Silent and the second most prevalent among men in Brazil: know about prostate cancer

O prostate cancer it’s the second most prevalent among men in Brazilsecond only to non-melanoma skin cancer, according to data from the National Cancer Institute (Inca). The last estimate released by the entity, carried out in 2020, indicates that 65,840 men will be affected by the disease urology annually, until 2022, throughout the country. This type of cancer is also the second in the list of those that kill the most in Brazilwith 15,983 deaths in 2019, according to the Ministry of Health.

According to experts, this is a silent diseasethat affects the male population from the age of 45 and that still crosses barriers of prejudice and misinformation with regard to early identification and appropriate treatment.

But what exactly is prostate cancer? How is he identified? What is the treatment? How to prevent yourself?

To answer these and other questions, the report by Pernambuco leaf interviewed the urologist Leonidas Nogueirafrom the Pernambuco Cancer Hospital, which shared the necessary information to alert the population and fight stigmas of the disease.

What is prostate cancer?

Leonidas Nogueira – Prostate cancer is characterized by an atypical and disordered proliferation of cells in the glandular tissue. This happens as we get older. This process is favored by the aging of our cells and genetic predisposition. These are abnormalities that we have in our genes that can be passed on for generations, from our parents to us, or through new mutations. That is, they are changes in the DNA of cells that happen throughout life. This causes the cell to deform and start to proliferate in the wrong way, leading to the formation of cancer.


In addition to genetic predisposition, what other factors can contribute to prostate cancer?

LN- The older you are, the higher the incidence of both benign hyperplasia and prostate cancer itself. These are the main risk factors, which, by the way, are unavoidable. We have no way to get rid of our genetic load and we have no way to get rid of getting old. However, there are also other factors that are associated, such as, for example, a high intake of protein and animal fat. Not that a barbecue on the weekend is prohibited or inadvisable, but we should minimize the consumption of fat and animal protein, red meat itself. We know (experts) that populations that consume large amounts of animal protein have a slightly higher incidence of prostate cancer than the general population.

Does the disease present signs or symptoms that can help in its identification?


LN– The symptoms of prostate cancer are indistinguishable from the symptoms of benign prostatic hyperplasia, including the two diseases commonly coexist. That is, the patient has the benign enlargement of the prostate associated with cancer. But there is no specific symptom for prostate cancer.


Symptoms of enlarged prostate are obstructive urinary symptoms. That is, the fact that the patient urinates tight, urinates without a stream, strains to urinate, in addition to irritating urinary symptoms, such as burning, waking up many times at night to urinate or urinating from moment to moment.

There are also urinary storage symptoms, which is difficulty holding back urine. But none of these symptoms are specific to prostate cancer. These symptoms coexist with benign prostatic hyperplasia and other associated diseases, such as diabetes, a stricture of the urethra, which is a narrowing of the urethra, infections, and other metabolic symptoms.


Prostate cancer, in general, is a silent disease. When he reaches the stage of presenting symptoms associated with benign hyperplasia, it is already a late stage, and the diagnosis at this stage will make treatment very difficult because the therapeutic options will be more restricted. Since there is no specific symptom, there is a need for the man to undergo serial exams.





What tests can identify prostate cancer?

LN– To close the diagnosis, it is necessary for the patient to have a prostate biopsy. This biopsy must be performed under ultrasound guidance and can be performed either through the rectum or through the perineum, which is the region between the rectum and the scrotum. But this exam is only done if the doctor has a suspicion that the disease is there.

At first, a digital rectal examination and PSA should be performed, which is the blood test that, when altered, can lead to suspicion of the existence of the disease. From there, an MRI may be requested to try to identify the most likely site of the cancer’s existence and this would lead to a prostate biopsy being indicated. The latter, yes, is essential to close the diagnosis and start the treatment. The patient diagnosed at an early stage has a chance of cure that varies from 80% to 90%.


Urologist Leonidas Nogueira. Photo: Disclosure



Are prejudice and lack of information still allies of the proliferation of prostate cancer?


LN– We have noticed that the stigmas to the touch exam have decreased, but there is still a part of the male population, mainly people from previous generations and those who have less access to information, with prejudice. However, this has declined for several reasons. Both by the campaigns carried out by the Brazilian Society of Urology and medical societies and by the press.

The population is aging and many men see their friends and family become ill with prostate cancer. This makes them afraid. Even with resistance and prejudice, they have increasingly sought to carry out preventive exams.


After the identification of prostate cancer, what is the treatment?


LN– There are several ways to treat. There is surgery to remove the prostate, which is only done for patients who have prostate cancer. This surgery can be performed via a conventional open approach (where the surgeon makes a single incision to remove the prostate and tissue), or via laparoscopy, which is through the holes in the belly (small incisions that remove the prostate).

After surgery, touch is no longer necessary. Only the PSA test is repeated, which must be performed quarterly until the first post-surgical year, and every six months until the third year. Thereafter, the exam must be performed annually. But each situation has its peculiarity. If there is a high-grade tumor, we shorten these periods.

For patients who do not want surgery for various reasons or in non-ideal conditions, such as obesity and heart disease, we perform radiotherapy, which requires approximately 40 sessions.

There is also active surveillance, which is not a treatment for the removal of the prostate, nor radiotherapy, but it is when the patient has a low-grade tumor and there is a follow-up and evaluation of PSA tests and semi-annual touch, in addition to biopsy at be repeated annually.


From what age should men take PSA?


LN– The Brazilian Society of Urology points out that men should perform the PSA test from the age of 45. In particular, I think that at least one PSA test should be done starting at age 40 for those patients who are at higher risk, such as those who have first-degree relatives with the disease. But, as a rule, the exam is carried out from 45 to 70 years, or even older.


Regarding the touch exam, in the past we doctors were more rigorous, but nowadays we no longer perform the routine exam annually. Patients who have PSA levels considered safe may take more time to perform the touch exam, according to what is evaluated by the doctor.

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