The word “cancer” alone can cause feelings of fear, despair and anxiety. However, this should not necessarily be the case when it comes to prostate cancer.
Statistically, 60% of men over the age of 65 will be diagnosed with prostate cancer, yet only 6% will die from the disease. This, however, depends on early diagnosis, which nowadays can be achieved through a relatively simple screening process.
What exactly is the prostate?
The prostate is a gland of the male reproductive system located just below the bladder. One of its functions is to make semen more alkaline, helping sperm survive more effectively in the acidic environment of the vagina.
Do I really need to be screened for prostate cancer every year?
Not necessarily. This is an issue that continues to be widely discussed within the medical community.
Based on a number of studies, men over the age of 50 — with the exception of those who belong to high-risk groups — should begin screening for the early detection of prostate cancer.
Depending on the results of the initial blood tests, the appropriate follow-up interval can then be determined and, in some cases, screening may be repeated as infrequently as every five years.
Who is considered to be at high risk?
Men with a family history of prostate cancer are considered to be at increased risk. If your father or brother has prostate cancer, your risk of being diagnosed with the disease is approximately twice as high.
African-American men also have approximately twice the risk of developing prostate cancer due to genetic factors.
If you belong to one of these higher-risk groups, the screening process should begin from the age of 45.
What symptoms may indicate prostate cancer?
There are no specific symptoms that reliably indicate the presence of prostate cancer while the disease remains localised.
Symptoms associated with difficulty urinating, such as frequent urination, nocturia, reduced urinary flow and similar urinary problems, are characteristic of benign prostatic hyperplasia and should not be confused with prostate cancer.
What is the PSA test?
PSA, or Prostate-Specific Antigen, is a protein produced by the prostate gland.
It is used as a tumour marker that may indicate the presence of a prostate condition. Unfortunately, it does not determine the exact nature of the condition, as PSA levels can also be affected by infections, benign prostatic hyperplasia, certain medications and other factors.
An elevated PSA is therefore essentially a starting point for further investigation.
What should a man do if his PSA level is elevated?
An elevated PSA level alone does not constitute a diagnosis of prostate cancer.
Until relatively recently, an elevated PSA would often lead directly to a prostate biopsy. As a result, many biopsies were performed with negative findings, while patients were still exposed to the potential complications and morbidity associated with the procedure.
In addition, a number of prostate cancers with extremely low malignant potential were diagnosed and treated even though they might never have caused any health problems during the patient’s lifetime.
Are there newer methods and technologies for assessing the risk of prostate cancer more accurately?
Yes. These methods are available and should be used by your urologist when considered appropriate, particularly when there is uncertainty regarding the likelihood of prostate cancer and whether a biopsy is necessary.
a) More specialised cancer markers
Over the past decade, in an effort to improve the prediction of prostate cancer risk, a number of new biomarkers and tests have been developed, including PCA3, the 4Kscore and PHI (Prostate Health Index).
Additional PSA-related parameters have also been introduced, such as PSA Velocity and the free-to-total PSA ratio.
Depending on the clinical indication, these tools can help us estimate the likelihood of prostate cancer more accurately.
b) Imaging techniques
In recent years, a specialised MRI technique known as multiparametric MRI (mpMRI) has been developed. It allows us to identify suspicious areas within the prostate, even at relatively early stages, and to perform targeted biopsies using MRI/ultrasound fusion biopsy technology.
Does the digital rectal examination still have a role in the diagnosis of prostate cancer today?
Absolutely.
Despite decades of major medical advances and the development of numerous molecular and biochemical markers, the digital rectal examination (DRE) remains a valuable diagnostic tool for the urologist.
It is a simple, quick and useful examination. A normal examination cannot completely rule out prostate cancer, but an abnormal finding can significantly increase the suspicion of cancer.
The examination itself takes only around 10 seconds.
What happens if the biopsy is positive?
Prostate cancer is considered curable when diagnosed at an early stage, before it has spread to other parts of the body.
With the diagnostic tools available to urologists today, early detection is increasingly achievable, provided that patients undergo the appropriate screening and follow-up.
There are several treatment options available, with surgery and radiotherapy being among the main approaches. With appropriate medical guidance and a careful assessment of all relevant factors, including the advantages and disadvantages of each treatment, the patient and doctor can determine the option that is most appropriate for the individual case.
Even at an advanced stage, prostate cancer can often be managed very effectively. With appropriate medication and regular monitoring, some patients can live for 10–15 years, and may ultimately die from causes unrelated to prostate cancer.
There are also prostate cancers with such low malignant potential that they may not require immediate treatment at all. In these cases, active surveillance may be recommended, with treatment introduced only if and when it becomes necessary.
