September has been designated internationally as ‘Prostate Cancer Awareness Month’, in an effort to raise awareness and support for sufferers.

Prostate cancer is the most common malignant disease of men and, although in many cases it is slowly progressive, delay in its diagnosis can be fatal.

The World Cancer Observatory (GCO) estimates that more than 7,000 new cases are reported in Greece each year. They account for 19.2% of all new cancer diagnoses in men.

In both sexes it is the fourth most common cancer, after malignant neoplasms of the breast, lung and colon.

Each year, more than 1,900 deaths from the disease are also recorded in our country, which makes prostate cancer the fifth most common cause of death from cancer in both sexes.

These figures mean that an average of 19 men learn every day that they have prostate cancer in our country and 5 die from it.

“Prostate cancer has a high cure rate when detected in the early stages. When localized, its prognosis is excellent with 95% of patients surviving for at least 15 years. Unfortunately, however, the cases of advanced disease are increasing because many men are not checked preventively.” But what are the risk factors for its development? The strongest are age and family history of the disease. It is estimated that at least 70% of men aged 70 years have cancer cells in their prostate, even if they have not been diagnosed with the disease.

The average age of prostate cancer diagnosis is 67 years, while diagnoses under the age of 50 are rare. In fact, 1 in 456 men under the age of 50, 1 in 54 between the ages of 50-59 and 1 in 11 over the age of 70 suffer from the disease.

The role of family history is also very important. The American Cancer Society (ACS) estimates that men who have a father or brother with prostate cancer are twice as likely to develop the disease themselves. The risk is fivefold to tenfold for those who have two or more relatives with the disease, especially when their relatives were relatively young when their prostate cancer was diagnosed.

“Factors with a less clear role in the risk of developing prostate cancer are diet (especially overconsumption of dairy products), obesity (seems to increase the risk of developing aggressive prostate cancer), smoking and exposure to certain chemicals,” adds Mr. Poulias.

The problem is that prostate cancer in its early stages usually causes no symptoms. In some cases there may be some difficulty urinating (eg slow or weak urine flow or frequent urination especially at night) or blood in the urine or semen. These symptoms, however, occur much more often in men with advanced prostate cancer.

Men with metastases may have additional symptoms, depending on the location of the metastases. Such symptoms are e.g. weight loss, bone pain, feeling very tired, loss of bladder or bowel control, numbness or weakness in the legs, etc.

Therefore, since prostate cancer in its initial stages does not cause symptoms, the only way to diagnose it early is to have a preventive measurement of the prostate specific antigen (PSA) in the blood. This antigen is a protein that increases when the prostate becomes enlarged for any reason (not just cancer). Depending on its levels, prostate cancer is also suspected. The ACS recommends that PSA measurement begin:
•

At age 50 in men at moderate risk for prostate cancer
• At age 45 in men at high risk because they have a first-degree relative (father or brother) diagnosed with the disease at an early age (under 65)
• At age 40 in very high-risk men because they have two or more first-degree relatives diagnosed at an early age

Depending on the results of the PSA test, the ACS recommends that men who do not have prostate cancer be screened again:
• Every 2 years, when PSA results below 2.5 ng/mL
• Every 1 year, when PSA has a result of 2.5 ng/mL and above

As part of the preventive check-up, a digital prostate examination can also be done. If these tests have suspicious or inconclusive findings, the next step is a multiparametric MRI of the prostate. The examination provides a detailed picture of the prostate gland and can significantly facilitate the early, non-invasive diagnosis of cancer.

Screening can reveal cancer that sometimes needs treatment and sometimes just monitoring. It can also have disadvantages, as it may lead to false positive or false negative results. However, overall it can prove life-saving when the cancer is carefully verified and patients are selected for treatment or active surveillance. A study published last year in the New England Journal of Medicine showed that active surveillance in appropriately selected patients has the same 15-year survival rate as radiation therapy and surgery.

The treatment options for treating prostate cancer are many and are constantly increasing. The cornerstone is surgical removal, performed with increasingly less invasive methods (laparoscopic robotics).

Depending on the stage of the disease, the aggressiveness and the general health of the patient, drug treatments, hormonal treatments (chemotherapy, immunotherapy or targeted therapies, etc.), radiation therapy, cryotherapy, etc. may also be administered.

There are also additional treatment options for patients who relapse after initial treatment, which is estimated at around 30%.

“Thanks to advances in early detection and treatment, men have a one in 8 chance of developing prostate cancer but a one in 44 chance of dying from it – and those odds are even slimmer when the disease is diagnosed in the early stages and dealt with in a timely and correct manner”.