Prostate cancer is a malignant tumor that often appears after the age of
forty. One in every ten patients may develop prostate cancer and previously it
was thought that 3 in every 100 could die of it, but this has changed as a
result of better diagnostic procedures. Prostate cancer is the most common
cancer after that of skin cancer.
In Spanish: Entrevista Canal Uno, Bogotá, 2016/11/18
Biopsia de próstata - Cáncer de próstata
Prostate cancer is the development of undifferentiated (malignant) cells within
the prostate; most often detected in the back part of it near the rectum but may
be located in any part of it or even outside of it as metastasis in the bones
and lymph nodes.
The symptoms of prostate cancer are more evident as the cancer progresses and in
its initial stages it is absolutely symptomless.
Factors that Increase the Risk of Developing Prostate Cancer
The factors that increase the risk of developing prostate cancer the most are
genetic, nutritional, environmental and hormonal derived from androgens.
Prostate cancer usually appears in men over 40 and its frequency increases
with the age of men, especially over 50. At least 65% of men over 70 are
believed to have microscopic evidence of prostate cancer, but fortunately its
growth is very slow and the men in this age bracket almost always die of other
causes. Different studies have shown that the younger the man is who develops
prostate cancer, the more aggressive it is, which in turn requires a more
Family History and Genetic Factors
Hereditary factors play an important role and men with a family history of
prostate cancer have a greater risk of developing it. Having a family history
prostate cancer doubles the risk of developing it and three relatives with
prostate cancer increases the risk eleven times.
Afro-American men have the highest risk of developing prostate cancer with a
probability 50% higher than that of white men. Though men living in Asia have a
lower risk, their risk increases if they move to North America, which suggests
environmental or nutritional factors.
The lack of access to preventive testing or timely diagnosis of the cancer
before it enters in metastasis increases the risk of developing prostate cancer.
The high risk in Afro-American men is associated with socioeconomic factors
impeding a timely diagnosis as their access to quality preventive exams is very
limited. For example, in a study of 2000 veterans which included whites and
blacks enjoying the same level of health care, there were no major differences
in the development of cancer.
Exams of elevated sensitivity, such as C.M.P. –Prostate, which diagnose disease
allover the body, significantly increase the resistance of the body to the
cancer as they allow treatment of a greater number of illnesses, raising the
general health of the patient which in turn increases his resistance to the
There is some evidence that some genetic factors may facilitate the
development of prostate cancer.
Exposure to Chemicals
Exposure to cadmium, dimetilformamide and acrilonitril can raise the risk of
developing prostate cancer. It has also been suggested that farmers have a
greater risk of developing this cancer. The risk increases with activities
related with paint and varnish, exposure to grease and lubricants, metallic
dust, pesticides and in professions associated with home maintenance and
Exposure to Diesel fumes
Several works have linked diesel fumes to prostate cancer due
to the PAH.
Infection and Swelling
The herpes virus, el papiloma y el citomegalovirus, along with some bacterial
infections transmitted by sexual contact are suspected to cause the development
of prostate cancer in males with a genetic susceptibility.
There is evidence that the swelling caused by these infections is a condition
facilitating the development of prostate cancer
Biopsies cause inflammation and swelling. The inflammation increases in
direct proportion to the number of incisions made and all the trauma caused.
Repeated biopsies indirectly increases the chances of developing prostate
cancer. Biopsies can also dramatically affect the quality of life and secondly,
in the case of prostate biopsies, facilitate the spread of the cancer.
There are dietary factors that increase or decrease the risk of developing
prostate cancer. Some studies show that obese men or those who eat a lot of
greasy food may develop prostate cancer but recent studies seem to suggest that
high calorie intake is a more important factor in developing prostate cancer.
Food cooked at very high temperatures may increase its appearance along with
moderate to heavy drinking.
Eating fish twice or more a week, vegetarian diets, whole grains, fiber,
soybeans and vitamins D and E may reduce the risk.
The Sedentary Lifestyle
Vigorous working out can reduce the risk of metastasis in prostate cancer.
Reduced Sexual Activity
Frequent ejaculation, be it masturbation or sexual activity, has been
associated with a reduced risk of developing prostate cancer as it eliminates
carcinogens. Promiscuous sexual activity however increases the risk of
It is also known that the poorer the health of the patient with prostate cancer,
the more aggressive it is as the weakened immune system facilitates the
extension of the cancer. It is for this reason that patients, for instance with
AIDS, develop the cancer more easily.
Healthy eating habits, physical exercise, positive attitude, avoiding
excesses and etc. increase the resistance to cancer.
As explained previously, the cancer presents no symptoms in its initial
stages, for which it is prudent to detect it as early as possible, along with
improving the health in general of the patient which improves his defenses.
