Prostate cancer

Men, from a certain age, have greater biological fragility and a higher incidence of concomitant diseases (cardiovascular, neurological, kidney, liver). In addition, some lifestyle habits such as, can influence prostate cancer. The advanced age and associated pathologies they can contraindicate surgery or increase its morbidity and also increase the toxicity of different cancer treatments (radiotherapy, hormonal therapy, chemotherapy).

For this reason, it is difficult to carry out an optimal therapeutic approach in the elderly population. The choice of treatment will depend more on the concomitant diseases than on the patient's own age. Thus, the elderly patients with good functional status and without associated pathologies receive a treatment similar to that of younger patients.

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Symptoms of prostate cancer

Manifestations of prostate cancer are more apparent as the cancer progresses and in its initial stages it is totally asymptomatic, for which its early detection is prudent. Usually, the more advanced the cancer is, the greater the number of symptoms it produces and the greater their intensity. The most frequent symptoms are those derived from enlarged prostate, with obstruction of urine flow or those caused by the spread of the disease to other organs.

Diagnosis

Visit the urologist from the age of 45

Currently recommended routine annual urological evaluation for all patients over 45 years old, which includes digital rectal examination and the determination of prostate specific antigen (PSA), increasing this frequency to a six-monthly visit for those with a family history of prostate cancer even when they appear in the maternal branch. This methodology allows most of the incipient prostate cancers confined to the gland.

Older than 70 years

There is significant controversy regarding the performance of routine prostate examinations in patients older than 70 years, since it is assumed that in this group of patients there is a high frequency of prostate cancer whose course may not be relevant for their life. The prolongation of life and the improvement in its quality in this age group, however, has led to a constant increase in the age up to which the aforementioned examination is suggested and it is possible that this practice will continue in the future. future if it is considered that at present it is very likely that a 70-year-old man has a life expectancy close to 85 years.

Medical tests

The prostate cancer diagnosis, upon suspicion, is carried out through the following actions:

• Rectal examination: it allows to suspect prostate cancer when it has grown enough to deform the prostate, or when it is located close to the rectum. As the digital rectal examination does not allow to evaluate the anterior part of the prostate, other more reliable diagnostic means are required.
• PSA (prostate specific antigen): used to assess the response to treatment but not to diagnose prostate cancer, since PSA is also increased by many diseases such as benign prostatic hypertrophy, prostatitis, cystitis, seminal vesiculitis, digital rectal examination, breast cancer, sexual activity, stress, etc. However, it does help to assess the need for further testing if it is elevated.
• Conventional prosthetic ultrasound: It allows to have an approximate idea of ​​the size and internal texture of the prostate; helps guide the prostate biopsy to suspicious areas.
• Prostate biopsy: It can determine with great certainty the presence of cancer when suspicious areas are identified by ultrasound; On the other hand, their effectiveness decreases when they do not appear and it is carried out by sampling in the different areas of the prostate (when the disease is sought in the presence of a repeatedly high PSA value).

Treatment types

- Surgery

In general terms, it is considered that the treatment of choice for prostate cancers confined to the gland, in patients younger than 70 years, is the radical prostatectomy by suprapubic or laparoscopic route. Is surgery It consists of the complete removal of the gland together with the primary draining lymph nodes. This operation, which is currently performed routinely and with low morbidity and mortality, presents a very high chance of cure depending on the clinical status and the histological type of the tumor, but it is estimated to be higher than 90% in cases confined to the prostate. The main complications of radical prostate surgery They include erectile impotence, which occurs in approximately 50% of cases depending on the age of the patient, the previous state of potency, and the extent of the resected tumor. Urinary incontinence, which occurs in approximately 5% of patients, should also be considered.

- Hormone therapy and radiation therapy

Apart from surgery, treatment is complemented with hormone therapy and sometimes radiation therapy. In most centers, radiation therapy is preferred as the primary treatment for patients with medical conditions that make major surgery impractical. Hormonal treatment is available in patients with more advanced disease. This treatment is extraordinarily effective in reducing size of the gland and the discomfort secondary to metastatic extensions but in general it is unable to achieve complete healings. Despite this, very significant referrals are the rule rather than the exception. Hormonal treatment is currently carried out by means of androgen deprivation, which can be achieved through one, disused, or through medications. Orchiectomy is equally effective and may be less costly than drug management, however it has a greater psychological impact, so it is hardly performed.

Prognosis and life expectancy

As with other malignancies, the prognosis it will depend on the degree of progression of the disease, being in any case excellent if the diagnosis is made when said tumor is limited to the prostate. In the case of patients over 75 years of age, even with more advanced cancers, life expectancy is close to 10 years, a life expectancy, it should be said, similar to that which would be had in the absence of disease.