“An accurate diagnosis of prostate cancer can only be made with a prostate biopsy.”

Prostate cancer is the most common cancer in men in Spain. According to the Spanish Society of Medical Oncology (SEOM), 29,002 new cases of prostate cancer were diagnosed in 2023, which is the most common tumor in men, followed by colon and lung cancer. “The risk of developing prostate cancer increases with age, but it is characterized by a more aggressive development in younger patients,” says Dr. Alberto Fantova, urologist at HLA Clínica Montpellier and HLA Centro Médico Zaragoza.

“Particular attention should be paid to implementing all preventive measures for early diagnosis of potentially more aggressive tumors in patients under 75 years of age,” says Dr. Fantova. Age is the main risk factor, with most cases diagnosed in men over 65, but not the only one. Other factors include a family history of prostate cancer, diet, ethnicity and some genetic factors. “Most prostate tumors are hormonally sensitive because they are clearly related to testosterone levels. Moreover, their development may be affected by a diet low in fiber and rich in carbohydrates and animal fats; In contrast, diets rich in lycopene, vitamins E and D and antioxidants, selenium, zinc and isoflavones (fruits, vegetables and various grains) are preferred. On the other hand, the genetic factor doubles the risk if there is a history of a first-degree relative who previously suffered from the disease. In these cases, for the purpose of prevention, a genetic study is carried out,” explains the doctor.

Prostate cancer in its early stages is usually asymptomatic. Sometimes it is detected during routine medical examinations. However, as the disease progresses, various symptoms may appear. “Daily difficulty urinating, both day and night, with increased urge or frequency and decreased force or flow of urine; presence of red urine (hematuria) or semen (hemospermia); Perineal or pelvic girdle pain or weight loss not related to diet are warning signs that are also present in noncancerous conditions such as benign prostatic hyperplasia or urinary tract infections. Therefore, it is extremely important that any man who experiences these symptoms consults a doctor for a correct diagnosis,” the specialist points out.

Early diagnosis of prostate cancer often includes a digital rectal examination (DRE) and a prostate-specific antigen (PSA) test. “Today it has been proven that early diagnosis saves lives, so a visit to a urologist for any risk factor is usually recommended after 45 years. As a rule, from the age of 50, an annual urological examination for the presence of prostate tumor markers in the blood, a urine test and, if necessary, a rectal examination is recommended, even in the absence of risk factors and the absence of symptoms. If any suspicious signs have appeared in recent years, high-resolution magnetic resonance imaging of the prostate can be requested as a very useful test to differentiate the need for a prostate biopsy. With this MRI, images are obtained with great accuracy, which allows us to differentiate the presence of nodes suspicious for malignancy. Although a definitive diagnosis of prostate cancer can only be made by prostate biopsy, MRI has allowed the previous diagnosis to be clarified and unnecessary prostate biopsy to be performed. At HLA Montpelier we use the most accurate test for diagnosing prostate cancer – prostate biopsy using image fusion using 3 Tesla magnetic resonance,” comments Fantova.

Regular urological examinations are necessary for early detection and effective treatment of various urological diseases, including prostate cancer. The frequency of these reviews depends on the patient’s age and tumor analytical marker. “For patients under 70 years of age, if the marker is less than three and they have no significant symptoms, an annual visit is usually recommended, however, if the PSA marker is greater than three, every six is ​​recommended; months. This frequency will also depend on the patient’s symptoms,” the doctor adds.

Each patient requires individual and personalized treatment depending on the age of diagnosis and tumor stage. “Currently, the two most important procedures are surgery and radiation therapy. Hormone therapy is usually reserved for more aggressive tumors. Since this is usually a hormone-dependent tumor, when the load of male hormones (androgens) decreases, the cells stop feeding and eventually disappear. In some cases, in older patients, hormone therapy may be used as the only therapy, and chemotherapy is usually prescribed when previous treatments do not help,” explains the urologist.

In recent years, there have been several significant advances in the treatment of prostate cancer that have improved therapeutic options and patient outcomes. “With advances in surgery, side effects such as urinary incontinence and erectile dysfunction have decreased significantly. In the field of medical oncology, in which urologists rely so heavily on surveillance of higher-grade tumors, improvements in hormonal therapy have led to an increase in the length and quality of life of patients with bone or visceral metastases. caused by prostate cancer. In addition, the support of rehabilitation and physiotherapy services and their specialization in the pelvic floor area has led to significant improvements in the quality of life of these patients with urinary incontinence. Regarding erectile dysfunction due to damage to the erector nerves, there are medical treatments, and in cases where there is no response to medications, other solutions such as implantation of prostheses can be used,” points out the specialist.

Fountain: HLA Hospital Group