Prostate cancer

Prostate cancer is the most common cancer detected and the second cause of death due to malignancy among men.

How common is prostate cancer?

The risk for lifetime diagnosis of prostate cancer is 15%
The risk for death of prostate cancer is 2.9%
In Western and Northern Europe almost 100 new cases of prostate cancer are diagnosed annually per 100.000 of population
In America approximately 30.000 men die of prostate cancer annually (more than any other tumor except lung cancer)

What are the risk factors for prostate cancer?

The age: The incidence increases in the elderly
Family history
Racial/ethnic background: Men of African descend show higher incidence of prostate cancer

How can I protect myself from getting prostate cancer?

No specific preventive or dietary measures are proven to have impact on prostate cancer incidence or progression risk of the disease. No specific measures of this type are recommended to reduce the risk of developing prostate cancer.

What can I do to prevent the effects of prostate cancer?

Prevention and early detection is the only way

Who and when should be examined?

men > 50 years of age;
men > 45 years of age and a family history of prostate cancer
African-Americans > 45 years of age.
men with a PSA level of > 1 ng/mL at 40 years of age
men with a PSA level of > 2 ng/mL at 60 years of age

The urologist offers an individualized risk- adapted strategy for early detection of prostate cancer in a well- informed man

Diagnosis:

Prostate cancer is usually suspected because of abnormal digital rectal examination of the prostate and/or PSA (prostate specific antigen: a protein produced by prostatic tissue) levels. Diagnosis is then confirmed by histological examination of prostate biopsy cores. Sometimes clinical suspicion persists even after negative prostate biopsies, then multiparametric magnetic resonance imaging (mpMRI) and fusion MRI prostate biopsy targeting of any mpMRI suspicious lesions, may be very useful.

Treatment:

Patients with localized low risk disease may be treated in a conservative way with:

Watchful waiting (follow up), when because of comorbidity life-expectancy is less than 10 years.
Active surveillance, for patients in good performance status suitable for curative treatment. If disease progression is observed the patient will undergo active treatment.

Surgical treatment: Radical prostatectomy for patients in good performance status and long life-expectancy with localized disease.

Radiotherapy for patients in good performance status and localized disease that don’t choose surgical treatment, for patients with locally advanced disease (extracapsular tumor infiltration) and for patient not fit for surgery (comorbidity and life-expectancy less than 10 years) with or not endocrine therapy (ADT).

Multimodal therapy for locally advanced, high risk disease: Combination of surgery, radiotherapy and endocrine therapy.

For metastatic disease: Endocrine therapy and Chemotherapy as well as Targeted therapies