Prostate cancer

Prostate cancer is the most common cancer in the Italian male population. Despite the high incidence, the risk of the disease having an unfortunate outcome is low, especially if timely intervention is made.

The cancer originates from the cells inside the prostate, which begin to grow uncontrollably. This gland is very sensitive to the action of hormones, especially testosterone, which influence its growth.

Among the risk factors there are: – Age: the chances of getting sick are low before the age of 40, but increase significantly after the age of 50 – Familiarity: the risk of getting sick is double for those who have a consanguineous relative (father, brother, etc.) with the disease compared to those who have no case in the family. – Mutations in some genes such as BRCA1 and BRCA2 or Lynch Syndrome – Lifestyle: diet high in saturated fat, obesity, lack of exercise

Diagnosis In the initial stages the tumor is asymptomatic, therefore the suspicion usually derives from the abnormal growth of PSA, a specific prostate antigen, detected by a blood test that every over 50 should undergo. Alternatively, even the finding of a prostatic nodule on rectal examination or ultrasound is sufficient reason to undertake the necessary checks.

The diagnosis will be based on: • Pelvic MRI • Prostate biopsy, i.e. taking prostate material using an ultrasound-guided hollow needle during prostate surgery. The material is then subjected to histological examination. Based on the information deriving from these imaging tests, the need or not to proceed with further tests to stage the disease (bone scintigraphy, total body CT) is established.

Therapy The therapy must be adapted to the stage of the tumor and always consider the patient’s preferences.

The main therapeutic options are: • Active surveillance: monitoring tumor growth without performing therapy but only checking that the tumor does not spread beyond its current stage. This is possible for small and not very aggressive tumors. • Radiotherapy • Medical therapy: use of medical therapy to stop tumor growth, mainly by depriving the body and the tumor of testosterone, which is essential for growth. • Radical prostatectomy: removal of the entire prostate together with the seminal vesicles, possibly associated with the removal of regional lymph nodes. Currently the robotic technique is widely used in the reference centres. • New minimally invasive techniques, including HIFU (High-Intensity Focused Ultrasound)