In Italy in 2020 about 36 thousand new cases of prostate cancer were diagnosed and in 2021 an estimated 7,200 deaths from prostate cancer were compared to 564 thousand patients with prostate cancer. As regards testicular cancer, however, 2,300 new diagnoses were estimated in 2020. The Romagna Cancer Registry has been active in Romagna since 1985, thanks to the commitment of the Oncological Institute of Romagna (IOR) and, from the published data, as regards prostate cancer, there are about 800 new cases per year, while for testicular cancer, a relatively rare neoplasm, the incidence, ie the number of new cases of testicular cancer per year, is about 4-5 new cases per 100,000 inhabitants. Roberta Gunellihead of the Urology Operating Unit of the “Morgagni-Pierantoni” hospital in Forlì and president of the Italian Urologists Association (Auro), explains to ForlìToday how regular checks of the urogenital and reproductive system are important from a young age to avoid consequences more severe as adults.
Dr. Gunelli, do men care too little about their health, going so far as to speak to a doctor when the problem is already in an advanced stage?
The answer is yes with regards to the reduced attention men pay to their health. However, I must make a clarification.
Nail…
The new generations are more attentive to their state of health and physical fitness so it is easier to be listened to by young people when a correct lifestyle and greater attention to their health is suggested, thus preventing the onset of diseases or at least by making the diagnosis earlier, avoiding finding diseases at such an advanced stage that effective treatment is impossible.
Are urological disorders on the rise? If so, for what reason?
Urological pathologies are constantly growing and one of the important reasons is certainly linked to the aging of the population. Neoplastic pathologies, in particular renal neoplasms, are on the rise, but also in the context of non-neoplastic pathologies, a progressive increase in frequency has been observed for 20 years to date. In particular I would like to pay attention to kidney stones, male infertility and erectile dysfunction, underlining how these problems often have a common origin in food problems, being more frequent in overweight patients.
Among the main causes of infertility?
An important place is taken by the consumption of alcohol and drugs, as well as cigarette smoking which can cause a reduction in the number of spermatozoa by up to 20% and we cannot overlook the important negative effects of pollution.
What about the rise in erectile dysfunction cases?
It should be noted that it is becoming a problem even for the youngest and that in this category an element of risk is that of the habit of drinking alcoholic beverages. Unfortunately, there is no knowledge of the fact that alcohol, often taken with the intent of disinhibition, is instead deleterious for the sexual sphere and for fertility, interfering in a negative sense with the normal hormonal balance.
What are the most frequent pathologies related to the urinary tract?
It is necessary to refer to the various age groups and there are obviously pathologies related to gender. Among men in adulthood, urination disorders are mainly related to obstruction caused by the prostate, although it is not fair to generalize as there may be disorders, such as “urgent” and frequent urination which may be due to an altered activity of the bladder musculature. In young males, voiding problems are instead more frequently linked to prostatic inflammatory phenomena. In women, infections of the lower urinary tract are relatively easy, cystitis, which can sometimes recur frequently, creating severe discomfort and the need to be carefully prevented. With regard to neoplastic pathologies, an increase in new cases has been recorded and, while for renal and bladder neoplasms the incidence is higher in men than in women, unfortunately prostate neoplasia is the master in men being the first cause of neoplasia in males (18.5% of all neoplasms), while for bladder neoplasms the incidence is increasing in females due to the increase in cigarette smoking. A constant presence is then that of kidney stones which, if neglected, can lead to a reduction in renal function.
What are the symptoms that need a specialist visit?
A symptom that should never be overlooked is that of the relief of blood in the urine, called hematuria in medical terms, in this case it is advisable to contact the family doctor who will be able to assess the need for a specialist urological visit in case there is a suspicion of neoplasm. bladder. Another symptom to investigate is the reduction in the strength of the urine flow during urination or the difficulty in starting the urination itself, this problem is more often male and it is necessary to look for the cause by recognizing the obstruction that could be due to the enlargement of the prostate or to a significant reduction in the caliber of the urethra, as the tube that connects the bladder to the outside is called. Sometimes, however, the absence of symptoms does not equate to the absence of disease, for example in the initial phase prostate cancer is asymptomatic and only with the progression of the disease some symptoms appear such as a decrease in the power of the urinary jet, pollakiuria (increase in frequency of urination), hematuria, dysuria and, in the most advanced stages of the disease, since the skeleton is the first site of metastasis, the development of bone pain is characteristic, mainly localized in the spine.
