¿Merece la pena diagnosticar y tratar el cáncer de próstata?

Written by: Dr. Pablo Juárez del Dago Anaya
Edited by: Alicia Arévalo Bernal

The diagnosis of prostate cancer has been varying and not all health professionals agree with Screening for prostate cancer and PSA study. The doctor. Pablo Juárez del Dago Anaya, an expert in urology and awarded a scholarship from the Spanish Association of Urology to study in a foreign center, explains the different views on the diagnosis of prostate cancer.


Prostate cancer is the second leading cause of cancer death in man, more than two million men live with it in Europe, many of them unknowingly. Every year, more than 92,000 men die on the continent from this disease.

In the 1970s Dr. Richard J Ablin discovered the PSA (Prostate Specific Antigen) protein and established its relationship with prostate cancer.

In fact, PSA is not a specific marker of cancer, it is only a protein that serves to dissolve the seminal clot and is released by the prostate glands, so it can be seen increased in different situations (by a prostatitis, benign growth, after having sex, because yes ...) but also in the context of prostate cancer. The job of the doctor and especially of the urologist is to discern between the different causes of the increase of the PSA and to discard causes that endanger the life of the patients.

It is relevant to highlight the tendency in medicine that some studies advocate, many of them in prestigious urology journals where articles have recently been published that discourage the study of PSA in men, through the Screening technique, to find prostate cancer. The study argues that according to statistics the different treatments currently in use for radical prostatectomy and radiotherapy only slightly increase the patient's life span, which must cope with side effects to a greater or lesser extent (incontinence and / or erectile dysfunction).

The wide range of variables of this type of cancer makes it difficult to choose the optimal treatment for each case. 

This idea is not new. In 2011, the USPSTF (United States Preventive Service Task Force) issued a statement advising against prostate cancer screening and the PSA study .This document was issued by internists, pediatricians, family physicians, gynecologists and nurses without any urologist or oncologist as participant, who are currently the specialists responsible for the treatment of this pathology that they share.

As expected, the statement caused a stir in the health sector and in 2013 officially refuted it at the international meeting of the PCWC (Prostate Cancer World Congress Consensus States). At the congress, practitioners said that abandoning the PSA study would increase the number of advanced prostate cancers, pushing back three decades of research.

Recently, u ne of the most prestigious scientific journals in the world has returned to defend this idea with data , which despite not being false, can be misinterpreted. The return to this refusal to study the PSA is a concern for specialists, who fear that general practitioners, primary care and other professionals stop requesting it in the controls.

Prostate cancer is a very variable disease , there are very aggressive cancers that in a short time end with the lives of patients and others who are indolent and therefore live with the affected without this shortening their life.

It is true, and this is the basis of these "fashions", that in the past the fear of disease made it deal with it more radically, with more side effects and with the consequent worsening in the quality of life of patients .Today, technology and science have advanced towards a much more precise diagnosis and a more accurate prediction that allows to decide a personalized treatment for each patient. This "a la carte" medicine has much more quality treatments, more effective and more accurate, both in terms of radiotherapy and surgery, thanks to laparoscopy and robotics minimize side effects. We are already working on new techniques, each day with more force, like the focal therapies , that would reduce even more the side effects improving the life expectancy.

Treating this disease adequately improves the survival and quality of life of patients, a fact that is reflected in the data and medical experience. Instead, it is the responsibility of the patient to go to a good specialist, to be informed in different sources and to request second opinions if necessary, after all, is the main implicated. The wide range of variables that present this disease makes it difficult to choose the optimal treatment for each case, more or less invasive depending on the cancer.

Just as it is the responsibility of the patient to be treated by expert and experienced hands, it is the responsibility of the medical professionals to commit to training, investing in knowledge, adapting to technology and even recycling, in order to deal with a pathology as transcendental as prostate cancer, ensuring a treatment that ensures the best results from the health sector.

*Translated with Google translator. We apologize for any imperfection

By Dr. Pablo Juárez del Dago Anaya

*Translated with Google translator. We apologize for any imperfection

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