Prostate cancer

It is estimated that some 6,500 new cases are diagnosed each year and some 3,000 Colombians die from the disease. Prostate cancer is the second leading cause of cancer death in men, only after gastric cancer.

“It is also the most common among men in Colombia and together with lung and colon and rectal cancers, they represent half of the cancers diagnosed,” said Dr. Lupi Alejandro Mendoza, a urologist and oncologist at the Medical Center.

According to the specialist, it is one of the cancers with the best prognosis and is detected early or localized, and in most cases chemotherapy or radiotherapy management is not necessary, as happened at the time with President Juan Manuel Santos.

This means that although one in twenty men will get prostate cancer during his lifetime, only one in 100 men will die from this disease. However, the mortality rate is increasing in Colombia and has tripled in the last 30 years. (See box: “Treatments”)

In 2000, 1,976 cases of death from a malignant tumor of the prostate were reported in Colombia, only surpassed by that of the stomach and above tumors such as those of the neck and breast, lung or colon. While the death rate per 100,000 deaths was 12.29 for stomach cancer, in the case of prostate cancer this figure was found at 9.43.

Statistics, according to the Colombian Society of Urology, indicate that in Colombia of every four tumors detected in the prostate, three are potential cancer generators. (Inset: “Stages of the disease”)

The prostate It is one of the male sex glands. Its size is like that of a walnut and it is used for the production of seminal fluid, which is part of semen or sperm.

It is located above the rectum and below the urinary bladder. The prostate surrounds the urethra (the tube that carries urine from the bladder to the penis) like a “float” at the point where the urethra connects to the bladder. “For this reason, when the prostate grows (prostatitis) there are difficulties when urinating or in sexual relations”says Dr. Mendoza.

According to the specialist, this type of cancer occurs more frequently in older men. The prostate continues to grow for most of life, which is why it is very common to present after the age of 60 with a harmless condition called “enlarged” prostate or benign prostatic hypertrophy (BPH), much more common than prostate cancer. Many of the signs and symptoms of BPH are the same as those of cancer.

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“Early detection and treatment increase the chances of a cure. Also, this particular type of cancer grows slowly. When it develops very late in life, the impact of the disease may be minimal.indicates the urologist from .

“Indeed – the specialist clarifies – many men die over time from causes unrelated to cancer itself.”

According to the urologist and oncologist, in its most initial stage, prostate cancer may not produce signs or symptoms. When the tumor grows, certain signs or symptoms may be noticed, such as difficulty starting or stopping urination or starting or stopping urination.

You may also lose strength in your urine stream, dribbling at the end of urination, painful or burning urination, urination a small amount each time and frequently, especially at night.

Painful ejaculation, blood in the urine, inability to urinate, and continuous pain in the lower back, pelvis, or upper thigh area are identified by the urologist as symptoms or alarms of prostate cancer. (See box: “Prognosis and epidemiology”)

Diagnosis

Digital rectal examination is the first and most important mechanism to detect any abnormality in the prostate. According to doctors, this exam should be part of the recommended annual physical check-up for men over 40 years of age, due to the American Cancer Association.

“With touch we feel the surface of the prostate through the wall of the intestine. Suspicious masses, abnormal textures or hardness will lead to further investigation.says Dr. Mendoza.

The specific antigen of Prostate PSA (PSA) is a protein produced by the prostate that can rise when cancer is present. PSA levels can help the doctor in monitoring a patient.

Prostate biopsy is the expeditious way and the only way to determine if a suspicious mass is cancer. It consists of microscopically examining a sample of tissue taken from the area.

“This sample can be taken by a needle placed directly into the prostate through the rectum or through the perineum (the space between the scrotum and the anus). A biopsy can also be obtained through an operation”says Dr. Mendoza.

If cancer is present, various other studies, including X-rays, laboratory tests, and computerized diagnostic radiology procedures, will be helpful in determining the extent of the disease.

According to doctors, the combination of digital rectal examination, PSA, and prostate biopsy continues to be the gold standard for diagnosis.

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For Dr. Lupi Alejandro Mendoza, the culture of prevention is not in force in our environment. The Colombian, and the Cali in particular, are not culturally prepared for the physical examination and the PSA.