Prevention is essential since adolescence. Is this often a taboo subject that needs to be addressed in schools, for example?
It is essential to prevent disease, when possible, and in adolescence it is important to involve boys and girls by giving indications on the correct lifestyle and, in particular for boys, to make their bodies better known to recognize the onset of nodules, usually not painful, in the testicles. This moment of meeting finds its ideal location in the school environment, already in the past the Urology Unit of Forlì, in collaboration with the Youth Consultancy and the Education Department, has carried out an information and targeted visits to the recognition of andrological pathologies at the institutes of secondary schools in Forlì, unfortunately the sad period Covid temporarily interrupted this activity which we hope to be able to resume as soon as possible.
Speaking of testicular tumors, we talk about self-examination of the organs to discover and treat the tumor in time. How does it work?
As I said, it is necessary to teach boys the easy technique of self-examination of the testicles to be able to recognize a change in their shape and consistency, just as girls learn breast self-examination. Only in this way is it possible to make an effective early diagnosis and if there should be a doubt on palpation, the boys will have to contact the family doctor and the urologist specialist to rule out the presence of a testicular neoplasm in the initial phase and therefore radically treatable. Also important is an evaluation of the scrotum and testicles by the specialist to rule out the presence of varicocele, an abnormal dilation of the veins starting from the testicle, which can be a cause of reduced fertility in adulthood.
Another tumor that scares man is that of the prostate. Does a correct lifestyle help survival?
Eating healthy, maintaining the right body weight, exercising regularly and moderating the consumption of alcoholic beverages can reduce the risk of getting cancer by up to 30% and these general rules naturally also apply to urological neoplasms (prostate, kidney and bladder) and in particular for bladder cancer, cigarette smoking is an important risk factor, without forgetting the severe risk also linked to passive smoking.
What are the therapies and how are they evolving?
For testicular cancer, recognized at an early stage, surgical therapy is often decisive and the histological examination and the progress of specific laboratory tests, the so-called tumor markers, guide us for any therapies to be associated with the surgical one. In the case of prostate cancer, the last few years have been important for the emergence of new surgical techniques, such as laparoscopy and the robotic technique that we have had the opportunity to use since 2007 when the da Vinci robotic system was acquired. Thanks to these new minimally invasive surgical techniques, now entered into our surgical routine, we can obtain an optimal oncological result associated with a faster recovery in the postoperative period, reducing the most feared complications, such as urinary incontinence and erectile dysfunction.
At the pharmaceutical level?
In the oncology field, important antiandrogenic and chemotherapeutic drugs have been proposed, evolving the classic hormone-suppressive therapies, going alongside the proposals of radiotherapy and radiometabolic therapy. Currently, the most complex patients have the opportunity to be evaluated by the uroncological multidisciplinary group (Tmd) in which Urologists, Oncologists, Radiotherapists and Anatomopathologists participate. The Tmd combines the activities of the Ausl Romagna with that of the Irst of Meldola to give patients all the competence and therapeutic possibilities available in accordance with the main national and international guidelines. However, I would like to mention what is truly the most innovative part.
What is it about?
I am referring to active surveillance. This proposal consists, after a positive prostate biopsy for a low-grade and therefore non-aggressive carcinoma, in putting patients under careful and regular surveillance without undergoing invasive, surgical or oncological therapies. In this way, patients can continue their lives and only in the event of a progression of the disease will they be directed to active therapy. To conclude, I would like to emphasize one aspect once again.
Of course…
Respecting one’s body, through a correct lifestyle, is the best way to take care of one’s health and that recognizing the most important urological diseases early, thanks to the most current laboratory and radiological investigation methods, is often possible, but even more so. the relationship between patient and doctor is important, allowing you to personalize an effective diagnosis process and allow the patient to make conscious and therefore serene therapeutic choices.