Interview Dr. Rabaça à Sapolilifestyle

About 50% of prostate cancer patients never talk or go several months without talking to their family about prostate cancer. We talked about this disease with the urologist Carlos Rabaça.

What is Prostate Cancer? And what is the impact of this disease in Portugal and in the world?

Prostate cancer is a malignant tumor of the prostate and is the third most common neoplasm in men and the second cause of death from cancer in men, being the main cause of years of life lost.

Despite being the 3rd leading cause of death from cancer in men, a survey recently carried out by the Portuguese Association of Urology (APU) and the Portuguese Association of Prostate Patients (APDP) showed that there is still a great lack of knowledge and literacy. Why does this happen?

The existing lack of knowledge is due, on the one hand, to the generalized lack of health literacy of our population, but also to an important lack of concern from the authorities in relation to this cancer. See, for example, the care given to screening for breast cancer or colorectal cancer, compared to the lack of a policy regarding prostate cancer.

The same survey concluded that about half of patients with prostate cancer never talk or go a long time without talking to their family about prostate cancer. What needs to be done to change this paradigm?

It is a widespread problem of cancer patients. There continues to be a sort of shame about having cancer and a preoccupation with hiding this disease. However, the progressive awareness that it is a disease that affects a large part of the population and is beginning to be considered a chronic disease that does not necessarily lead to death, has allowed the assumption of it and the discussion on the subject.

What are the main symptoms of prostate cancer?

Contrary to popular belief, prostate cancer rarely gives symptoms at an early stage. Those urinary symptoms typical of older men are the result of benign prostatic hyperplasia and not prostate cancer. In fact, the first symptoms of the disease are usually the pain resulting from bone metastases. At this stage, the disease has long since passed the healing stage.

How is the diagnosis made?

The diagnosis of the disease must be made a long time before it manifests itself, if we want to do it at a stage where it is curable. It is done through a prostate biopsy (conventional ultrasound-guided or fusion), after a change in the digital rectal examination, the PSA (tumor marker measured in the blood) or an imaging test (ultrasound or magnetic resonance imaging).

Is it possible to prevent prostate cancer?

There is currently no known way to prevent prostate cancer. Hence the need for early diagnosis, which is why we recommend carrying out a PSA (Prostate Specific Antigen) test and a digital rectal examination from the age of 40.

What treatments are available?

They depend on the stage at which the tumor is diagnosed. In an initial phase, when the cancer is located in the prostate, without metastases, the treatment can be done by radical prostatectomy (surgical removal of the prostate by open, laparoscopic or robotic approach, all three methods being similar in terms of oncological and in terms of complications, namely erectile dysfunction or incontinence), by external radiotherapy, or by prostatic brachytherapy (placement of radioactive seeds in the prostate). At the moment, we are starting to do focal treatment of prostate cancer, that is, treating only the affected part of the prostate and not the whole prostate, thus reducing side effects, using techniques such as cryosurgery, brachytherapy or HIFU.

In metastatic cancer, treatment is based on hormone therapy (chemical castration, as prostate cancer is hormone-dependent). In the last ten years, several highly effective drugs have appeared, such as chemotherapy, second-generation antiandrogens, radiopharmaceuticals or PARP inhibitors. These new drugs allowed a significant increase in the survival of these patients, helping to change the paradigm of prostate cancer from a deadly disease to a chronic disease.

The survey of patients with prostate cancer and their caregivers, developed by APDP and APU, was carried out as part of the awareness campaign #VamosTocarNesteAssunto. How did this campaign come about and what are its objectives?

The #VamosTocarNesteAssunto campaign aims to promote increased literacy in the area of prostate cancer and alert the population, and especially men, to the importance of early diagnosis and periodic examinations from the age of 45-50.



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