The test to assess the health of the male gland has been under discussion for many years. Its indiscriminate use has resulted in unnecessary treatments, but now scientific societies have found an agreement on its more appropriate use.
After years of discussions and the collection of a huge amount of data, the scientific community has found an agreement on the Psa test as a preventive tool for the early diagnosis of prostate cancer: the test is useful and should be recommended to men starting from 50 years, but it is essential that its execution is prescribed by doctors following precise guidelines for two reasons. First, because if anomalies emerge in the report, these must be interpreted well by the urologist who must explain them to the patient and there is a new procedure of examinations to be followed in order to reduce the number of useless biopsies. Second, because even when it comes to ascertaining the presence of a neoplasm it is not said that it should be treated and if the disease is not dangerous it is useful to promote the use of active surveillance.
When tumors are clinically insignificant
How did this decision come about? Important international studies involved hundreds of thousands of men in Europe and the United States and their outcomes were compared with statistics relating to newly diagnosed cases and mortality from prostate cancer over the past 20 years. The heart of the problem is avoiding both the risk of diagnosis and treatments in access, and of arriving late to the discovery of the tumor, compromising the chances of recovery – explains Alberto Lapini, president of the Italian Society of Oncological Urology (Siuro) and head of the Prostate Cancer Unit to the Careggi University Hospital of Florence -. Since the 1990s, the widespread use of the PSA test and the increase in the number of biopsies have led to an increase in diagnoses of prostate cancer, in particular of limited forms with a low risk of progression where the treatment could create more problems (incontinence and erectile dysfunction) what benefits. In fact, scientific research has confirmed that a large number of prostatic neoplasia are clinically insignificant: that is, they are indolent, small, non-aggressive tumors that do not affect the patient’s life. So in 2008 the experts of the American Task Force ruled against the use of PSA, but this led to a drastic drop in the execution of the test and, consequently, led to a significant increase in locally advanced or metastatic cases at diagnosis.
Evaluation of the Psa-density
It could be said that, based on the best scientific knowledge gathered over the years, we have now finally found the right middle ground – continues Lapini – and the European Urology Association (Eau) has set up an early diagnosis program for prostate cancer that allows a balance between doing nothing or doing too much. It is an innovative project (proposed to the European Commission as part of the plan to beat cancer 2021-2027) that has been married and is being carried out by all the Italian scientific societies dealing with urology. In practice, an algorithm has been developed that provides for a “rational” use of the PSA, which takes into account different age groups and men’s risk factors. And, when necessary, after the visit with rectal exploration and in the presence of a suspected Psa, it provides for the evaluation of the Psa-density and multiparametric magnetic resonance imaging of the prostate as subsequent diagnostic steps, before arriving at a biopsy. The density of the Psa relates the value of the Psa to the prostate volume: larger prostates are expected to produce greater (and therefore higher levels) of Psa. Furthermore, multiparametric resonance analyzes three parameters (density, diffusion and vascularization) and highlights the morphology of the prostate gland and surrounding structures and at the same time detects areas with particular characteristics, different in healthy and tumor tissue.
What the PSA reports
All men must be well aware that elevated values in the Psa result (the blood test that measures prostate specific antigen) prove the presence of a prostate gland disorder: it can be inflammation (prostatitis), an increase volume (hypertrophy), an infection or a tumor. For this reason, before getting alarmed and deciding on any intervention, it is necessary to carefully evaluate the results and proceed, if necessary, with other investigations, explains Giario Conti, head of urology at the S. Anna Hospital in Como and secretary of SIUrO. And even when the process leads to a diagnosis of cancer, it must be borne in mind that up to about 40 percent of prostate cancer cases correspond to potentially insignificant tumors. Therefore, instead of treating them and exposing the person to the unwanted consequences that traditional treatments (surgery, radiotherapy and brachytherapy) can have, they should only be kept under observation. Safe and effective “active surveillance” – concludes Conti -. The assumption on which this strategy is based is that the evolution of low-risk tumors is so slow (and only local, without metastases) that treatment can be avoided or postponed and at the same time maintained the curability window. If the pathology changes, we are able to interrupt the observational path, intervene promptly and direct the patient to treatment.
After the age of 50 periodic visits to the urologist
With about 36 thousand new cases diagnosed in 2020 in Italy, prostate cancer is the most frequent cancer among Italian males. Fortunately, more than 90 percent of patients are still alive 10 years after diagnosis: an important milestone, especially if we consider that a form of cancer typical of old age and that most patients are over 70 years old. and to the progress of research, the prostate cancer of neoplasms which, in the last five years (2015-2020), has recorded the greatest decline in mortality (-15.6%) Visit the urologist once a year, starting at the age of 50 (or 40 if you have several cases of cancer in your family) a simple and very effective way to stay healthy and to find out in time, when they are easier to treat, any problems. prostate cancer at onset (these are signs that accompany benign prostatic hypertrophy and therefore should not alarm), we must not ignore the appearance of various urinary problems such as: blood in the urine, burning, difficulty in starting the min urinary flow, high frequency of urination, urgency to empty the bladder and presence of nocturnal urination. Just talk to your doctor who will decide if and which tests to prescribe.
July 15, 2021 (change July 15, 2021 | 18:50)
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