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Prostate cancer is the most common cancer in men, as 1 in 6 men will develop cancer and 1 in 36 of them will lose his life. It is not often in men younger than 45, as the middle age of diagnosis is 70 years. Men over the age of 80 have 80% chance to create prostate cancer. Men, who have first- degree relative of someone with prostate cancer are twice as likely to develop the disease than men with no history.
Usually, prostate cancer does not have early symptoms. In a more advanced stage, difficulty urinating, bone pain, erectile dysfunction, blood in semen, and decreased urine flow may occur.
Gleason score is a 10-grade system that indicates how much the prostate cells have lost their structure. The higher the Gleason score is, the more aggressive the tumor is. In addition, CT and Bone Scan are needed to check for metastatic disease and to have a clue about the progression of the disease.
Annual check-up, which should begin at the age of 50, can help detect prostate cancer at an early stage. Thus, in most patients it is diagnosed before it metastasizes. The required exams are:
Prostate cancer, especially the more common type that occurs in the typical elderly patient, usually develops so slowly that no treatment is needed.
It is important that the choice of the treatment is made after informing the patient about the possible complications that accompany them.
1) Watchful waiting: regular checkup (every 3 to 6 months). It is recommended for patients with a small tumor that is not very aggressive or for patients with a short life expectancy due to other serious health problems.
2) Surgery: removal of the entire prostate (radical prostatectomy) with open procedure or endoscopically (laparoscopically or robotically). The oncological outcome is the same, but endoscopic methods are superior due to shorter hospitalization and post-operative pain. It is recommended for patients younger than 75 years of age. Complications: erectile dysfunction, inability to ejaculate, urinary incontinence. The sexual desire is maintained and they have a dry orgasm.
3) Radiation: can be given externally (via X-rays) or by implanting radioactive seeds into the prostate (brachytherapy) in order to kill cancer cells. External radiation therapy is done daily for 7-9 weeks. Complications: diarrhea, frequency, tiredness, erectile dysfunction. Brachytherapy is performed using a transrectal ultrasound. Complications: frequency, erectile dysfunction.
4) Hormone therapy: stops the production of testosterone or prevents it from reaching the prostate, which causes the cancer cells to die or grow slowly. It is given as an injection (monthly or every 3 months), or as a pill. Complications: erectile dysfunction, hot flashes, osteoporosis, decreased libido, increased appetite, heart attack or stroke (in chronic use).
5) Chemotherapy: it is used when the disease is advanced and there are bone metastases, to prolong life and reduce pain. However, it is not very effective at an early stage.
6) Cryotherapy: destroys prostate cells and prostate tumors by freezing them, using argon gas or liquid nitrogen. Complications: erectile dysfunction, urinary incontinence.
7) High-intensity ultrasound: destroys prostate cells by heating them, using very high-intensity ultrasound waves from the rectum. Complications: erectile dysfunction, urinary incontinence.
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