Fear of sexual dysfunction and urinary incontinence weigh on prevention. New surgical techniques reduce the chance that sexual function will be affected.
“Men, take care of your health, check your prostate.” This is the unanimous appeal made by urologists and patients to the male population over 50 years of age (before, for those with a history) and which is also extended to the health authorities: start up “now” the screening for cancer of the prostate. And it is that this is the most frequent tumor in men (20,000 new cases per year) and the third cause of death from cancer in men, behind lung and colon cancer (6,000 deaths). It is estimated that one in five men will be diagnosed with this disease.
Most cases appear around the age of 65, but the prognosis is good if detected in the early stages. The problem is that many men are reluctant to go to the family doctor or urologist to request a PSA (prostate specific antigen) test, some markers that are determined with a blood test. “There is a lot of fear, a fear linked to the disease, of course; but also to other issues that have to do with masculinity. It is time to speak publicly about all this,” says Carlos Albero, secretary of the National Association of Prostate Cancer Patients (Ancap).
The masculinity? Yes, because one of the ballasts in combating this disease is that many men inevitably associate prostate cancer with sexual dysfunction and urinary incontinence. They also feel rejection of the digital rectal examination (which is not always done) and which has given rise to so many “macho” jokes, says Albero (“I hope the doctor has fine fingers” or “let’s see if I’m going to like it” ). Hence, he indicates, the silence that has surrounded this disease, already silent in itself.
To this must be added the “masculine personality”, explains Estefanía Linares, from the urology service of the La Paz hospital in Madrid. The man has more qualms about talking about his health, he goes to the doctor less and goes mainly when he is ill. And even though he has symptoms, he avoids telling his friends, let alone symptoms such as those that affect the prostate. Also, medical check-ups are not part of his schedule.
“It was not my case,” explains Albero, who was diagnosed with prostate cancer two years ago. I had been having check-ups for a long time (it started at 47 because his father had benign hyperplasia) and when the PSA markers increased, they did the pertinent tests (there was no digital rectal examination) that confirmed the tumor (I was 55 years old). ). I had no qualms about telling it, not at all. And all of a sudden, co-workers I was rubbing shoulders with told me they were too. And no one knew anything!”
A completely different situation from that experienced by women with gynecological tumors. “You cannot make any kind of simile, at least for the moment. Women have been hearing for decades that they have to have check-ups, there are screenings, campaigns and, above all, a lot of communication between them. They have it completely normalized. That female social network, telling each other how they are, their fears, how they are, helps a lot”, explains Dr. Linares.
But is it true that having prostate cancer is accompanied by urinary incontinence or sexual dysfunction, the main questions that men ask the urologist? Not always, far from it. First, it must be explained that as men age, the prostate can enlarge and block the urethra or bladder, causing difficulty urinating (decreased caliber or interruption of the urine stream; increased frequency of urination, especially night; difficulty urinating or itching) or problems with sexual function. This problem is known as benign prostatic hyperplasia and can be treated with drugs or require surgery to correct it, according to the Spanish Society of Medical Oncology (Seom).
The symptoms of benign prostatic hyperplasia or other problems that affect the gland can be similar to the symptoms of prostate cancer. However, in most cases in which the tumor is diagnosed at an early stage, patients are usually asymptomatic.
When the tumors grow they can produce urinary symptoms such as those of benign prostatic hyperplasia and other less frequent ones such as the presence of blood in the urine, in the semen or sexual impotence.
And when the prostate is removed? “When the prostate was removed by surgery, it was very difficult to preserve the nerves and there were sequelae. But that has changed a lot thanks to laparoscopy and robotics. And, also, to pharmacological treatments (among them, Viagra)”, points out the urologist.
Ancap was born precisely to speak publicly and “normally about the effects caused by its treatment, that is, active surveillance, surgery, radiotherapy and hormone therapy that frequently lead to urinary incontinence, erectile dysfunction and urinary fistulas, as well as anxiety symptoms -reactive depression and loss of self-esteem ”, they point out from the association.
The secretary of the Spanish Association of Urology, Mario Álvarez, believes, however, that the silence that accompanies this disease is changing. “More and more men over the age of 50 go to the family doctor or urologist to have their prostate checked. Middle-aged men are increasingly aware and go to the doctor to consult and request the PSA, which allows early diagnosis and reduces mortality. This is not the case with the older ones, who often come with an advanced, metastatic tumor ”. It has also helped a lot, says Álvarez, that many companies have included the PSA in the blood tests of their workers.
But what is PSA? A substance produced exclusively by the cells that make up the prostate. In general, the higher the PSA value, the greater the chance of prostate cancer. However, it must be borne in mind that PSA levels can also rise with age, in benign prostatic hyperplasia, with infection or inflammation of the prostate, or trauma to the area. “It is a very valuable instrument, which must be extended to the entire population over 50 years of age. Its cost is minimal and it saves lives”, says Linares. Celeste Lopez
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