Everything you need to know about prostate cancer risks and its non-invasive assessment.

Prostate cancer is the second most common cancer among men. However, despite being a frequent type, it is also the most difficult to be approached, often limiting early diagnosis and care.  

First of all, what is the prostate? 

The prostate is an exocrine gland present only in men and is located below the bladder, with the urethra passing through it and in front of the rectum. It is surrounded by a fibromuscular capsule and contains glandular and connective tissue. 

The prostate glands produce fluid that is part of the semen, the substance that is released during ejaculation as part of the male sexual response. 

During men’s aging, the prostate is subject to two conditions:  

1. benign increase (BPH – benign prostatic hyperplasia); 
2. prostate cancer, justifying the higher prevalence of prostate cancer in elderly individuals.  

In this context, it is unquestionable that constant vigilance in men’s health plays a key role in men’s life expectancy. 

What is Prostate Cancer?       

Prostate cancer is a malignant tumor that affects the prostate.      

It stands out as the second most common type of cancer among men, representing a real global health problem.  

     According to the World Health Organization (WHO), 1,414.25 new cases of the disease were registered in 2020, reaching about 3.8% (375,304) of mortality cases among male cancers.  

What are the types of prostate cancer?       

Most prostate cancers are of the adenocarcinoma type (cancer that originates in glandular tissues, formed by cells with the ability to secrete substances to the body) being developed from the cells of the gland (cells that produce prostate fluid which is added to the semen).  

Other types of cancer can start in the prostate, but they are rare, such as the following: 

• Small-cell carcinomas 

• Neuroendocrine tumors  
• Transitional cell carcinomas 
• Sarcomas 

Some prostate cancers are fast-growing, but most of them are slow-growing.  

Necropsy studies revealed that many older men (and even some younger men) who died of other diseases also had undiagnosed prostate cancer.  

Some studies suggest that prostate cancer can start with a precancerous condition; however, there are still no clear explanations for this. These conditions are found, in some cases, when the patient undergoes a prostate biopsy.   

Prostatic intraepithelial neoplasia:  

It can be found in some men in their 20s.  

In this condition, it show changes in the prostate cells when viewed by a microscope, but the abnormal cells do not appear to be growing in other parts of the prostate (as would occur with cancer cells).       

Based on the abnormal appearance of the cell patterns, they can be classified as: 

• Low-grade prostatic intraepithelial neoplasia: patterns of prostate cells appear almost normal. This condition is not believed to be associated with prostate cancer. 
• High-grade prostatic intraepithelial neoplasia: cell patterns appear more abnormal. This condition is believed to be a possible precursor to prostate cancer, being an indicator of increased risk for the development of prostate cancer.   

However, it is worth mentioning that many men with PIN (Prostatic intraepithelial neoplasia) may never develop prostate cancer. 

Proliferative inflammatory atrophy:  

In this condition, prostate cells seem smaller than normal, and there are signs of inflammation in the area. However, the condition is not cancer, but some researchers believe that, in some cases, it can lead to high-grade prostatic intraepithelial neoplasia, or perhaps directly to prostate cancer. 

What are the causes and risk factors that can develop Prostate Cancer?      

Necropsy studies have shown that 1 in 3 men over the age of 50 have cancer cells in the prostate, with 80% of these cancers detected at necropsy being small, with tumors that are not harmful (benign). 

Even though there is no known reason for prostate cancer, there are many associated risks:  

• Age – During men’s aging, the prostate is subject to two conditions: benign enlargement (BPH – benign prostatic hyperplasia) and prostate cancer. 
• Ethnicity – It is estimated that African American men have the highest incidence of the disease, with 1 in 6 men, also presenting a higher risk of fast-growing aggressive tumors. Other ethnicities, such as Hispanics and Asians, are less likely to develop prostate cancer. 
• Family history – Men with a family history of prostate cancer are 2 to 3 times more likely to have prostate cancer. This risk increases according to the number of relatives diagnosed with prostate cancer.  
• Smoking  – The risk of prostate cancer can double for smokers. Smoking is also associated with an increase in mortality from prostate cancer. However, in 10 years after quitting smoking, the risk of prostate cancer decreases, reaching the risk for a nonsmoker of the same age. 
• Diet – Although the mechanism by which the diet contributes to affect the risk of prostate cancer is not clear, there is a likelihood that the risk will increase in the case of high consumption of calories, animal fats, refined sugar and low consumption of fruits and vegetables. Obesity is also associated with higher mortality from prostate cancer.  

How to prevent prostate cancer?      

There is no way to prevent prostate cancer, since risk factors such as age, ethnicity and family history cannot be controlled.  However, there are measures that can be taken to decrease the risk of developing prostate cancer.  

