Prostate cancer: the fourth most diagnosed in the world

11,686 men were diagnosed with this condition in 2020, and 3,964 died. It is the most common tumor in Argentine men, but it can be treated: if detected early, it is a condition that can be treated successfully. World Prostate Cancer Day is marked every 11 June. The date becomes a prompt that professional and patient associations use to help raise awareness among adult men, and their families, about how important periodic urological check-ups are in preventing this condition. It also helps spread the word about the available diagnostic methods.

In 2020, the latest Globocan scientific report was published, prepared by professionals from the respected International Agency for Research on Cancer. According to that document's statistics, that year 1,414,259 men worldwide received a prostate cancer diagnosis.

In that same period, in Argentina, 11,686 men were diagnosed with this condition, and 3,964 died from the disease, making it the most common tumor in the male population in our country. Compared with all the other forms of cancer diagnosed in Argentina, in both men and women, prostate cancer ranked fourth by number of cases (8.9%) and fifth in mortality (5.7%).

Both the incidence and the prevalence of this condition have remained largely unchanged in recent years. One more figure: 1 in every 6 to 8 men will have prostate cancer at some point in their life. But it is important to grasp something key: medical knowledge on this topic has advanced so much that today we know with certainty that not every case needs to be treated.

In many cases, this tumor develops slowly and with little aggressiveness, to the point that it does not need treatment, only monitoring. It is enough for the person to have the recommended check-ups periodically in order to detect any change that does require a specific intervention or treatment to control the condition.

A recent medical study called Prostate Testing for Cancer and Treatment, published in late April in the prestigious New England Journal of Medicine, showed that many patients develop prostate tumors with “low malignant potential.” In most of those cases, the current professional recommendation is to monitor their progress, but in many a specific intervention does not appear to be necessary. The key today is to identify which tumors do need to be treated.

Prostate cancer: preventive tests. Every man over 50 should have a consultation with a urologist.

A conversation with a specialist is important to review the family medical history and assess each man's personal risk. Based on that, there are variations: for example, if the patient has a family history of direct relatives with cases of prostate cancer or even breast or ovarian cancer, he may be advised to begin specific periodic check-ups from age 45 or, in some cases, from 40.

To detect the possible presence of a prostate tumor, there are two types of tests that are complementary and are usually ordered together.

PSA (Prostate-Specific Antigen), a biomarker whose value is obtained from a common blood test.

Digital rectal exam, which can help determine the presence of a tumor at an early stage.

The current PSA value considered “normal” is ideally under 3 nanograms. But that test alone is not enough, since in a significant percentage of cases PSA can read “high” for non-oncologic reasons while the prostate is healthy. Conversely, some prostate tumors can develop without producing a PSA value that exceeds the normal limits.

Depending on the results, the test may be repeated annually or, in the best cases, even every two years or more.

If prostate cancer is diagnosed in time and it is confined to the prostate gland, we are looking at a scenario of possible “cure” of this condition. If, on the other hand, it is diagnosed late and the tumor cells have already migrated from that specific tissue to other organs, various therapeutic interventions can be considered to aim for a scenario in which the disease becomes chronic.

In other words, for the patient there are significant differences between reaching an early diagnosis, made when the tumor is localized, and a late diagnosis, which happens when the disease has already advanced or metastasized. The five-year survival rate for most patients with localized prostate cancer is more than 90%, while for patients with advanced prostate cancer the five-year survival rate drops to 31%.

The likelihood of having prostate cancer rises rapidly after 50. More than 80% of cases are diagnosed in men aged 65 or older. And while it is uncommon in men under 40, hereditary factors and family history can play a decisive role. Men with first-degree relatives (father, brother, son) have 2 to 3 times the average risk of developing prostate cancer.

* Head of the Uro-Oncology Section in the Department of Urology at Hospital Alemán de Buenos Aires

Feature written for the newspaper Perfil. See the feature here