Usually the more advanced the cancer, the greater the number of symptoms and the
greater their intensity. The most frequent symptoms are:
1. difficulty or pain urinating
2. weak stream
4. frequent desire to urinate
5. blood in the urine
6. blood in the semen
7. Probable back pain if there is metastasis in the backbone.
8. Pain on ejaculating
9. Pain in the back
10. Muscular pain
11. Pain in or near the testicles
12. An elevated PSA
These symptoms may appear when the prostate cancer is present and relatively
advanced but are also very common with other illnesses and diseases, for which
it is indispensible to take exams such as C.M.P.- Prostate which can clarify the
The Classification of Prostate Cancer
There are various classifications of prostate cancer and the most precise are
those that depend on surgical results.
The most common classification is that which refers to the extension of the
tumor (A, B, C, D). The explanation of this technique has been adapted to actual
knowledge as previously it was considered that the prostatic antigen was part of
this classification. Now it is known that its usefulness is very limited because
the PSA goes up for many reasons aside from prostate cancer.
The Gleason scoring system
This is a simple classification system based on operating discoveries
microscopically classifying the cells from well differentiated (first degree) to
very undifferentiated (fifth degree). Two structural patterns are studied (first
and secondary) adding up to a minimum of two points and a maximum of ten points.
Degrees one and two are normal. Third degree (moderately well differentiated
cells) is the most common and it is still considered normal. For this reason,
the sum of the two values, equal to six can also be considered normal.
The fourth degree corresponds to cancer and is the most important and some times
difficult to differentiate from the third degree. The total of the two values
equal to seven is suspicious. Even the eighth degree, adding the two values may
The fifth degree is undifferentiated, corresponding to cancer.
In this way, a Gleason score of10 would be the most serious of all and a Gleason
score of 2, totally normal.
For clear evaluation the total of the two factors should be reported, for
example: 7 (3+ 4), and the higher the number the more serious. It is common for
a biopsy to show a Gleason score of 7 or less and there is no cancer but rather
an inflammatory reaction or other non malignant illness. For this reason the
result of the biopsy is not reliable for a Gleason score of less than 8. It is
worth considering that biopsies usually show results of less than 8, reducing
their usefulness considerably.
The TNM Grading
This has replaced the ABCD system for classifying prostate cancer and follows
that of Gleason scoring in its usefulness.
The T means a primary tumor and represents the extension of the cancer within
the prostate and the tissue directly adjacent.
The N means lymphatic nodes and is for when the prostate cancer has invaded
neighboring lymphatic nodes.
The M signifies metastasis and means that the prostate cancer has invaded
distant tissues such as the bones and lungs.
These letters are followed by a number from 0 to 4 representing the extension of
the tumor and occasionally a small letter which represents additional
Stage T0, no evidence of cancer
Stage T1, the cancer is limited to the prostate and detected by initial
diagnostic means of greater sensitivity.
Stage T2, the cancer is confined to the prostate and discovered by initial
diagnostic means of greater sensitivity and occasionally by those of lesser
Stage T3, the cancer has extended to the immediate neighboring tissues and/or to
the seminal vesicles.
Stage T4, the cancer has extended to neighboring organs such as the bladder.
The Stages N and M indicate respectively the presence of cancer in neighboring
lymphatic nodes and metastasis and they are represented when they are positive
as N+ and M+, followed by numbers and/or letters in progressive order depending
on the size and extension.
Diagnosis of prostate cancer
Digital rectal examination: allows suspecting prostate cancer when
this has grown enough to deform the princludesostate,
or when it is located near the rectum. As this Digital rectal examination does
not allow evaluating the front of the prostate, other diagnostic means more
reliable are necessary.
PSA (Prostate specific antigen): This is useful for evaluating the
response to treatment but not for diagnosing prostate cancer, as the PSA also
increases for many illnesses such as benign prostate hypertrophy, prostatis,
cystitis and seminal vesiculitis, breast cancer, sexual activity, stress, etc.
and digital rectal examination. PSA along with C.M.P. - Prostate allows
calculating the PSADI which is a very sensitive indicator of the evolution of
Prostate Biopsy: Can determine with a lot of certainty the presence of
cancer when this is very advanced, that is to say when the Gleason scores are
high, usually above 8. Unfortunately the values under 8 can result in false
positives, that is to say cancer is detected when it does not exist.
Additionally, the biopsy is very painful, can spread the cancer and can be
complicated with hemorrhaging, infection (especially septicemia) and the
spreading of the tumor. Also, the reuse of needles and other implements
increases the possibility of transmitting infections and AIDS. Most biopsies
result negative, even when there is cancer for which they are repeated until
there is a permanent inflammatory reaction promoting cancer development.
Conventional ultrasound testing: Allows an idea of the approximate size
of the prostate but due to its low sensitivity is usually associated with
prostate biopsies and the serious consequences that these may have.
C.M.P. - Prostate, in addition to detecting prostate cancer, detects
other illnesses in the prostate and the rest of the body, allowing a timely
treatment and improving the general resistance of the patient to cancer. The
additional advantage is that it is totally painless and safe and can be carried
out without any limitations.
