Prostate cancer differs in its behavior from other types of cancer because the rate of division of prostate cancer cells is usually slow/ShutterStock
Every year in Israel, about 2,500 new patients are diagnosed with prostate cancer, and this disease is the most common of all malignant diseases among Jewish men (over the age of 50) and the third most common among Arab men in Israel.
Prostate cancer is considered to be the second most common cause of cancer death among men in the Western world, with the disease causing the death of approximately 375,000 people worldwide each year.
The prostate gland is located at the base of the bladder and surrounds the urethra - the tube that carries urine from the bladder to the outside.
The role of this gland is to produce part of the seminal fluid and is essential for male fertility.
A cancerous tumor develops when one of the cells in the tissue does not stop multiplying.
Cancer cells divide repeatedly and form a cluster of cancer cells in one area.
The mass grows continuously and destroys the normal tissues bordering it.
Later, the cancer cells may spread outside the prostate, and this is how the metastases are formed.
Prostate cancer differs in its behavior from other types of cancer because the rate of division of prostate cancer cells is usually slow.
The causes of the disease are unknown, but old age (almost all men at the age of 90 will get this cancer), ethnicity and family history - increase the risk of disease.
Early stages of prostate cancer usually have no symptoms.
These appear only when the tumor grows and creates pressure on the urethral tube.
As a result, there may be symptoms such as difficulty urinating, increased frequency of urination, pain during urination or ejaculation and the presence of blood in the urine.
If the tumor has metastasized, there may be pain in the bones, lower back, pelvis or hips.
There are many treatment options for prostate cancer/ShutterStock
40% may develop a metastatic disease
The suspicion of prostate cancer morbidity rises when the doctor feels a lump during a physical examination that includes palpation of the gland (through the anus) or when there is an increase in the PSA level in the blood.
The PSA is a protein secreted by the prostate, and an increased level of it can indicate various diseases in the gland (including inflammation, benign enlargement of the prostate and also a malignant tumor).
If it is suspected that it is cancer of the prostate gland, a biopsy is done to confirm the diagnosis.
There are many treatment options for prostate cancer and the type of treatment is determined according to the stage of the disease, the patient's condition and wishes.
About 40% of patients treated for prostate cancer in the local stage (such as surgery and radiation), may develop a recurrence of the disease and the appearance of metastases.
"When prostate cancer is limited to the prostate itself, local treatment can be offered for the purpose of healing, through radical prostatectomy surgery or through external radiation in combination with hormonal therapy for six months to two years depending on the degree of risk of the tumor," explains Dr. Moran Gadot, a senior specialist physician in the unit for tumors of the urinary system and genitals at the Sheba Medical Center. "In the case of a metastatic disease, we offer castration hormone treatment, the purpose of which is to lower the level of testosterone in the body, this is in view of the fact that testosterone - the male sex hormone - is required by the cancer cells for proliferation, and in its absence, the disease will regress .
In most cases, we will combine additional hormonal drugs in order to extend the duration of the response to the treatment, and delay the time until the disease progresses.
In some cases, we will also combine chemotherapy treatment already in the early stages of the disease."
Are these lines of treatment likely to eradicate the disease?
"Unfortunately, in most cases, the cancer will at some stage develop resistance to the existing hormonal treatments, and then the disease is considered 'resistant to castration,'" explains Dr. Gadot .
"At this stage, we can offer the patient chemotherapy or treatment with radioactive isotopes. We will also add bone-supporting treatments, and spot radiation can also be offered to relieve pain caused by bone metastases."
In 2023, a comprehensive genomic test for patients with metastatic prostate cancer entered the health basket.
This is a molecular test that is performed on the tumor cells themselves, and locates various mutations in the tumor.
The main importance of the test is to identify mutations in the BRCA gene in the tumor.
"The BRCA1 and BRCA2 genes are genes whose role is to maintain the proper replication of our genetic material. When these genes are damaged, they allow mistakes that occur in the genetic material (mutations) in the cells to go unchecked," explains Dr. Gadot. "One in forty Ashkenazi men in Israel BRCA gene mutation carrier.
Mutations are also present in men (and women) of non-Ashkenazi origin but at a lower frequency.
Men carrying a mutation in the BRCA1 gene are at a 3.5 times increased risk of developing prostate cancer than the general population.
Men carrying a mutation in the BRCA2 gene are at an increased risk of up to 8.6 times of developing prostate cancer than the general population.
This cancer may also be more violent.
The identification of the mutations in this gene is particularly important as there are currently targeted treatments suitable for these patients.
Targeted treatments may be effective for prostate cancer patients who are carriers of the BRCA mutation (hereditary mutation), and also for those in whom the mutation exists only in the tumor itself, and not in the rest of the body's tissues (somatic mutation)," explains Dr. Gadot.
"Targeted treatments are currently being tested as part of clinical studies even in the earlier stages of the disease"/ShutterStock
To what extent is this good news for the patients?
"This is an additional and effective line of treatment that can postpone the period of time until the disease progresses and prolong life in patients whose disease is already resistant to hormonal treatment and chemotherapy," explains Dr. Gadot. .
In the event that a hereditary carrier is found, we will recommend genetic counseling and testing of family members (men and women) so that they can monitor and detect early prostate, breast and ovarian cancer.
" In the future, the prognosis of prostate cancer patients whose tumor expresses a BRCA mutation", concludes Dr. Gadot.
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