“Ideally, men after 40 should have a rectal test or examination at least once a year, as well as the PSA, as complementary tests to detect the disease in time. This doesn’t really happen.”laments, finally, Dr. Lupi Alejandro Mendoza, urologist and oncologist at the Medical Center.

STAGES OF THE DISEASE

  • Stage I. In this stage it is not felt and does not cause any symptoms. It is found only in the prostate and is detected incidentally.
  • Stage II. Cancer cells are found in the prostate gland only. The tumor can be detected by means of a needle biopsy, or by simple digital rectal examination.
  • Stage III. Cancer cells have spread outside the lining (capsule) of the prostate into surrounding tissues.
  • Stage IV. Spread (by metastasis) to lymph nodes (near or far from the prostate) or to organs and tissues located far from the prostate – bone, liver, or lungs.
  • recurrence The cancer comes back after it has been treated. It can come back in the prostate or in another part of the body.
  • TNM CLASSIFICATION: Prostate cancer can also be classified using T (size of the tumor), N (extent of spread to lymph nodes), and M (extent of spread to other parts of the body).

TREATMENTS

Treatment is highly individualized, and many factors must be considered, especially:

  • The stage of the disease.
  • The general medical history of the patient.
  • Age.
  • The general state of health.
  • Life expectancy.
  • SURGERY: Varies from removing just the cancerous growth, to removing the entire prostate and surrounding lymph nodes.
  • Radical prostatectomy. It consists of the removal of the prostate and part of the tissue that surrounds it. Surgery can be done through an incision in the space between the scrotum and anus (perineal prostatectomy) or through an incision in the lower abdomen (retropubic prostatectomy). Radical prostatectomy is done only if the cancer has not spread outside the prostate.

In some advanced cases, removal of the testicles may be indicated – these two glands are the main producer of the male hormone testosterone in the body, which stimulates the growth of the disease.

The main side effects of prostate removal are impotence (inability to get or maintain an erection) and urinary incontinence (inability to control urinary function). They are usually temporary, but in some cases they can be permanent.

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TRANSURETHRAL RESECTION: It consists of the removal of prostate cancer using an instrument that is inserted into the prostate through the urethra. This operation is sometimes done to relieve symptoms caused by the tumor before other treatment, or in men who cannot handle a radical prostatectomy due to age or other illness.

CRYOSURGERY: A type of surgery in which cancer is destroyed by freezing.

OTHER THERAPIES: In addition to surgery, one or more of the following may be indicated to treat prostate cancer:

  • Ionizing radiation (Radiotherapy).
  • Cancer drugs (chemotherapy).
  • Hormones (Hormonotherapy).
  • Biological therapy or Immunotherapy (use of the body’s immune system to fight cancer).
  • Hormone therapy: Male hormones (especially testosterone) can contribute to the growth of prostate cancer. Female hormones (estrogens) or drugs called LHRH agonists that reduce the amount of male hormones may be given to stop the growth of the cancer. The reason is the same that sometimes leads to removal of the testicles (orchiectomy) in order to prevent them from producing testosterone. This treatment is generally used in men with advanced prostate cancer.

SYMPTOM

You also experience some of the following symptoms most of the day, almost every day:

  • He feels sad, with a low spirits.
  • Loses interest, taste or pleasure for the activities you do.
  • Cries easily.
  • Lose self esteem.
  • You feel guilty, worthless, or afraid.
  • You feel hopeless, pessimistic, or abandoned.
  • You feel tired or without energy.
  • Has slow or scant language.
  • Lose or gain weight significantly.
  • Sleep a lot or little.
  • It is difficult for you to think, concentrate and make decisions.
  • You feel confused and forget things easily.
  • You have recurring thoughts of death, suicidal ideation, or suicidal attempts.
  • Decreases or loses sexual desire.
  • Their movements slow down.
  • He isolates himself socially. He doesn’t want to share with other people.
  • Complains of physical discomfort, without any explanation (pain in the body, headache, muscle pain, vision
  • blurring, weakness, tingling, choking sensation or shortness of breath, nausea, vomiting, dizziness, dry mouth, menstrual disorders, etc.).
  • In children and adolescents, irritability or sadness may occur most of the time, indifference, disappointment, inferiority, low self-esteem (monitor changes in school performance, sleep and behavior).
  • The elderly may have feelings of emptiness and constant sadness, loss of appetite, changes in sleep.

Seek help from a health professional or someone close to you to guide you!