For several years now, November has been the “male” cancer awareness month. On this occasion, the editors of Poradnik Zdrowie invited specialists dealing with cancer treatment among men for an interview. Marcelina Dzięciołowska talks about prostate cancer with the head of the Urology Department at the European He alth Center in Otwock at the II Clinic of Urology at CMKP.
The "Movember" campaign (the so-called mustache) is a social action whose idea originated in Australia. At present, it covers the entire world. Its aim is to raise awareness of cancer in men and to show solidarity with those who are already struggling with the disease.
Sir, has the medical community noted an increase in interest in preventive examinations since more talk about cancer awareness in men started to be discussed?
Dr. Łukasz Nyk:I think so. For several years we have been observing such a situation that more and more men report for a checkup because they heard about the tests on TV or on the radio, or someone from their relatives asked to see a doctor, check if everything was okay.
Men at what age most often come to your office?
I am watching two groups of men who report to us. The first of them are men who start to have problems urinating or something bothers them about the quality of urination, e.g. they start to get up more often at night, have a weak urine stream, or if they go to the toilet, they cannot start urinating as soon as those next to him. These are mostly men around the age of 60. The second group, on the other hand, includes younger men - over 40 years of age. This is most often the group that heard somewhere about the necessity to be tested, or was prompted by their partner / partner to do so.
In your opinion, at what age should the first visit take place, regardless of whether these symptoms are present or not?
Mostly after the age of 40. Cancer of the prostate gland is genetic. Sons or grandsons of men with prostate cancer are up to 11 times more likely to develop this cancer than people whothey do not have a genetic basis. It is increasingly said that men who have had a family history of this cancer should report at least 10 years earlier than the age at which their ancestor's cancer was diagnosed. So if a prostate cancer was diagnosed, for example, in the 45th year of the father's age, the son should report to him around 35 years of age.
What if it doesn't have this genetic basis?
Such a consultation should take place most often between the ages of 40 and 45.
How often should you get tested if the results showed nothing disturbing? In such a situation, when should a man go for a checkup next time?
It depends on the test results, because apart from the fact that the man comes for this check, we also order tests. The basic test that determines the frequency of such visits is the determination of PSA concentration. The PSA norm ranges from 0 to 4. The lower the concentration, the lower the risk for the patient, and thus we can extend the period between checks.
What about the rest of the research?
Another examination is the rectal examination of the prostate. The juxtaposition of these two studies gives the urologist an approximate view of the stage of the patient's disease. If there are any other suspicions, then we extend the diagnostics by performing an MRI, which is the best imaging test, showing what the morphology of the prostate gland is (that is, what it "looks like inside") and if there are any disturbing foci. These three studies allow us to determine with a high degree of probability whether there is a risk or not, and we can safely control the patient by arranging an appointment in a year or a half.
If a man comes to us between the ages of 45 and 50, we recommend checking once a year, unless there are other indications that such checks should be done more often.
Are there any other risk factors besides the genetic background? Why do these men get sick?
There are two primary risk factors - genetics and age. The older the man, the greater the risk of developing prostate cancer. Prostate cancer in men under 40 occurs in less than 1 percent. men.
We also know about geographic dependence. For example, the Japanese are sick less often than Americans or Europeans.
When does this risk increase?
The risk increases significantly in men over 60. Age is a predisposing factor to the occurrence of this cancer and the genetic background I mentioned earlier. These are two indisputable factors.
Are there other known factors?
More and more and more and more about other factors. There are works that have tried to prove the beneficial or unfavorable influence of certain foods on the development of prostate tumors. There is no direct evidence confirming this relationship, although a he althy diet and physical activity may reduce the risk of this and other cancers.
Is it true that men used to be less likely to suffer from prostate cancer?
I don't think so. There was simply no advanced technology to diagnose these diseases before. In the past, social awareness was also much lower. Men either died of cancer without knowing it, because, for example, they suffered pathological bone fractures as a result of a significantly advanced cancer, or this cancer was diagnosed in a very advanced condition, where nothing could be done.
What does it look like today?
Now we are able to recognize cancer in the initial stages of its development. We have PSA (prostatic antigen) at our disposal. The introduction of prostate antigen determination into common use in the 1980s actually revolutionized the approach to the diagnosis, diagnosis and treatment of prostate cancer. Since then, we have been observing a significant increase in the recognition of the disease. The increase in recognition does not result from the fact that men get sick more, but from the fact that we recognize this cancer earlier and more often, because we have tools for it.
Does lifestyle affect the development of this cancer?
When it comes to a he althy lifestyle, there are reports that limiting the amount of red meat, a high-fat diet, limiting s alt in foods we eat every day, and limiting smoking and alcohol consumption may have a protective effect on this tumor.
Is prostate cancer the most common cancer in men?
Yes, definitely yes. Depending on the statistics, these data change from year to year. It is a cancer that is among the top three most commonly diagnosed cancers in men. In addition to colon cancer and lung cancer, prostate cancer is one of the most commonly diagnosed. Unfortunately, it is also in the top three cancers that kill men the most. It ranks second or third in terms of mortality, depending on epidemiological data.
Does this data only concern our country?
This is the case not only in Poland, but also in all highly developed countries anddeveloping in the world.
There is a diagnosis: cancer, what next? What are the treatments and prognosis?
