Prostate cancer

How common is prostate cancer?

Prostate cancer is the second most common cancer in men and the fourth most common cancer in general. It is the sixth most common cause of cancer death in men worldwide and it is estimated that about one in nine men shall develop prostate cancer.

Who are more likely to get prostate cancer?

Most patients (75%) are over 65 years of age, but it is possible that the disease may occur at younger ages. Rarely, men younger than 40 years of age may also be diagnosed with the disease. The most important predisposing factor for prostate cancer remains age. Other factors include geographical origin (Europe and North America), race (African-Americans), heredity (twice the chance of developing when a first-degree relative has a history of prostate cancer), an animal fat-based diet, and some gene mutations involved in carcinogenesis.

Is there a screening (check up) for prostate cancer?

Screening includes a simple blood test (measurement of prostate specific antigen – PSA) and palpation of the organ (digital exam) by a doctor to look for a possible suspicious lesion. Periodic screening (check-up) concerns all men over the age of 50. In men under 50 years of age, it is not necessary, since prostate cancer is rare in younger men. Only if a first-degree relative (father, brother or siblings of parents) has been diagnosed with prostate cancer, PSA testing is useful at the age of 40-50.

What is prostate specific antigen (PSA)?

PSA is a protein produced only by certain prostate cells, it is detected in semen, but some of it is also detectable in the blood. It should be stressed that PSA is not a cancer marker and is therefore widely used in the detection of the disease. In addition to cancer, PSA is also increased in cases of benign prostatic hyperplasia, inflammationd of the organ, after a prostate biopsy or when a catheter or medical instruments are inserted into the urethra.
Despite the advantages of early cancer diagnosis, there are some disadvantages associated with PSA measurement. PSA testing in some cases of prostate cancer shows low values (about 1% of cancers), while in other cases, high values will lead doctors to submit patients to biopsy without a significant chance of finding cancer. It is worth noting that there is no specific PSA value or a value separating normal from pathological cases. The doctor co-evaluates the value, the change in value on successive measurements, and the patient’s age. In some cases, measurement of free PSA is also indicated (total PSA consists of free and bound PSA). The free PSA rate is lower in men with prostate cancer compared to men without cancer.

How often is prostate cancer diagnosed at an early stage?

Extensive screening of the male population by measuring prostate specific antigen (PSA) has resulted in a large number of patients being diagnosed at the asymptomatic stage.

Are there any symptoms indicative of prostate cancer?

The main symptoms of prostate cancer are related to urinary tract dysfunction as the prostate surrounds the prostate part of the urethra. These symptoms are non-specific and may be due to other benign conditions. Frequent urination, nocturia (urination during the night), dysuria (pain on urination) or haematuria (blood in the urine), reduced urine radius and sexual dysfunction may also occur. In the case of prostate cancer accompanied by bone metastases, it also manifests with diffuse bone pain.

What tests does a patient with suspected prostate cancer undergo?

The doctor should examine the patient with a digital exam, which often reveals sclerosis, asymmetry and swelling of the prostate gland. The blood prostate antigen is elevated and there is usually an abnormality in the ratio of free PSA to total PSA.

How is prostate cancer diagnosed?

If cancer is suspected, further imaging with prostate ultrasound (mainly corrective) and possibly MRI is required. For cancer diagnosis, a prostate biopsy is required, which is usually performed under local anaesthesia using a special biopsy instrument and always with the help of ultrasound guidance.

What are the treatments available today?

The treatment plan for each patient is determined by the stage of the disease, the patient’s age and general health status. Available treatment options include surgical cancellation (prostatectomy), radiotherapy, hormone therapy and chemotherapy, often in combination.