PROSTATE CANCER

What is the prostate?
The prostate is a male gland located in front of the rectum that has an important role in the reproductive functions, as it produces and secretes seminal fluid. Under normal conditions the prostate is small-sized; however, ageing and some diseases can cause its enlargement triggering urinary problems that can become severe.

What is a prostate cancer?
Uncontrolled growth of the cells inside the prostate results in the formation of cancer tissue. Almost all prostate cancers originate from glandular cells, hence they are called adenocarcinomas. In rare cases, sarcomas and carcinomas can also develop.

Prostate cancer is classified according to three parameters:

  • Grade, which refers to the aggressiveness of the neoplasia. The cancer is given a Gleason score upon performing a biopsy (procurement of some cancer tissue) on a scale from 1 to 5 based on the similarity between cancer cells and healthy cells: the more similar the cells, the lower the Gleason score.
  • Stage, measured with the so-called TNM system (T = tumor extent, N = node status, M = metastasis present).
  • PSA (prostate-specific antigen) levels in the blood. PSA is an enzyme produced by the pancreas. For many years, PSA has been considered a “tumor marker” for prostate cancer, but actually its values are influenced by multiple factors not necessarily related to the presence of a neoplasia (e.g., local infections, inflammation, traumas, unhealthy diet, and benign formations). This is the reason why PSA levels are monitored over time, rather than taking into account the outcomes of one test only.

The neoplasia is classified according to these three parameters and assigned a class of risk: low (limited spread and unlikely metastasis), intermediate, or high.

In Italy, prostate cancer affects 1 out of 8 men (34,800 new cases were diagnosed in 2017), representing 20% of all male cancers. Over the last years there has been a significant increase of the reported cases, due to the rise in the average age and to the spread of the PSA test. Luckily the mortality rates deriving from this neoplasia are steadily reducing: survival rate after 5 years from diagnosis amounts to 91%, one of the best among the oncology diseases. The reason is certainly the crucial role of prevention, and hence of early diagnosis, thanks to spontaneous PSA screenings and urological consults.

Prostate cancer risk factors:

  • Age: the likelihood of contracting a prostate cancer is quite low before 40 years of age, and increase considerably after 50 years of age.
  • Family history: anyone with a consanguineous relative who has suffered from a prostate cancer has twice as many possibilities to contract the disease compared to those with no family history of this disease. Some genetic mutations can also increase the risk.
  • Unhealthy lifestyle: physical inactivity, unhealthy diet, and obesity are all factors that increase the risk of onset.

Treatment of prostate cancer
There are multiple therapeutic options for prostate cancer that are chosen and customized according to the patient’s age and general health, severity of the neoplastic disease, and extraprostatic extension, if any.

  • Surgery – If the tumor is only located in the prostate, then prostatectomy (surgical removal of the prostate) is the standard treatment also considering its high success rates. However, the impact of post-surgery complications on the patient’s quality of life calls for a careful assessment before choosing surgery as the therapeutic solution.  Furthermore, surgery alone is not sufficient for advanced neoplasias, and it is generally combined with radiation or hormone therapy.
  • Radiation therapy – Radiation therapy (RT) plays a fundamental role in the treatment of prostate carcinoma in all stages, from early to locally advanced tumors. RT can be delivered as exclusive treatment after surgery or to treat recurrences. At UPMC Hillman Cancer Center Villa Maria we perform stereotactic radiotherapy and radiosurgery.
  • Hormone therapy – When the tumor has reached a metastatic stage, hormone therapy is the first choice treatment to reduce the levels of testosterone that promote prostate cancer cell growth. Unfortunately these treatments cause several side effects (decreased sex drive, impotence, osteoporosis, fatigue, etc.).
  • Chemotherapy – When hormone therapy is not effective, chemotherapy can be used to try to reduce the size of the tumor, to relieve symptoms and pain, and preserve a fairly good quality of life.
  • Watchful waiting – When the tumor is not aggressive and localized, and the patient is elderly and/or suffers from other serious diseases, it can be decided to not intervene and delay treatment to when the symptoms appear, while at the same time closely monitoring the disease.