Prostate cancer is the most common malignancy and the second leading cause of cancer death in men, behind lung cancer. Its incidence varies by country and race in Spain 82,27 100.000 new cases per inhabitants / year, data from the National Registry of prostate cancer occur 2010.
But despite these figures, apparently alarming, it is a disease that today has no cure if diagnosed in the initial state (organ-confined). This cure is based on opportunistic early diagnosis in patients over 50 years, by performing 2 simple tests: digital rectal examination, looking indurated nodules or induration of the gland and determination in a simple blood test PSA level ( Prostate Specific Antigen). The high variability and low specificity of PSA makes sometimes exist elevated PSA levels without existing cancer, and prostatitis, prostatic infarct or bulky prostates as the PSA is a specific organ marker prostate, but not a marker specific cancer.
Therefore PSA and DRE asymptomatic patients should be offered 45-75 between years, provided they accept the "opportunistic screening" and the risk / benefit of it. In asymptomatic men over 75 years PSA testing has serious doubts, because the risks of biopsies and on treatment outweigh the benefits in terms of survival.
They are being sought more specific for prostate cancer as PCA3, proPSA or mutations in BRCA1, BRCA2 or HOXB13 marker genes.
In recent times, prostate cancer is undergoing continuous advances in both diagnosis and treatment. They are carried out protocols "active surveillance" based on images in certain patients with cancer without treating it. They are being made "focal treatments" only the cancerous areas of the prostate gland healthy respect; imaging techniques are used to locate, and view focalise extension of "significant" prostate cancer by diffusion or multiparametric MRI and being treated by laparoscopic surgery and robotics.
Today we still need prostate biopsy for diagnosis and Gleason grade. Perhaps soon imaging techniques avoid many biopsies to patients.
The systematic or massive PSA screening is not indicated by any urological scientific society (ACS, NCCN, AUA or EA). However, the "screening or opportunistic screening" indicated by physician, urologist or patient (family history) does seem to have accepted by all without any discrepancy, as long as the decision of screening and biopsy is informed and shared. It is not possible to prevent the occurrence of a cancer cure but if an early diagnosis is made.
Dr. Pedro Romero Pérez. Urologist Doctor of Medicine and Surgery Clinic Saint Charles Denia.