with a number of health benefits, including reduced risk of various diseases, including cancer. It is recommended to perform moderate physical activity, such as walking, cycling or swimming, at least 150 minutes a week.
- 3. Knowledge of risk factors and symptoms: It is important to be aware of risk factors for prostate cancer such as family history, advanced age and ethnic origin. In addition, being aware of possible symptoms, such as urinary changes, can help in the early detection of the disease.
Although these measures can contribute to good health in general, it is essential to emphasize that regular consultation with a specialist physician, such as a urologist, is important to individually assess risk factors and the need for early detection tests, such as the PSA and digital rectal examination. These tests can help identify prostate cancer early, when the chances of successful treatment are greatest.