Weight, food and physical activity:  

The mechanisms of dietary contribution to the risk of prostate cancer are not well understood. Some studies suggest an increased risk of prostate cancer in men with diets rich in dairy products, calcium and high consumption of calories, animal fats, refined sugar and low consumption of fruits and vegetables. Obesity is also associated with higher mortality from prostate cancer.  

Thus, it is suggested that the individual remains physically active, with a healthy diet, including a variety of fruits and vegetables and that he avoids the consumption of red and processed meats, drinks sweetened with sugar and highly processed foods. 

While not all studies agree, several have found an increased risk of prostate cancer in men whose diets are high in dairy products and calcium. 

Vitamins, minerals and supplements:  

Vitamin E and Selenium: Some initial studies have suggested that consumption of these supplements may contribute to reducing the risk of developing prostate cancer. However, the results are conflicting. A large study entitled Selenium and Vitamin E Cancer Prevention Trial (SELECT) demonstrated that selenium and vitamin E were not associated with reduced risk of prostate cancer, even using vitamin E supplements associated with a slightly increased risk for the development of prostate cancer. 

Soy and isoflavones: Initial studies suggest that soy proteins (known as isoflavones) have benefits in reducing the risk of prostate cancer. However, further studies are needed to show the correct relationship.  

Some drugs can also contribute to reducing the risk of developing prostate cancer. However, any drug or supplement can present risks and benefits, and should be guided and prescribed by the treating physician or specialist.  

What are the symptoms of those with Prostate Cancer?  

In its initial phase, prostate cancer has a silent evolution and often patients do not have any symptoms or, when they do, they are symptoms related to benign prostatic hyperplasia, such as: 

• Difficulty urinating; 

• Increased urinary frequency. 

In the advanced stage of the disease it can: 

• Cause bone pain; 
• More severe urinary symptoms; 
• Generalized infection; 
• Renal insufficiency.  

      What are the types of treatment for Prostate Cancer?       

Faced with a diagnosis of prostate cancer, non-surgical treatments can be performed, such as: 

• Androgen deprivation therapy, 
• Radiotherapy, 
• Ablative therapies, 
• Chemotherapies, 
• Immunotherapies, 
• Surgical Treatments (performed alone or in conjunction with radiotherapy and/or hormonal treatment).  

All treatments take into account the risk, disease control and whether there has been or is any previous treatment.  

The choice of the best treatment must be evaluated individually for each patient, after defining the risks, benefits and best results according to the stage of the disease and clinical conditions. Faced with this, the possibility of treating prostate cancer in the initial stage and in a personalized way can prevent worse prognosis and achieve better results.  

 Can Prostate Cancer Cause Sexual Impotence? 

During the different stages of coping with the disease, the patient with prostate cancer presents changes in his life at the physical, psychological and social levels.  

Regarding the diagnosis, it is common for the patient to feel insecure, and in the collective imaginary, the disease is often associated with death. In addition, prostate cancer affects an anatomical location responsible for men’s sexual functions, and can present several conflicts related to their sexuality. 

The risk of having sexual impotence due to prostate cancer is related to several factors, such as: age over 65, obesity, smoking, vascular diseases and the discovery of the disease in an advanced stage. 

Regarding the treatment of prostate cancer through surgery, the risk of sexual impotence varies from 30-100%, this risk being dependent on the stage of the disease, tumor size, status of sexual function prior to the surgery and age). However, if the patient has erections, the sensation of orgasm is practically unchanged, with only absent (cases of cancer) or retrograde (benign prostatic disease) ejaculation.  

However, there are strategies that can accelerate the recovery of the erection after removal of the prostate, such as the use of drugs with vasodilating action in the corpus cavernosum. Pelvic physiotherapy can also be combined with penile rehabilitation. 

It is worth mentioning that the recovery time is variable, but it is estimated that the time required can reach 18 months. The treatment indicated for rehabilitation of sexual impotence after surgery must be individually evaluated and proposed by the treating physician or specialist. 

What are screening and diagnostic tests for prostate cancer? 

Given the lack of classic prostate cancer symptoms, screening tests have stood out with the objective of early diagnosis. The serological measurement of the prostate-specific antigen (PSA), approved as a screening test by the FDA in 1994, is commonly used in clinical practice as the main screening test.   

However, about 15% of diagnosed men have normal PSA values. Despite being widely used in screening for prostate cancer, PSA may also be elevated in other pathologies, including benign prostatic hyperplasia, prostatic infection and prostatic infarction (which can accompany acute urinary retention). Therefore, this test, by itself, does not have excellent characteristics for a biomarker in prostate cancer screening due to its low predictive precision. 

