Prostate cancer

Where is the prostate?

The prostate is located in the lower part of the male abdomen, below the bladder and in front of the rectum.

What is the prostate for?

The prostate produces and stores part of the seminal fluid, which together with the sperm make up the semen.

Does the prostate exam hurt?

The rectal touch examination causes mild discomfort, but only takes about 5 seconds. With the touch, the doctor feels the prostate and can analyze abnormalities. It’s an exam that can evaluate a man’s health and diagnose cancer early.

Does surgery for the removal of this cancer cause impotence?

“The prostate is a small gland located between the bladder and the penis and is responsible for producing a lubricating and nutrient-rich fluid for the sperm. It is surrounded by a capsule, through which pass small nerves responsible for penile erection. Cancer is a neoplasm that develops from prostatic cells. When it is still confined to the gland, it may require treatment with radiotherapy, hormone therapy, or surgery. And what allows the medical team to define the best therapeutic strategy among these modalities are individual factors such as age, clinical conditions, PSA level, size, and degree of aggressiveness of the tumor.

In cases where surgical treatment is recommended, it is not possible to remove only the part of the prostate affected by the tumor. It is necessary to remove the entire prostate, carefully dissecting its capsule, in a surgery called radical prostatectomy. Performing a prostatectomy requires great skill. The surgeon’s objective is to remove all the glandular tissue and with it cancer. At the same time, it is necessary to preserve part of the capsule, where the nerves that participate in erection are located, which, if damaged, could lose their function. In simplified terms, it is like removing the pulp from a lemon, leaving its peel intact.

Sometimes, the procedure becomes technically difficult, either due to the patient’s own anatomical characteristics or to the degree of invasion of the tumor, which may be affecting the capsular region. In certain cases, the removal of the prostate is conditioned to the lesion of the nerves, and the urologist has no choice. Invariably, in the search for a cure, a considerable portion of these patients may become impotent.

The good news is that, in most cases, this does not happen. It is natural that in the first days to months after the surgery, erectile dysfunction appears, but this is due to inflammation of the nerves by surgical manipulation. However, with time, and with the help of physiotherapy and modern medicines, the results progressively improve. Technology has provided tremendous advances in medicine and prostatectomies are becoming safer and safer. In experienced hands, the chances of serious adverse events are minimized, and the patient is almost always able to maintain a good quality of life and remain sexually active.”

Is the PSA test alone sufficient for diagnosis?

“Prostate Specific Antigen (PSA) is a protein produced and secreted by prostate cells. Under normal conditions, this value is low in the blood. However, in the case of prostate changes, it can rise to alarming levels. Besides cancer, several other benign conditions promote an increase in the PSA, among them: trauma, prostatitis (infections) and, more commonly, benign prostatic hyperplasia, which consists of the natural growth of the gland with advancing age. Therefore, differentiating these situations is practically impossible with just the PSA blood test.

In addition to a comprehensive conversation with the doctor and the PSA test, the patient should also undergo a clinical examination, which consists of the rectal examination. Through these three elements, the examiner is able to compose a more precise diagnostic hypothesis and recommend additional tests to confirm it.

Even with a compatible clinical history, an elevated PSA, and a rectal examination suspicious for prostate cancer, a confirmatory biopsy is usually necessary. This is a relatively simple procedure, which is done under ultrasound guidance. Besides confirming the diagnosis, the biopsy also provides an idea of the degree of prostate involvement and the aggressiveness characteristics of the disease. With this information, it becomes possible to draw up the ideal therapeutic plan for each individual.”

Does ethnicity/skin color influence the risk of prostate cancer?

Prostate cancer rates in men do vary according to race and ethnicity. In the United States, for example, in 2011, black men had the highest incidence of the disease, followed by whites, Hispanics, Asians, and American Indians, respectively. The reasons for these differences are unknown, although recent studies suggest that some genetic mutations more present in blacks predispose them to it. This is still a territory of many uncertainties and little explored. The real justification for this disparity requires further study.