Prostate Cancer

What is prostate cancer?

Prostate cancer is a disease in which malignant (cancerous) cells form in the tissues of the prostate. The prostate is a gland of the male reproductive system whose function is to make a fluid that is part of semen. The prostate is located below the bladder and surrounds part of the urethra. It is about the size of a walnut.

The incidence of prostate cancer diagnosis varies greatly between different geographical areas, and this may be related to ethnic factors, aging of the population, as the incidence is mainly age-dependent, and the routine use of PSA for prostate cancer screening.

Family and ethnic background are associated with a higher incidence of prostate cancer, suggesting a genetic predisposition to the disease. Hereditary prostate cancer is associated with an earlier disease onset of six to seven years, but disease aggressiveness and clinical course do not appear to differ.

Types of prostate cancer by stage or staging

Depending on whether or not the tumor is located within the prostate and the presence of metastases, prostate cancer can be classified into different stages. This classification is important because, depending on the evolution of the tumor, different treatments can be applied:

• Localized prostate cancer. This is the type of tumor that is within the prostate and has not invaded lymph nodes or produced metastasis. It is curable in a large proportion, and the most indicated treatments in this situation are surgery (radical prostatectomy, external radiotherapy, focal treatment or active surveillance). Therefore, the prognosis is very good.
• Locally advanced prostate cancer. This is a prostate tumor that has "come out" of the prostate or has affected neighboring lymph nodes, but has not metastasized. It is still a curable tumor, but we must apply surgery (prostatectomy and lymphadenectomy) or radiotherapy and hormone therapy. Focal treatment is not indicated. The prognosis is intermediate, but it is a curable tumor.
• Prostate cancer with metastasis. When the tumor metastasizes to other organs or to the bones, prostate cancer is not considered curable. Systemic treatment (hormone therapy or systemic chemotherapy) will be necessary. More and more treatments are becoming available that make it possible to contain the disease for very long periods of time.

Complications of prostate cancer

Prostate cancer and some of its treatments may be associated with various complications:

• Urinary incontinence. When a radical prostatectomy is performed, urinary incontinence or involuntary urine loss can sometimes occur. To prevent this from occurring, it is advisable to perform rehabilitation exercises prior to surgery and to resume them early after the operation. In the event of urinary incontinence after surgery, it should be treated in stages, with rehabilitation, suburethral mesh implantation or even artificial urinary sphincter implantation.
• Erectile dysfunction or impotence. Erectile function can be affected by the treatment used for prostate cancer, whether it is surgery, radiation or hormonal therapies. To treat erectile dysfunction there are a multitude of therapeutic options, from medications, to vacuum devices that help achieve erection, to penile prosthesis implant surgeries.