Prostate cancer
What is prostate cancer?
Prostate cancer is the second most common type of cancer among men in the United States, and according to the incidence in Costa Rica between the period from 2000 to 2015, prostate cancer was also the most common in men, followed by skin, stomach, colon and lung.
The prostate is a gland that only men have, therefore it belongs to the male reproductive system, it is located just below the bladder and in front of the rectum. Prostate cancer occurs when prostate cells begin to grow out of control.
HOW CAN PROSTATE CANCER BE DIAGNOSE?
The most common tests for prostate cancer are:
RECTAL TOUCH: It consists of an examination in which the doctor puts on a lubricated glove and rectally palpates the prostate through the rectal wall in search of nodules or abnormal areas. The prostate gland is located immediately in front of the rectum, and most cancers begin in the back of the gland, which can be felt during a rectal exam. This test is uncomfortable, but it is not painful and takes very little time to perform.
PROSTATE ANTIGEN TEST: Measures the level of Prostate Specific Antigen, a protein found in a man's blood, produced by the prostate gland. The chance of having prostate cancer increases as the PSA level rises. Most men without prostate cancer have PSA levels less than 4 ng/mL of blood. When prostate cancer forms, the PSA level often rises above 4. However, a level below 4 ng/ml does NOT guarantee that a man will not have cancer. About 15% of men who have a PSA less than 4 will develop prostate cancer if a biopsy is done.
PROSTATE BIOPSY: In which the doctor obtains tissue from the gland to determine if cancer cells are present. For some men, having a prostate biopsy may be the best option, especially if the initial PSA level is high. This test is the only way to know for sure if a man has prostate cancer. If prostate cancer is found in a biopsy, this test can also help indicate how likely the cancer is to grow and spread quickly.
If prostate cancer is found in the biopsy, a grade will be assigned. The grade of the cancer is based on how abnormal the cancer looks under a microscope. This test will confirm the diagnosis of cancer and will give us an idea of the tumor volume and the degree of aggressiveness. The Gleason score, which has been in use for many years, assigns grades when comparing cancer with normal prostate tissue:
SYMPTOMS:
Need to urinate often, especially at night
Difficulty starting or stopping urine stream
A weak or interrupted passage of urine
Difficulty urinating
Dripping urine when laughing or coughing
Pain or burning when urinating
Blood in urine or semen
A dull pain or stiffness in your lower back, ribs, or upper thighs
Swelling, weakness or numbness of the lower extremities (areola) or the skin of the breast, Redness or small holes in the skin over your breast, like the skin of an orange.
TREATMENT
Among the techniques that are used and provided in 21st Century Radiotherapy are:
INTENSITY MODULATED RADIOTHERAPY (IMRT): Allows the RT dose and intensity to be varied (escalated) during therapy. Reduces side effects and facilitates treatment when pelvic lymph nodes must be included in the field. It allows very high doses (81 Gy) to be administered with little intestinal toxicity. This technique uses a computer-controlled machine that moves around the patient as it delivers radiation. In addition to configuring the beams and directing them at the prostate from various angles, the intensity (strength) of the beams can be adjusted to limit the radiation doses reaching adjacent normal tissues. This allows doctors to deliver an even higher dose of radiation to the cancer.
STEREOTAXIC RADIOTHERAPY (SBRT): It consists of administering a high dose of irradiation to the prostate using complex and precise radiotherapy techniques. Currently, early stages can be treated with this radiotherapy technique in just 5 days in our center with greater precision without increasing the side effects of the treatment.
IMAGE GUIDED RADIOTHERAPY (IGRT): It also allows the administration of higher doses of external radiation therapy (even reaching up to 90Gy) through the use of advanced imaging techniques such as magnetic resonance imaging with spectroscopy or an integrated imaging scanner. This advancement allows the doctor to take photographs of the prostate just before administering radiation to make minor adjustments to the direction of the rays. This appears to help deliver the radiation even more precisely, leading to fewer side effects, and is a novel technique currently being applied at our medical center.
ACTIVE SURVEILLANCE: For very low risk and low risk stages. If you and your doctor agree that active surveillance is a good idea, your treatment will include regular doctor visits and blood tests to measure prostate-specific antigen (PSA). If the cancer grows or your condition changes, your doctor may start treatment
If the cancer has spread beyond the prostate, doctors use systematic treatments. These include hormone therapy, chemotherapy, and vaccines for prostate cancer.
