How to diagnose prostate cancer early

Prostate cancer is one of the most common and most aggressive types of cancer in men. It is estimated that one in seven men will develop prostate cancer during their lifetime. When the prostate cancer is diagnosed late, the results of the treatments which are currently available to us are modest, and the mortality is particularly high. An extremely serious factor is the metastatic nature of this cancer; in particular, bone metastases are responsible for a significant percentage of prostate cancer mortality. The quality of life of these patients is severely affected due to bone pain as well as pathological bone fractures which, in turn, can give rise to many complications.

At the same time, prostate cancer is one of those cancers that currently can be diagnosed early. Many countries, including Romania, promote prostate cancer screening programs, which have proven to be very effective.

The essential test from which the screening starts is abbreviated PSA (Prostate-Specific Antigen) and consists of a simple blood sample that can be taken during other investigations or, upon request, specifically for this determination.

Who should take this test?

Basically, all men after the age of 50, and those with risk factors after the age of 40. Among the risk factors in the first place is the family history: close male relatives who have had prostate cancer or close female relatives who have had breast or genital cancer. Other risk factors include obesity, smoking, a high-fat diet, and a sedentary lifestyle.

It is generally considered an increased risk of cancer when the PSA level exceeds 1.4 ng/mL in men under 40, 2 ng/mL in those between 40-50 years, 3.1 ng/mL between 50-60 years, 4.1 ng/mL between 60-70 years and 4.4 ng/mL over 70 years.

It should be noted, however, that there is prostate cancer with PSA below 4 ng/mL and, conversely, the PSA level can also be increased above 4 ng/mL in several benign conditions such as prostatitis or benign prostatic hyperplasia. These situations will be discussed with the urologist who will determine the further conduct.

A major red flag is the steady and progressive increase in PSA, which usually means a diagnosis of cancer.

When there is an increase in PSA levels beyond the limits mentioned above, the patient should consult a doctor immediately because an early diagnosis can save his life.

Usually, the next step in prostate cancer is an MRI (magnetic resonance imaging) examination followed by a biopsy, which is performed by the urologist.

If the biopsy report is positive, the urologist will indicate the treatment. Lately, radiotherapy has made remarkable advances and may be indicated in certain forms of the disease. At the forefront, however, remains the surgery that is called radical prostatectomy, which involves the complete removal of the prostate along with the seminal vesicles, but with the complete preservation of the urinary sphincter and, as far as possible, the erection nerves, which ensure a normal sexual function after surgery.

These objectives are best achieved today with the help of robotic surgery, in which both the superior visibility and the possibility to perform surgical maneuvers more easily and accurately provide the greatest certainty in achieving the objectives of the surgery.

Under these conditions, robotic radical prostatectomy provides maximum safety both in terms of the remote evolution of prostate cancer and in terms of the patient's quality of life, with direct reference to his urinary and sexual function.

The remote evolution of cancer will be subsequently monitored via the PSA test, whose values should return to normal after surgery and maintain this level for the rest of his life. Any subsequent increase in PSA values usually means a recurrence of the disease and should bring the patient back to the urologist and oncologist.

Overall, however, for cases detected early, the remote results after treatment are very good. That is why we believe that the PSA test should be considered by all men after the age of 50 and performed whenever possible. As beyond this age, there are other reasons to perform blood tests, the recommendation would be that the test is done as often as possible, especially since, as stated above, a steady increase, even with low values, can be a red flag. If there are no other reasons to take blood for tests, then the PSA test should be done at least 1-2 times per year.