Prostate cancer

If there is suspicion due to symptoms or an elevated PSA, a digital rectal exam and a new blood PSA test will be performed. If the rectal exam is positive (a nodule or hardening of the prostate is detected), a biopsy will be carried out. If the rectal exam is negative, PSA levels will be evaluated to decide whether a biopsy is necessary. PSA is used as a screening tool in the general population to enable early diagnosis of prostate cancer.

It is a good tumor marker because it increases when the prostate glands are disrupted due to tumor growth. Since it is also present in the normal prostate and increases in benign prostate growth, it must always be interpreted in the individual context of each patient. An elevated PSA is not synonymous with prostate cancer, and a rectal exam and ultrasound should always be performed. The final diagnosis is made only by biopsy.

What causes it?

Risk factors for developing the disease include:

• Age: the older a man is, the higher the likelihood of being diagnosed with prostate cancer.
• Family history: men with a father or brother who has had prostate cancer, especially at a younger age, are more likely to develop the disease. This is particularly true if they were diagnosed before age 55.
• Ethnic group: the tumor is more common in men of African descent.
• Genetic factors: mutations such as BRCA (also associated with breast and ovarian cancer) are linked to a higher risk of developing prostate cancer.

Who does the disease affect?

The typical profile is a man aged 50–70 years, in whom benign prostate growth may coexist.

Signs and symptoms

Many men with prostate cancer are asymptomatic.

Often, the first sign of the disease is a casual finding of an elevated prostate-specific antigen (PSA) in a routine blood test. Sometimes the disease can produce local symptoms related to the growth of the prostate gland, which may mimic those caused by benign prostatic hyperplasia. In these patients, bone pain is usually associated with more advanced stages of the disease.

Experiencing urinary discomfort does not necessarily mean you have prostate cancer. Consult your doctor if you have any of these symptoms to ensure you receive an accurate diagnosis and appropriate treatment.

Diagnosis

Prostate cancer is diagnosed through serum PSA levels, digital rectal exam, and ultrasound-guided prostate biopsy.

Risks or complications

Prostate biopsies can cause some complications, which in most cases resolve without lasting effects. The most common are:

• Bleeding: blood may appear in semen, urine, or stool.
• Urinary or prostate infection.
• Urinary retention.

Usual treatment

When prostate cancer is localized and low-risk, it can be treated with surgical removal and radiotherapy. In cases of spread, treatment with radiotherapy and hormones is considered to slow tumor growth. Sometimes, if the patient is elderly, the progression of the cancer is closely monitored before surgery, as in some cases it does not pose a short-term threat to survival.

Prevention

Prostate cancer survival depends on the stage at the time of diagnosis: it is quite favorable in localized cases, less favorable in advanced cases, and worst in disseminated cases. For this reason, periodic evaluation of the prostate by a primary care physician is recommended.