Thus, in the face of suspected prostate cancer, tissue biopsy is still considered the gold standard for diagnosis. 

Despite being the most frequent type of cancer among men, prostate cancer is also the most difficult to be approached, often limiting early diagnosis and care. Qualitative research suggests that when it comes to men’s health, we often run into sociocultural factors, which may justify the low adherence to the demand for medical services.  

The digital rectal examination has one of the greatest limitations for the diagnosis of prostate cancer, even if it presents good efficiency in conjunction with the serological testing in the early detection of prostate cancer. 

Therefore, it is important to have a screening procedure capable of verifying the risk of aggression of the pathology, at first, without the need to perform the biopsy. 

In view of the difficulty in adhering to conventional screening tests, SYNLAB offers the Stockholm3 test, a minimally invasive test, with greater sensitivity than the commonly used biomarker, to assist in the early detection of prostate cancer. 

What is the Stockholm3 test for the early detection of prostate cancer?           

The Stockholm3 test is a non-invasive screening analysis for aggressive prostate cancer (defined as ISUP> 2), performed by by collecting blood by venipuncture blood collection, in men aged 50-69 years.  

The test determines the concentration of five plasma markers in a blood sample (PSA, free PSA, intact PSA, hK2, MSMB and MIC1):      

1) PSA – Prostate-specific antigen: 

      It is a protein produced by prostate tissue, so if the man has prostate tissue, either in benign or malignant conditions, it will be detected in the examination. Two types of PSA circulate in the body: Free PSA, which is the PSA that has not bound to any proteins and the bound PSA, which is PSA that has bound to proteins. 

As the prostate enlarges with the evolution of cancer, it is expected that, in this condition, the PSA level is increasing.  

2) PSA – free: 

     PSA not bound to proteins. Free PSA tests are often used in conjunction with other PSA tests to confirm a diagnosis or test results. 

3) hK2: 

     Human glandular kallikrein 2 (hK2) is a prostate-specific kallikrein (produced by the prostate epithelium with approximately 80% DNA sequence homology with PSA) that is being described as a potential PSA-adjunct biomarker of prostate cancer. 

4) MSMB: 

      The beta-microseminoprotein (MSMB) is a protein synthesized by prostatic epithelial cells and secreted in the seminal plasma. Protein expression is reduced in cases of prostate cancer.  

5) MIC1: 

     Macrophage-inhibiting cytokine-1, also known as a prostate-derived factor (PDF), has been linked to the progression of several types of diseases, including prostate cancer. It has been shown that the MIC-1 gene can be directly regulated by cytokines associated with inflammation in prostate cancer cells, and the activation of the MIC-1 gene may be an early response due to inflammation, infection or injury to the prostate, providing an advantage of cell growth, leading to an environment that favors the development of prostate cancer.  

The Stockholm 3 test also performs the analysis of 101 genetic variants, integrating the results of the analysis into an algorithm that includes the patient’s age, family history and the result of the previous biopsy, if any.  

Due to the integration of the different parameters, it is possible to define a risk percentage (score risk) that the prostate biopsy is positive if performed (Gleason ≥7 – The Gleason score is a score given to a prostate cancer based on its microscopic appearance. Higher scores are associated with worse prognosis, since they are given to more aggressive cancers). 

Scientific studies show that the application of this test can reduce the number of biopsies by 32%, without compromising the diagnostic capacity of medium-grade prostate cancers (Gleason ≤7), in comparison with the use of the PSA value 3 ng / mL as the cut-off value for biopsy recommendation.  

SYNLAB’s Stockholm3 test provides information relevant to making decisions about performing a biopsy. 

For whom is the Stockholm3 test indicated? 

It is indicated for men 45-75 years old with: 

• Family history of prostate cancer
• High PSA (> 1.5 ng / mL) or altered digital rectal examination
• Negative result on a previous prostate biopsy

What are the advantages of the Stockholm3 test? 

The Stockholm3 test has several advantages over conventional screening tests, such as: 

1. Increased the rate of detection of aggressive cancers by 100% compared to current clinical practice 
2. 50% reduction in the number of unnecessary biopsies compared to routine clinical practice 
3. Enables the detection of aggressive cancer in men with low PSA values (<3 ng / mL)
4. Providing concise recommendations based on risk, making it easier for the specialist to make decisions and reducing the waiting time between initial suspicion and the first treatment

About the SYNLAB Group 

The SYNLAB Group is a leader in providing medical diagnostic services in Europe, providing a full range of clinical laboratory analysis services to patients, healthcare professionals, clinics and the pharmaceutical industry. Resulting from the Labco and Synlab merger, the new SYNLAB Group is the undisputed European leader in medical laboratory services.