Prostate cancer represents a significant health issue for men, being the most commonly diagnosed cancer and the third leading cause of cancer-related death. Understanding the risk factors, diagnosis, and treatment options is essential for effectively addressing this disease. Screening programs are vital for early diagnosis and reducing mortality associated with this condition.

RISK FACTORS

Several factors can increase the risk of developing prostate cancer, including:
– Age: Incidence increases significantly with age, rising from a prevalence of 5% in men under 30 years old to a prevalence of 60% after 80 years old.
– Genetics: A certain genetic predisposition is suggested by an increased incidence in specific ethnicities and within families. We have identified over a hundred mutations that confer a greater susceptibility to the development of this disease. The genes most implicated in this regard are Brca1 and Brca2, whose mutations are also involved in the onset of breast cancer.
– Lifestyle: High alcohol consumption and protein intake from dairy products have been associated with a higher risk of mortality from prostate cancer. Conversely, caffeine and tomato intake seem to have a protective role.
Screening programs are vital for early diagnosis and reducing mortality associated with this condition. All men aged 50 and older should undergo an annual urological examination; the age is lowered to 45 years old for men with a family history and to 40 years old for those with a documented mutation of Brca1 and 2.

DIAGNOSIS

In the early stages, prostate cancer is asymptomatic, only presenting urinary symptoms in more advanced stages. Generally, suspicion of prostate cancer arises from an increased PSA.
However, PSA can increase in all conditions affecting the prostate, including benign ones like prostatitis or BPH (benign prostatic hyperplasia). For this reason, a single measurement of this antigen, without evaluating its trend over time or its density relative to prostate volume, is insufficient for making any diagnosis: PSA must always be correlated with the patient’s clinical picture.
Digital rectal examination can provide information about the size and consistency of the prostate: the presence of nodularity, irregular margins, or focal increases in consistency are highly suspicious and should always be investigated further, regardless of the PSA level.

Multiparametric magnetic resonance imaging (MRI) plays a crucial role in diagnosing and managing prostate cancer. Besides suggesting the presence of neoplasia, MRI provides detailed information about the localization and extent of the disease, which are essential for staging.
When suspicious lesions are observed on imaging, a targeted prostate biopsy can be performed, which improves the likelihood of detecting carcinoma compared to a standard biopsy. The combination of imaging and biopsy is therefore a key element in the diagnosis of prostate cancer.

TREATMENT

Prostate cancer is a complex condition that requires in-depth analysis to determine the most suitable treatment for each patient, considering various individual factors and disease progression. Available treatment strategies include active surveillance for older patients or those with severe illnesses, and for those with low-risk tumors.
When an active intervention is decided upon, radical prostatectomy is one of the main options, aimed at removing the entire prostate. The procedure can be performed using classical or robotic techniques, with comparable results in terms of long-term outcomes. In cases of advanced disease, it is often necessary to combine surgery with other therapies such as radiation therapy or hormone therapy.
Radiation therapy, including external beam radiation and brachytherapy, has proven effective even in low-risk tumors. When dealing with advanced forms of prostate carcinoma, hormone therapy is generally preferred over chemotherapy. This is known as androgen deprivation as it reduces testosterone levels to inhibit tumor growth, but it can cause significant side effects such as decreased libido, impotence, weight gain, and erectile dysfunction.
For patients with castration-resistant carcinoma, new hormonal therapies and innovative approaches, such as radiometabolic therapy, are under development. Additionally, there are new targeted molecular therapies, particularly for men with specific genetic mutations, and potential developments in immunotherapy that could open new avenues for treatment.

In summary, the approach to prostate cancer care is continually evolving, with the goal of offering increasingly personalized and effective treatments depending on the stage of the disease and the characteristics of the patient.

View also: