fault of aging, but not only – breaking latest news

One in eight men in Italy will come to terms with a diagnosis of prostate cancer, the most frequent type of cancer among males and whose cases in our country have been on the increase for years. On the one hand why the number of elderly people is growing and this neoplasm (like all, after all) in the vast majority of cases affects men over 65 years old. On the other hand because those are more and more widespread incorrect lifestyles, starting from overweight and poor diet, which increase the risk of getting sick, even before the age of 50. Finally, it must be considered that, by submitting to regular checkups especially with the PSA test, a greater number of men discover the presence of a mildly aggressive tumor, in the early stages, before it causes symptoms. The specialists of the Italian Association of Medical Oncology (Aiom) discussed it, meeting in Bari in recent days for the national conference «News in GU Oncology» dedicated to genitourinary neoplasms and the medical-scientific innovations emerging from the American congress «Asco Genitourinary Cancer (GU) Symposium».

Who risks the most

«In 2022, there were 40,500 new cases of prostate cancer recorded in Italy, up from 34,800 in 2017: therefore there was a 16% increase in just five years — he says Saverio Cinieri, national president Aiom -. The causes can be various, starting with the continuous general aging of the population. It is also essential that men, of all ages, undertake to limit the known risk factors for this and many other types of cancer: from bad eating habits, to the consequent overweight, to a sedentary lifestyle. A recent American research reiterated it: with a diet rich in vegetables and fruits the risk of tumor progression and relapses also decreases for those who already fall into the category of patients. For the healthy to rise the chances of getting sick are above all a high protein content in the diet and metabolic syndromea disease characterized by an increase in the circumference of the abdomen, arterial hypertension, hypertriglyceridemia, reduced levels of “good” HDL cholesterol and an increase in fasting blood sugar. If you have even three out of five of these characteristics, you have metabolic syndrome and the risk of cancer rises because a favorable microenvironment is created for cancer cells to develop and multiply».

Those who are familiar with this pathology are then more at risk not only of getting sick, but also of having it a more aggressive neoplasm and at an earlier age: i.e. men with first-degree relatives (father and brothers) with prostate cancer, especially if it occurs under the age of 55. Or those who have family members with hereditary breast and/or ovarian cancer (due to the BRCA genes).

The PSA test

The growth of cases can also be partly attributed to the widespread use of the PSA test which is carried out through a normal blood sample and measures the prostate specific antigen. AND a useful tool for the early diagnosis of prostate cancer: can help detect early-stage disease, when it is easier to treat e it can be cured permanently. Today, however, it is also certain that it can lead to many cases of over-diagnosis and over-treatment because they are also identified so-called “indolent” tumorswhich are not clinically significant (in practice they may never have any consequences for men’s health), with the risk of a consequent over-treatment (ie the adoption of inappropriate therapies which involve unnecessary costs for the health system and, in terms of side effects, also for the patients).

Today, according to experts, PSA is useful and should be recommended for men who have prostatic symptomsi.e. urinary problems, from 50 years old and those who have familiarity they should start between the ages of 40 and 45. However, explaining well what are the advantages and limitations of the method and what might be necessary to carry out if this examination is not within the normal limits.

The therapies

When prostate cancer is diagnosed, there are many therapies available today: in the initial stages surgery, radiotherapy and brachytherapy they have proved to be able to offer very good results, in terms of both healing and long-survival. They are valid and stackable options especially for those forms at low and intermediate risk of progression (that is, in practice, with little probability of evolving and giving metastases), which are the majority. Active surveillance, which consists of periodic tests and checks, is also offered to people with a small and minimally aggressive carcinoma.

“In cases of advanced or metastatic cancer, it is then possible to proceed with various drugs that are prescribed on the basis of the characteristics of the individual patient – he explains Marcello Tucci, director of Oncology at the Cardinal Massaia Hospital in Asti —. We have both hormone therapy and various other treatments that are effective in prolonging survival, even by years, with a good quality of life. The scientific evidence presented at the ASCO GU in San Francisco opens up interesting news on theuse of hormonal therapies for both hormone-sensitive and castration-resistant disease. We are “refining” the treatments that can be used, always with a view to greater personalization of treatments. It is a trend that has been going on for at least 20 years and has allowed us to arrive at over 90% five-year survival after diagnosis».

Symptoms

Difficulty starting urination, weak urine stream, incomplete emptying of the bladder, frequent urination, urgency to empty the bladder and presence of nocturnal urinations: these are the symptoms (very common in males over 50 because they are also typical of benign prostatic hypertrophy) which are not to be underestimated and ignored. Just talk to your family doctor who will assess whether a visit to the urologist specialist is necessary.

«Identifying a tumor in the early stages means having more likely to fight it decisively and with less invasive treatments — remember Camillo Porta, Professor of Medical Oncology at the Aldo Moro University of Bari and director of the Medical Oncology Division of the Bari Polyclinic —. While the search for new therapies that offer useful solutions in those cases of metastatic neoplasms for which we currently have no effective solutions continues, new and interesting confirmations on themultimodal artificial intelligence and data from a recently published study on the Journal of Clinical Oncology. These new technologies are used to develop biomarkers that can give us more detailed prognostic information and also a series of predictive parameters on the possible responses to some treatments.

“In other words, we can favor personalized oncological medicine and predict whether some targeted therapies are effective, or not, on the individual case. The American one is a feasibility study, a randomized phase 3 trial involving over a thousand men with high-risk localized prostate cancer. The first data that emerged are very interesting, but will need to be confirmed by involving other groups of patients. However, biomarkers, created thanks to artificial intelligence, are not yet usable in daily clinical practice (in Europe and the USA). However, they represent a future prospect with great potential and research must continue», concludes Porta.