Genitourinary cancer

The prostate is a gland belonging to the male reproductive system. It produces and stores seminal fluid. The purpose of seminal fluid is to feed the sperm and forms part of semen.

The prostate is located below the bladder and in front of the rectum. It surrounds the upper part of the urethra, which is the tube that empties urine from the bladder. If the prostate becomes too enlarged, the flow of urine may slow down or even stop.

In order to function correctly, the prostate requires male hormones (androgens). Male hormones determine male sexual characteristics. The main male hormone is testosterone, which is chiefly produced by the testicles. Some male hormones are produced in small amounts by the suprarenal glands.

More than 18.870 cases of prostate cancer are diagnosed in Spain every year. The chances of a male adult developing cancer increase with age. The adjusted rate of incidence in Spain is 81 cases per 100,000 inhabitants.

Cancer is a set of diseases that occur when cells become abnormal and multiply in an uncontrolled way.

All the organs of the body are made up of different types of cells that divide and multiply in accordance with their own needs and requirements. Abnormal cell growth may give rise to tumours, which can be malignant (cancerous) or benign (non-cancerous).

Benign prostatic hyperplasia is the abnormal growth of benign prostate cells. This growth of the prostate exerts pressure on the urethra and the bladder, which obstructs the normal flow of urine. More than 50% of males between 60 and 70 years of age in the United States, and more than 90% between the ages of 70 and 90 have symptoms of benign prostatic hyperplasia. If such symptoms become serious they require treatment.

Malignant tumours grow and may damage other tissues and organs. If they emmigrate, they may spread through the lymphatics and blood vessels to other parts of the body, a phenomenon known as metastasis.

When prostate cancer spreads beyond the prostate, the cancerous cells are often found in the nearby lymphatic ganglia.

It is still not known why some men develop prostate cancer and some do not. Different studies have shown that certain risk factors exist that can predispose individuals to this type of cancer. However, there are also other factors that are unknown. Exposure to risk factors means there is more likelihood of developing prostate cancer, although risk factors can exist without development of the disease, or even cases that show no sign of risk factors and still develop the disease.

In some studies it has been found that the following risk factors are related to prostate cancer:

• Age: According to studies carried out in the United States, prostate cancer is found mainly among men older than 55 years of age. The average age of patients at which diagnosis of prostate cancer takes place is 70.
• Cases of prostate cancer among family members. The risk of suffering from prostate cancer is greater if a father or brother has had the disease.
• Race. This disease is much more frequent among black rather than white men, while it is less common in Asian men.
• Diet and food factors. Diets rich in fats contitute a factor of predisposition. It has been suggested that foodstuffs containing lycopene, such as tomatoes, may have a protective effect (Source: "New England Journal of Medicine", Nelson).

A blood test is performed to detect the prostate specific antigen (PSA), and also a rectal exploration (manual examination of the prostate through the anus, carried out by a specialist).

It is advisable to carry out these explorations on a regular basis after the age of 50. If cases of prostate cancer among family members exist, regular exploration should be carried out from the age of 40.

The most common symptoms of prostate cancer are: difficulties in urinating (particularly on starting and finishing urination); blood in the urine or a stinging sensation; frequent urination (twice or more during the night).

In a high percentage of cases, prostate cancer presents no symptoms, especially in the early stages. It is therefore important to make regular visits to a specialist after the age of 50.

Diagnosis of prostate cancer is confirmed by a biopsy of prostate tissue by means of a transrectal ecograph. This tissue is analyzed to detect existence of cancer.

Once the presence of prostate cancer has been confirmed, the following tests are recommended:

Depending on the results of these tests, a decision will be taken on performing more tests; for example, a PET scan (Positon Emission Tomography).

• X-ray of the thorax: to check for cancer infection of the lungs.
• Abdominal-pelvic TC: to check for cancer infection in organs close to the prostate (rectum, etc.), ganglia and liver.
• Bone gammagraph: shows if cancer has spread to the bones.
• Endorectal nuclear magnetic resonance: performed by placing an endorectal coil where the RMN transducer is introduced. This helps to identify the tumour and to check whether the prostatic capsule or the seminal vesicles are infected.

The type of treatment is based on the age of the patient, his physical state of health and the condition of the disease, among other factors.

Surgery

The most frequent surgical procedure in the treatment of prostate cancer is radical prostatectomy. This is an operation in which the prostate is completely removed, as well as the surrounding tissue. In recent years, this operation has been performed by laparoscopic surgery, a scarcely invasive technique that obviates the need for large incisions.

Radiotherapy

Radiotherapy mainly employs very high energy ionizing radiation to destroy tumorous cells, preventing them from dividing. All cells grow and divide, but tumorous cells do so far more rapidly. Radiotherapy destroys the cell and prevents it from dividing. Some normal cells may be affected by radiation, but the majority recover, since healthy cells are equipped with self-repairing mechanisms.

In prostate cancer and other tumours, it has been demonstrated that the greater the radiation the better the chances of cure and recovery. Thus reduction of unnecessary healthy tissue exposure to radiation is a prime objective in any treatment employing radiotherapy. Toxicity in prostate tumours can be considerably reduced by using high-precision radiotherapy techniques, such as intensity-modulated radiotherapy.

The Centro Médico Teknon is a pioneer in the application of intensity-modulated radiotherapy. This has been regularly peformed for several years with the Shaped beam radiosurgery Novalis / Radiotherapy Unit, with great experience and excellent results.

Chemotherapy

Different types of medicines are administered to destroy cancerous cells. Chemotherapy is employed in prostate cancer when the tumour has spread and fails to respond to hormone treatment.

It is important to carry out monitoring after treatment. Your doctor will continue to carry out tests to check that the cancer does not reappear. These tests include rectal exploration, explorations by imaging and PSA.

Research includes studies of the ways of preventing, detecting, diagnosing and treating prostate cancer. Several studies are under way about how to prevent prostate cancer by ingestion of dietary supplements or following diets that include a regular intake of foods such as tomatoes. Diagnostic techniques also exist that help us to detect the extension of the tumour in order to provide the most effective treatment.

With regard to treatment, studies are at present under way on new drugs for use hormone therapy, chemotherapy, and biological therapy. High precision radiotherapy (intensity-modulated radiotherapy) and surgical procedures are currently being researched with the aim of achieving higher rates of cure with minimum of side effects.

Likewise, research work is being carried out to improve prostate cancer treatment in its advanced stages with the use of new drugs targeted at a molecular level for therapeutic purposes.