Prostate cancer treatment
If prostate cancer has been diagnosed you should know the different treatment
options. The treatment chosen depends on the type of cancer and its extension
and principally on your personal priorities after considering the benefits and
inconveniences, your age and general health, as the better your health, the less
extreme treatments are required and it is even possible that no treatment is
Aggressive actions such as biopsies may paradoxically cause metastasis and it is
better to avoid them. It is also good to remember that extreme treatments reduce
quality of life and may additionally affect the health of the patient and the
resistance of the immune system.
Actually the PSADI velocity index allows having an approximate idea of the speed
of growth of the cancer and because of this measuring the PSADI is part of the
C.M.P. –Prostate test.
The most recent prostate cancer treatments are:
This consists in observing the patient without any kind of treatment until
the symptoms appear or get worse. It is recommended in cases just beginning in
very healthy patients whose quality of life would be very affected by the
treatment, in very old men whose life expectancy may be very reduced, and
naturally if the patient wishes this and requests it.
Pelvic Lymphadenectomy: This consists in removing the lymph nodes in
the pelvis whicch are immediately examined under microscope. If the nodes have
cancer, the prostate is not removed and another treatment is recommended.
Radical Prostatectomy: The prostate is removed along with neighboring
tissues and lymph nodes. This produces impotency, along with urinary and fecal
Transurethral prostatectomy: Part of the prostate tissue is removed
through the urethra, through a cystoscopy. This is used to alleviate an
obstruction, especially in old men or persons who could not resist a radical
operation or its side effects.
This consists in using radiation to kill the cancer cells. The external
irradiation is with a machine which irradiates the body and internal irradiation
(brachytherapy) through radioactive seeds, wires or catheters. Radiation therapy
frequently produces urinary problems.
This consists in blocking the hormonal action to impede tumor growth. The
therapy often produces heat waves, alterations in the sexual functions, loss of
sex drive, impotence and bone disorders. The treatment of hormone therapy
Antagonists of the liberating factor of luteinizing hormone which impedes
testosterone production by the testicle (luproide acetate, goselerin and
Antiandrogens such as the flutamide and bicalutamide, which offset the
Drugs that prevent that the adrenal glands produce androgens such as
ketoconazole and aminoglutamide.
Orchiectomy or removal of the testicles, which are the main source of
Estrogens, which promote female sexual characteristics impeding
testosterone production by the testicles. They are little used because of their
serious adverse effects.
Cryosurgery, The cancer tissue is destroyed with very low temperatures.
Chemotherapy, medicines are used to kill or impede the growth of the
malignant cells. They are administered orally or injected.
Immunotherapy or Biological therapy, this consists in stimulating the
active or passive immune system that is responsible for preventing the growth of
High-intensity focused Ultrasound, this is the implementation of high
intensity ultrasound through an intrarectal catheter to destroy cancer cells.
New treatments are investigated every day that will be published here.
Questions for choosing the best treatment for prostate cancer
Is the cancer limited to the prostate, or has it already extended?
Prostate cancer can extend to neighboring organs and tissues, bones and the
lungs. To know this adequate tests are necessary, beginning with a
When a patient is in good health in spite of having cancer cells, his defenses
are better and it is possible that the cancer doesn’t extend more. It is for
this reason that many with prostate cancer that hasn’t extended don’t need any
treatment. It is important to emphasize that a prostate biopsy doesn’t say
anything about the extension of the cancer and thus is useless for this.
Is the cancer aggressive or slow growing?
The speed of the PSADI or PSADI velocity index gives a very precise idea of the
speed of growth of the prostate cancer. The PSADI is measured in the
Prostate if you have a previous PSA.
How is your health in general?
A timely C.M.P. - Prostate is the ideal exam to know your health in general.
How old are you?
In young men the life expectancy is greater and there is a higher probability
that the cancer can be cured in the near future without the need for surgery.
Obviously the general health and the extension of the cancer are variables to
consider in this.
Can the patient resist surgery?
C.M.P. - Prostate should be carried out before any surgery implying local or
general anesthesia, or that implies certain risk such as in the case of a
Is the patient willing to suffer for life the adverse effects of a radical
prostatectomy to reduce the risk of death by prostate cancer?
The principal adverse effects are urinary incontinence and impotence, and
eventually rectal incontinence and all that this implies. This should be
carefully considered before a prostatectomy.
How important is it for the patient, in his work and recreation, to enjoy
good control of the bladder and the intestine?
This also, should be thought about carefully before undergoing surgery.
How important is it for the patient to have an erection?
If the patient has an active sex life, he should know that this aspect of his
life will change very much with the cancer treatment.
How much would it affect the life and activity of the patient to know that he
is living with a cancer and not receiving treatment and needs frequent exams?
Some men can support the pressure of living with cancer while others can’t.
Each patient with prostate cancer should consider all of the previous points
before deciding on the treatment which is best for him.
When prostate cancer is detected, the next step is to determine its extension
and evaluate as thoroughly as possible the whole organism to determine the best
It is not always necessary to operate and many treatments should be ruled out.
The best exam to evaluate the patient already detected with prostate cancer is
the C.M.P. - Prostate
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