Prostate cancer is the most common tumor in men

He prostate cancer is a slow process and may not be perceived by the patient in the initial stages of the disease. Therefore, medical specialists It is recommended to consult a urologist and undergo preventive examinations starting at the age of 45. and, if there is a family history, from age 40.

According to the Spanish Society of Medical Oncology (SEOM), it is expected that 2024 most common tumors be those of colon and rectumwith 44,294 new cases, followed by breast cancer cases (36,395), lung (32,768), prostate (30,316) and bladder (22,097). These figures keep prostate cancer as the cancer with the highest incidence among men in Spain for another year.

Although the incidence of prostate cancer has increased in recent decades, advances in screening programs, new treatments and medications, and innovative diagnostic techniques have made prostate cancer “virtually chronic.” the cure rate is “about 90-94%”As the doctor explained. Juan CasanovaHead of the Urology Service of the Valencian Institute of Oncology Foundation (IVO).

The problem of diagnosing a tumor before it develops

June 11 World Prostate Cancer Day. One of the main problems in diagnosing prostate cancer is its detection in the early stages, recalls Dr. Casanova. “Typical urinary symptoms such as nocturia, feeling of urgency to urinate“, frequency and incomplete emptying are non-specific and are not associated with prostate cancer, but rather with prostate hyperplasia or enlargement, which affects all adult men.” He the expert also remembers that prostate-specific antigen or PSA“It is a nonspecific marker, and not all patients with elevated levels of this marker have prostate cancer.”

Magnetic resonance imaging (MRI) is performed here. plays a fundamental roleas emphasized by Dr. Paula Pelechano, Physician Assistant at the Radiation Diagnostics Service of the IVO. MRI, by establishing a category of suspicion (PI-RADS), allows biopsies to be directed to suspicious lesions, avoiding unnecessary biopsies and improving diagnostic yield.

To diagnose this type of tumor at an early stage, early detection programs exist in Spain, targeting men aged 45 years and older. As Dr. Casanova notes, the test makes it possible to differentiate surveillance according to risk groups and It consists of a simple examination such as a digital rectal examination and a blood test. usual for determining PSA levels. “This test is comparable to those conducted for early detection of breast cancer in women, which is becoming increasingly popular among men.” And remember the importance of visiting a urologist once a year “for proper and accurate interpretation of any symptoms and signs.”

Doctor. Casanova It also highlights that advances in imaging tests such as MRI and PET scans, combined with PSA, “are allowing cancer to be diagnosed more accurately and many unnecessary biopsies to be avoided.” Notably, IVO has an opportunistic early diagnosis program. for prostate cancer by digital rectal examination and blood test to determine PSA. “If there is a suspicious touch and two PSA levels above 4 ng/ml, an MRI is performed and sent to the uroradiology commission, where emphasizes the needbiopsy and, if this is done, it will be by synthesis.”

In this sense, the head of the urology service of the Institute of Military Education reminds that fusion biopsy, a biopsy procedure that combines magnetic resonance imaging and ultrasound to create detailed three-dimensional images of the prostate, has become one of the major “milestones” in diagnosing prostate cancer. “Currently we is able to “orient” in the prostate andtake samples from suspicious places judging by the resonance. We not only make a diagnosis earlier, but also better characterize the tumor and can more accurately select the appropriate treatment option,” says the expert.

According to the doctor Ana CalatravaHead of the pathological anatomy service of the IVO, a biopsy is necessary to confirm the existence of cancer and determine its histological characteristics. “Assessing the biopsy and MRI together allows us to choose a therapeutic option. most appropriate for each patient and at each stage of the disease.” Clinical trials are currently underway exploring the possibility of immediately confirming the existence of cancer using confocal microscopy, allowing treatment to be carried out in the same surgical procedure as diagnosis.

Risk factors

Most of more than 30,000 new cases of prostate cancer which will be discovered this year, will be diagnosed in older men, with 90% of patients over 65 years of age and an average age of diagnosis of 75 years.