The choice of the treatment method depends on the stage of the cancer. The earlier we recognize the cancer in its initial stages, when it does not infiltrate the capsule and seminal vesicles, when it does not infiltrate other pelvic organs, when there are no lymph nodes or bone metastases, we are able to offer men many methods of treatment and management. .
What are these methods?
Starting with active supervision / observation, i.e. careful observation of such a patient with cancer. We assess PSA at appropriate intervals, examine the man - we perform imaging tests in the form of resonance imaging, biopsy of the prostate gland and decide whether this is the moment that he should undergo surgery or radiotherapy. This approach is about safely delaying radical treatment until cancer progresses.
However, such a basic form of treatment is radical treatment: surgery or treatment with X-rays. We are observing a very dynamic development of surgical treatment methods, mainly minimally invasive. I am thinking of classic laparoscopy or, more and more often, robot-assisted laparoscopy. This increases the chance for a good quality of life and a very good oncological effect.
There are also intermediate methods of dealing with active surveillance and radical treatment. I am thinking of focal treatment, the condition of which is that the patient is well qualified for such treatment, because it involves the destruction of only the part of the prostate in which the tumor is located. That is why precise diagnostics before starting our activities is so important.
This applies to early stage cancers, however.
Yes, these are prostate tumors that offer a chance for a full recovery.
However, we meet with such stages of advancement that do not allow the implementation of these methods of treatment with the intention of curing.
What if this happens?
In such situations, we can slow down the development of this disease. We have hormone therapy and chemotherapy that definitely stop the rate of cancer development. Sometimes it even happens that men who initially did not qualify for surgery or radical treatment, after using such chemotherapy or hormone therapy, decrease their advancement degree to such an extent that it gives a chance for radical treatment, i.e. surgery. These are quite difficult operations.
Most of these methods make it possible for a man to be fully functional?
We are observing a decisive progress in the possibilities of surgical treatment of patients. However, we must remember that surgical management of patients with prostate cancer has several aspects.
What?
The first is the oncological aspect that is very important, if not the most important, especially in those men whose cancer is highly malignant or advanced. However, we must also remember about the functional aspects of our procedure, because unfortunately we are able to generate such side effects and complications that may significantly reduce the comfort of a man's life after surgery.
What are the potential side effects and complications?
I am thinking of urinary retention problems and penile erectile dysfunction after surgery. The less malignant and advanced the tumor is, the greater the possibility of good oncological treatment, as well as maintaining a good quality of life after surgery, because we are then able to save the vascular-nerve bundles that are responsible for penile erection after surgery and for urinary incontinence, we are also able to dissect a long section of the urethra, save the neck of the bladder. And these are the aspects that affect the quality of life for men after surgery.
And as for the tools you have at your disposal?
The tools at our disposal are more and more perfect and precise, and the crowning achievement of this technology that enters medicine, urology, which gives a lot of opportunities to maintain a good quality of life for men after surgery, without losing the oncological quality , is the introduction of robots for surgical treatment that help the surgeon to be even more precise and accurate.
In the clinic in Otwock, you already have such equipment.
Yes, we have a 3D laparoscopic system, i.e. 3D vision, and an operating robot that we have been using for almost two years.
It's good news that technological advances are giving patients more and more opportunities that they never had before.
I remember how about four years ago I came back from training in robotic surgery in America, which I did at the center for the implementation of robots in urology (University of Chicago), in our country there were only two robotic systems, of which only one of them was used.
What does it look like today?
Currently we have about these systems25, it is a gigantic technological advance and a chance for men to be able to finally effectively and precisely treat men with prostate cancer.
This is probably one of the most important arguments for getting tested.
Yes, but the most important argument for getting tested is that a cancer diagnosed early creates very good conditions for treatment and complete cure, thanks to the application of the latest technological achievements, without losing the quality of life after surgery.
Thank you for the interview.
Expert
Łukasz Nyk, MD, PhD, doctor of medical sciences, urologist specialist, head of the Urology Department at the European He alth Center Otwock in the Second Urology Clinic of the Medical Center for Postgraduate Education, accredited by the European Board of Urology. A graduate of the 1st Faculty of Medicine of the Medical University of Warsaw. He completed a specialization in urology and passed the certification exam before the prestigious European Board of Urology, obtaining the FEBU (Fellow of European Board of Urology) title. He obtained the title of doctoral student in medical sciences at the Medical Center of Postgraduate Education in Warsaw (CMKP). Intern in the urology unit at Guy's and St. Thomas' Hospital, London. He completed a post-graduate internship at the Central Railway Hospital in Międzylesie. He began his specialization in urology at the Provincial Specialist Hospital in Krakow, which he transferred a year later to the Urology Clinic of the CMKP in Międzylesie under the leadership of prof. dr hab.med. Andrzej Borówka. He completed an internship at the Department of Oncological and Surgical Sciences Urology Clinic at the University of Padua in Italy. He received a scholarship from the Kościuszko Foundation in the field of Research Fellowship in Minimally Invasive (Robotic) Urologic Surgery at the University of Chicago, USA. Assistant professor at the Urology Clinic of CMKP ECZ Otwock. Main medical fields of interest: oncological urology, urological laparoscopy, endourology, new technologies (HIFU, robotic surgery). Outside of work, he is interested in sports: road and mountain biking, swimming, Kyokushin karate and motorization; likes to travel.