2023-12-13 09:45:18
by Vera Martinella
The photograph taken from the survey promoted by Europa Uomo on over 5,500 patients. Erectile dysfunction and incontinence are the heaviest side effects, avoidable with active surveillance (which is not for everyone)
One man in eight in Italy will have to deal with a diagnosis of prostate cancer, the most frequent type of cancer among males and whose cases in our country have been increasing for years. How do you live after the diagnosis? Well according to many interested parties, even very well for about one in five patients. However, the side effects of the treatments weigh much more than what has been noted so far: first of all erectile dysfunction, followed by incontinence, hormonal disorders, anxiety and depression and pain (present in the more advanced stages, due especially to bone metastases). This is why, whenever possible, men should be offered an active surveillance program, which only involves checks and therefore has no consequences on sexuality and urinary function, before starting treatment. This is reiterated by the results of EUPROMS (Europa Male Patient Report Outcome Study), the survey promoted by Europe Manconducted in 32 countries, involving 5,500 patients, on average aged in their seventies.
Increasing cases before the age of 50
«For the first time, a collective story emerges of men who have received a diagnosis of prostate cancer and which faithfully reflects their experience after treatment – says Maria Laura De Cristofaro, president of Europa Uomo Italia -. From the survey, then, three key messages arrive: first, the importance of early diagnosis, all the more crucial since prostate cancer shows no signs of occurring in its initial phase; second, the need to strengthen diagnostic-therapeutic pathways defined through the creation of Prostate Units within which a multidisciplinary team operates, the only one that can guarantee quality of care, avoid inadequate treatments and ensure a better quality of life, in addition to psychological support; third, active surveillance (a systematic plan of checks at defined intervals for low-risk prostate cancer) is the approach that best preserves the patients’ quality of life”. Prostate cancer is the most frequent cancer in men and new cases recorded in 2022 in Italy were around 40,500. Thanks to early diagnoses and increasingly effective therapies, today over 90% of patients are able to recover or live with the disease for decades. «Its incidence increases with advancing age, but it is a mistake to consider this neoplasm as a “disease of the elderly”, because it also affects productive age – recalls De Cristofaro -. The number of young men who, before the age of 50, are diagnosed with prostate cancer has been growing for years.”
Don’t ignore these symptoms
«Although there are no characteristic symptoms of prostate cancer at the onset, we must not ignore the appearance of various urinary problems – explains Bernardo Maria Rocco, president of the European Men’s Scientific Committee -, such as: difficulty in starting urination, weak urinary flow, need for “pushing” during urination, incomplete emptying of the bladder, high frequency of urination, urgency to empty the bladder and presence of nighttime urination. These are symptoms that accompany benign prostatic hypertrophy, which is very common in males over the age of 50 and therefore should not be alarming, but should not be underestimated and ignored. Just talk to your family doctor who will evaluate whether a visit to the urologist specialist is necessary, preceded by any tests. This simple attention could be the best prevention of prostate cancer, allowing for an early and timely diagnosis”. Then there is the Psa test, a normal blood sample (which measures the specific prostate antigen), which has advantages and limitations because values high levels do not necessarily mean cancer, rather they indicate that something is wrong with the prostate: it may in fact be inflammation (prostatitis) or an increase in the volume of the gland (hypertrophy), but physiological factors such as previous sexual intercourse may also be involved upon withdrawal.
Treatment and surveillance
What is the most effective treatment? «The possible therapeutic choices available to us today (i.e. surgery, radiotherapy and brachytherapy) have proven to be able to offer very good results in terms of both recovery and long-term survival – replies Giuseppe Procopio, director of the Prostate and Genial Medical Oncology Program -Urinary at the IRCSS Foundation National Cancer Institute of Milan—. They are valid and comparable options especially for those forms of cancer that we know are at low and intermediate risk of progression (i.e., in practice, with little probability of evolving and causing metastasis), which are the majority. While for high-risk forms “multimodal” treatments are generally proposed, i.e. they combine different therapies. With equal efficacy for the results obtained against the disease, the choice must therefore be made taking into consideration the possible side effects, preferences and expectations of the person concerned. It is men who, weighing the pros and cons of each option, must establish what is best for their quality of life.” And then there is active surveillance, introduced into clinical practice for 20 years now, but still little proposed to interested parties: «It is a strategy reserved only for certain types of patients – explains Procopio -, those with small-sized carcinoma and not aggressive. Today it is estimated that around 40% of cases diagnosed every year in Italy belong to a category of low or very low risk of progression, which can only be kept under control (in surveillance, in fact) and do not require immediate treatment. Postponing any treatments until the disease changes attitude, if it does. Thus postponing, for years or for a lifetime, together with the therapies also their possible side effects.”
Side effects
The EUPROMS survey on quality of life highlighted a much greater impact of the side effects of treatments than what was found with investigations conducted in a clinical setting. «More than 50% of the participants received the diagnosis before the age of 65 – underlines Cosimo Pieri, General Secretary of Europa Uomo Italia -. Over half of those interviewed declared sexual dysfunction problems and, specifically, 60% of men who had undergone surgery and more than 47% of those who had radiotherapy. This is the problem most felt by patients. Even on the incontinence front, there are post-surgery and radiation problems”. Various solutions are available for both urinary and sexual disorders, “but they are only used by 30% of patients because they are not proposed adequately – continues Pieri -. 42% of participants then suffer from anxiety or depression and psychological support is rarely offered in our hospitals.” Even oromonotherapy, prescribed for an advanced stage neoplasm with the aim of blocking the growth of the disease, can cause undesirable effects: «The treatment is well tolerated, but can cause chronic fatigue, osteoporosis, mood disorders, difficulty concentration and memory, gynecomastia, hot flashes, negative effects on sexual desire – says Masasimo Di Maio, director of the 1U Medical Oncology at the City of Health and Science in Turin and General Secretary of the Aiom (Italian Association of Medical Oncology) -. There are many strategies that can be implemented to control or reduce these adverse reactions. The first step is not to underestimate the toxicity and disorders reported by the patient. Informing patients will then help them manage the situation better and ask for help in case of problems.”
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December 13, 2023 (changed December 13, 2023 | 09:20)
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