The most common cancer in men.
A man undergoing a medical examination (Photo: ShutterStock)
Prostate cancer is the most common cancer among men in Israel and each year in Israel over 2,000 people are diagnosed with the disease.
According to statistics, one out of 6-9 men will get prostate cancer during their lifetime.
Although it is accepted to treat it as a mild cancer (most cases are discovered in the early stages of the disease and the cure rates are high and exceed 90 percent) it is the second leading cause of death among all cancer cases in men.
"The prostate gland is a gland located at the base of the urinary bladder that actually wraps the tube that carries the urine out and is called the urethra. The role of the prostate is to produce part of the seminal fluid that is important, among other things, for sperm function," explains Dr. Yoram Dekal, director of the urology department at Carmel Hospital. Over the years, two main diseases may appear in the prostate: one is a benign enlargement of the prostate gland which is very common and causes urination disorders that are common in adults, and the other is a malignant tumor in the prostate.
It is important to clarify that there is no connection between the diseases."
In addition, the prostate also produces a protein called PSA, this protein is known as one of the tools for evaluating the condition of the disease after the diagnosis through a blood test.
"There are a variety of reasons why the level of PSA can be high in the blood," explains Dr. Dekel, "from a benign tumor through inflammation to prostate cancer.
That's why we use this protein as a "warning" marker that requires investigation or further treatment."
Risk Factors
"There are several risk factors for prostate cancer," says Dr. Dekel, "of course, being a man is a necessary condition.
In addition, this is a cancer of older age, and it is rare that a disease will develop in young people under the age of 50. In cases where there is a family history of prostate cancer from a first relative, there is an increased risk of morbidity, as well as carriers of a hereditary genetic mutation such as in the BRCA gene, which is more familiar to us than breast cancer - The risk of morbidity increases.
Lifestyle habits such as the lack of physical activity and the consumption of fatty food can be risk factors, but they are significantly less powerful."
According to Dr. Dekel, although the chances of recovery from prostate cancer are very high, in some men it can still cause serious illness and death.
"This is where the dilemma comes from regarding the method of treatment"
Surgery, radiation or follow-up
"In most cases, the cancer is located in the prostate and is without symptoms. In such cases, there are several types of treatment," explains Dr. Dekel. "The mild cases include only follow-up.
This is about active monitoring, the rationale being that this disease can be mild and develops very slowly, and since the treatment for prostate cancer involves side effects such as impaired sexual function and urination disorders, so in this situation we continue monitoring with a physical examination, blood test and repeated biopsies," he adds. If there is a change, then we change the strategy and start treatment."
"In addition to follow-up, there are several other treatments such as local treatment where we only treat the lesion we saw on the MRI; treatment for the entire prostate which can be surgical and includes resection of the prostate and radiation therapy to the prostate, where in some cases it is combined with hormonal treatment for a period of several months", Dr. Dekel explains. "In cases where the cancer has already metastasized, the treatment can be hormonal, chemotherapy and immunological, which can be combined with radiation therapy of one kind or another."
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Not every cancer leads to surgery.
Urologists in a surgical procedure (Photo: ShutterStock)
A prostate oncotype test is very helpful in choosing the treatment
The "Oncotype Prostate" test by the Oncotest company checks the expression of 17 genes in the tumor cell tissue removed in a biopsy.
The aforementioned test is performed on the biopsy that has already been taken and there is no need for any additional procedure.
The result obtained from the test determines how violent the tumor is, what is the chance of the cancer spreading in the next ten years, and what is the probability of dying from the cancer.
According to the results, the method of treatment can be determined.
"Broadly speaking, we divide prostate cancer according to the level of clinical risk," explains Dr. Dekel. "For patients from the low clinical risk group, we usually decide on active surveillance.
Patients from the medium risk group are a more heterogeneous group.
Among this group, sometimes we prefer treatment and sometimes we prefer follow-up.
At this intersection of the division into risk groups, we can use the genomic test."
"When we meet a patient and inform him that he has a malignant tumor on the one hand, but recommend only follow-up on the other hand, this causes a lot of confusion," says Dr. Dekel, "even if I am convinced that follow-up is necessary, I offer the patient a genomic test in order to increase his confidence in the path The chosen treatment," he adds. "In a moderate clinical risk level, the clinical indicators don't always help us.
And in this group, a prostate oncotype test also helps me as a therapist to decide whether it is right to offer the patient follow-up, or whether the patient needs treatment that includes the possible side effects because the risk is such that it justifies it."
"The decision was easier after the test"
One of the patients who underwent an "oncotype prostate" test after being diagnosed with the disease is Dr. Petar Yosifov. An orthopedic surgeon by profession, 60 years old, who lives in Kiryat, married and the father of three grown children. Yosifov discovered the disease last March randomly after his fever rose and the family doctor sent him For blood tests that also included diagnosing prostate cancer markers, the results clearly showed that he had the disease.
"After the results arrived, I began an investigation, including an MRI and a biopsy, and after that I came to Dr. Dekel, who recommended performing a prostate oncotype test because, according to the test, a more accurate decision can be made regarding continued treatment," says Petar, who, as mentioned, is a doctor in his profession and understands the importance of the in-depth investigation. "According to the result of the test, we decided that it would be better to do a radical prostatectomy, because the chance of finding an aggressive tumor was high.
After I received results from the biopsy of the surgery to remove the entire tumor and the prostate, which was conducted only about two weeks ago, we saw that the situation was even more serious and the prostate oncotype test correctly predicted the prostate situation."
In a few weeks, Peter will undergo another blood test that should determine if there are any more cancer cells. Although at the end Of having to undergo treatment, Peter insists on emphasizing the importance of the test "The decision to have surgery was easier for me when I received more information and I knew that the surgery was necessary and I am not doing it in vain."
"I was ashamed to go to the family doctor"
Michael (pseudonym), 65 years old and father of three, also discovered that he was ill last March.
This was after he said he had been carrying urination problems for many years, but was ashamed to address them.
"Like most men, I was ashamed and didn't say anything, and only after years did I go to a family doctor who was angry with me for arriving only now," he recalled.
"I did a PSA test, an MRI and a biopsy - and according to the Gleason index the results were not high, so the doctors weren't excited and neither was the oncologist," he recalls, "they actually told me that I could live with the tumor without problems. But Michael asked to do an "oncotype prostate" test which showed that there is close to 50 percent aggressiveness of the tumor and the indicators were a little closer to the middle and that is what stressed the doctors
.
I recommend the test because it gives information.
It actually gives the most up-to-date and true picture of the situation."
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cancer
prostate cancer