On the occasion of November – the month of awareness for male health in general and prostate cancer in particular, we have brought you a number of questions and answers about prostate cancer, which is considered common among men over the age of 50.
What is prostate cancer and why is it formed?
Prostate cancer is the most common cancer in men and the fourth most common in terms of mortality from cancer in men. Similar to breast cancer, each of nine men will be diagnosed with prostate cancer during their lifetime. In most cases, prostate cancer is sporadic (random), and no link has been found between environmental factors (diet, smoking) and its development. In a certain percentage the cancer will be hereditary, with the inherited gene responsible for its development. The risk of developing prostate cancer is higher when a first-degree relative (father or brother) is diagnosed, and in cases where women in the family have a history of ovarian and breast cancer. Two prominent genes that are linked to heredity of prostate cancer are the BRCA 1 + 2 genes, which have gained a lot of resonance mainly around heredity of breast cancer, but men can also be carriers and pass on the mutation to their children.
Who should be tested and when?
For all men over the age of 50, an annual examination by a urologist is recommended, and for men with a family history of prostate cancer, an examination is recommended at the age of 45. The purpose of the test is to bring about early detection and thus allow healing. The two diagnostic tests that are routinely used are a blood test for PSA and a rectal test for prostate palpation. Today most cancers are detected in the early stages when they are not palpable, and in most cases the decision to perform a prostate biopsy relies on an increased value of PSA in the blood. PSA protein is a marker for prostate cancer and its level rises when prostate cancer develops. There are now new, more accurate studies than PSA that may help decide on a prostate biopsy, diagnose more cancers, and “save” unnecessary biopsies.
Prostate MRI and Prostate Biopsy Oriented MRI (Prostate FUSION Biopsy)
In recent years, MRI scans have become another tool that helps assess and diagnose prostate cancer. The high level of accuracy of the MRI will help us in the decision to perform a prostate biopsy and when there is a prostate lesion, you will direct the biopsy signal. MRI-guided biopsy will be performed using a dedicated computerized system that integrates the prostate MRI images along with the sonar image which is performed in real time, thus helping to direct the needle in the biopsy and improve sampling accuracy. FUSION biopsy is more accurate, and diagnoses more aggressive cancer cases. A FUSION biopsy can be performed under general or local anesthesia so that the operation is painless.
How is prostate cancer treated?
Treatment for prostate cancer depends on the stage of the disease and its degree of risk, which are determined based on the tumor data and imaging tests. The goals of localized prostate cancer treatment are to cure the disease while minimizing side effects and maximum preservation of sexual function and quality of urination. The standard treatments currently given for localized prostate cancer are robotic prostate surgery and external radiation. Disease with distant involvement (metastasis) will be treated through systemic therapy. There are many considerations for choosing prostate cancer treatment and it is advisable to consult a urologist and an oncologist who specialize in treating this type of cancer. In some cases, it is possible to follow up and treat if there is progression of the disease.
In conclusion – it is recommended that any man over the age of 50 contact a urologist for an examination. It is important to note that since screening for prostate cancer screening began in the 1990s, prostate cancer mortality has dropped to half of what it was before, so early diagnosis saves lives.
The author is a specialist in oncology and oncology, a senior physician at Meir Hospital and a senior surgeon at Herzliya Medical Center.