As Dr. José Antonio López Guerrero explains: Head of the Molecular Biology Service of the Institute of Higher EducationIn some ways, there is a certain genetic predisposition to developing this type of cancer, but not all cases are hereditary. “At the family level, there are two scenarios that increase the risk of prostate cancer.

: one that occurs in a family in which there is a certain cluster of cases, which is called familial prostate cancer and occurs in approximately 20% of cases; on the other hand, we will have hereditary prostate cancer, which is less common and is the cause Approximately 5% of diagnosed prostate cancers” And he elaborates: “Compared with sporadic cases, hereditary prostate cancer is characterized by an early onset, more aggressive cancer behavior with a greater risk of recurrence after surgery.”

The importance of an integrated and interdisciplinary approach

As Dr. Miguel notes: Angel Clement, clinical director of the IVO medical oncology service, after confirming a diagnosis of prostate cancer, “the first step is to locate the cancer.” This involves extensive diagnostic tests such as CT scans, bone scans and PET scans.

In cases where the tumor is located in the prostate gland, there are many treatment options. treatment ranging from active surveillance and focal therapy (treatment aimed solely at intraprostatic tumor) to more radical treatments such as surgery or radiation therapy. “The choice of treatment depends on patient characteristics, such as their age and other diseases they may have, as well as the size and location of the tumor.”

In the case of tumors with metastases, Dr. Clement emphasizes that the main treatment remains antiandrogen hormone therapy. (procedures that block the action of androgens, male hormones). In this case, treatment with chemotherapy, radioactive isotopes such as Ra223, radioconjugates such as Lutetium-PSMAor treatments that work when there are certain genetic changes in the tumor. “All of these treatments have shown promising results, although we are still determining exactly what clinical situations give the best results” and adds: “Every patient is unique, and our goal is to offer him the most appropriate treatment according to his characteristics and the specific situation of his disease.”

Radiation therapy in the treatment of prostate cancer

¿What role does radiation therapy play?prostate cancer treatment? As explained by Dr. Leoncio Arribas, head of the IVO Radiation Oncology Service, radiotherapy “It’s very effective» at most stages of the disease. Thus, in low-risk initial stages, “brachytherapy is an alternative to surgery, with 10-year IVO results above 90%.”

Regarding intermediate risk stages, Dr. Arribas explains that both brachytherapy and external beam radiation therapy, alone or in combination with each other or with hormonal therapy, continue to account for best therapeutic options. For locally advanced cases, the expert highlights the results of combining radiation therapy with hormonal therapy. Likewise, Dr. Arribas recalls the role that radiation therapy plays in the treatment of pain caused by metastases in the bones or brain, etc. “IVO has extensive experience to offer each patient the radiation therapy that best suits their needs.

Both at the level of external radiation therapy and at the level of brachytherapy,” the doctor emphasizes.

Benefits of Robotic Surgery

Robotic surgery represents one of the greatest advances in radical surgical treatment for prostate cancer. In this sense, Dr. Alvaro Gómez-Ferrer, Clinical Director of the IVO Urology Service, emphasizes: “reduction of pain in the postoperative period and, overall, faster functional recovery with a shorter hospital stay,” are among the main benefits it offers the patient.

For the surgeon, this provides “surgical precision, enhanced 3D vision and moreergonomics“, which improves the functional results of prostatectomy and minimizes surgical complications, offering excellent oncological results.

Achievements and research

Among the advances in treatment, experts pin their hopes on immunotherapy: “No We still have important results that allow generalization of these treatments for this cancer, but there are many clinical trials underway that are expected to produce good results and we will be able to have new treatment alternatives for these patients,” explains Dr. Clement.

Also, the clinical director of the IVO medical oncology service emphasizes the importance of taking into account the symptoms reported by the patient, the PSA value obtained in the blood test, and the degree of histological aggressiveness of the tumor obtained in the biopsy. And adds: “In recent years, new, more sensitive diagnostic tests have been developed to identify possible sites of metastases.such as PET-choline or PET-PSMA, which are indicated depending on the disease situation.”