Prostate Cancer
EPIDEMIOLOGY
It is the most common cancer in
man in Portugal 6 600 new cases of prostate cancer per year in Portugal 4th cause of cancer death in Portugal 2nd cause of cancer death in men in Portugal 1 800 deaths per year in Portugal.
RISK FACTORS
Age, 60% of diagnoses in men over 65, Black race. Most common in North America, Western Europe, Australia and the Caribbean. Sedentary life, Excessive meat consumption. Family history: first-degree relative with prostate cancer, especially if diagnosed before age 60.
SIGNS AND SYMPTOMS
Localized disease is not
symptomatic. They are almost always late and associated with advanced disease. When advanced, prostate cancer can be associated with changes in urination. Evolution is usually slow. Urination changes. Bone pain and fractures associated with spinal and rib injuries in advanced disease.
DIAGNOSIS
Prostate cancer screening should be reserved for men over 50 years of age and with a survival rate of more than 10-15 years. There are scales that help define the risk of the disease and the probability of its evolution. Currently, screening is advocated
of opportunity – you should not look for cancer in all men as we run the risk of treating too much. The diagnosis is made through PSA analysis, digital rectal examination and prostate biopsy. Prostate biopsy consists of removing small fragments through a needle transrectally, under local anesthesia. The most common side effects of prostate biopsy are blood in the semen, urine, or stool. Prostate biopsy does not carry the risk of spreading the disease. Through biopsy analysis, the Gleason scale is determined, which classifies the aggressiveness of prostate cancer and can vary between 6 (less aggressive) and 10 (very aggressive). MRI is a good diagnostic weapon: it can be used
to assess the risk of the presence of the disease, and to guide the prostate biopsy.
Treatment
Treatment depends on the stage of the disease, age and general condition of the patient.
LOCALIZED DISEASE
For men with a life expectancy of <10 years the preferred treatment is hormone suppression (testosterone), as it is a hormone dependent tumour. It can be done in two ways: surgical (removal of the testicles) or chemical, with drugs that inhibit the production of testosterone (usually injections). It is a palliative treatment, with temporary effectiveness (a few years), but which allows you to avoid the side effects of curative treatments, and at the same time control the disease.
For men with a life expectancy of >10 years, the proposed treatments are aimed at cure. Surgery: (Radical Prostatectomy), consists of removing the prostate, seminal vesicles and, in cases of more aggressive disease, also the local lymph nodes. In some cases (more aggressive disease), radiotherapy may be necessary after surgery. External Radiotherapy: through a machine, high-energy rays are released, with the aim of destroying prostate tumor cells, trying to spare the normal surrounding tissues as much as possible. Treatments are usually performed daily for 7 to 8 weeks.
In cases of higher risk disease, this technique can be associated with hormone therapy for 6 to 36 months. Brachytherapy: radiation comes from material radioactive substance contained in seeds, needles or thin plastic tubes, which are placed directly into the prostate. This technique can be used alone or in association with external radiotherapy. Active Surveillance: in some cases of tumors with low aggressive characteristics only surveillance can be proposed. This implies a tight follow-up plan, which implies the determination of PSA, resonance MRI and prostate biopsy periodic.
For men with a life expectancy of >10 years, the proposed treatments are aimed at cure. Surgery: (Radical Prostatectomy), consists of removing the prostate, seminal vesicles and, in cases of more aggressive disease, also the local lymph nodes. In some cases (more aggressive disease), radiotherapy may be necessary after surgery. External Radiotherapy: through a machine, high-energy rays are released, with the aim of destroying prostate tumor cells, trying to spare the normal surrounding tissues as much as possible. Treatments are usually performed daily for 7 to 8 weeks.
In cases of higher risk disease, this technique can be associated with hormone therapy for 6 to 36 months. Brachytherapy: radiation comes from material radioactive substance contained in seeds, needles or thin plastic tubes, which are placed directly into the prostate. This technique can be used alone or in association with external radiotherapy. Active Surveillance: in some cases of tumors with low aggressive characteristics only surveillance can be proposed. This implies a tight follow-up plan, which implies the determination of PSA, resonance MRI and prostate biopsy periodic.
METASTIZED DISEASE
The most frequent sites of metastasis (tumor foci outside the prostate) are the lymph nodes and bone.
In the vast majority of cases it is an incurable disease. The available treatments are carried out, with palliative intent, with the following objectives:
– Control the disease and delay its progression
– Increase lifespan
– Improve symptoms related to the disease and prevent its onset.
Hormone therapy or surgical castration: is the mainstay of treatment of metastatic disease. It aims at hormonal suppression.
The effectiveness of hormone therapy is temporary, usually lasting 2-3 years, making prostate cancer resistant to castration.
This means that even with very low testosterone levels, the tumor progresses and metastases grow. In addition to hormonal suppression, other treatments are carried out:
2nd generation hormone therapy: Oral drugs (pills) that inhibit the production of male hormones produced in smaller amounts in other locations.
Chemotherapy: is a type of treatment used to destroy tumor cells. In prostate cancer, it is a treatment given through a vein, always in a hospital context.
– Increase lifespan
– Improve symptoms related to the disease and prevent its onset.
Hormone therapy or surgical castration: is the mainstay of treatment of metastatic disease. It aims at hormonal suppression.
The effectiveness of hormone therapy is temporary, usually lasting 2-3 years, making prostate cancer resistant to castration.
This means that even with very low testosterone levels, the tumor progresses and metastases grow. In addition to hormonal suppression, other treatments are carried out:
2nd generation hormone therapy: Oral drugs (pills) that inhibit the production of male hormones produced in smaller amounts in other locations.
Chemotherapy: is a type of treatment used to destroy tumor cells. In prostate cancer, it is a treatment given through a vein, always in a hospital context.
Prognosis
Good prognosis with >95% of patients alive after 5 years. It varies depending on the stage at which it is diagnosed. When it comes to localized disease and a treatment with curative intent is performed, we have a cure rate of 40 to 85%. When it comes to a metastatic disease, about 30% of patients are alive at the end.
of 5 years. After curative treatment, 3 out of 10 patients
will have a recurrence of the disease.