Prostate cancer: should you be screened from the age of 40?

Prostate cancer is, as its name suggests, a cancer that affects the prostate. The prostate is an exclusively male gland that participates in the production of sperm and therefore plays an essential role in reproduction (removal of the prostate always results in sterility). Prostate cancer is very common in men. In some countries such as France, it is the second most common cancer. The first being lung cancer. It represents on average 20% of male cancers worldwide.

One in eight men is affected in his lifetime by this cancer. It is more common in men over 50 and even more so in men over 65. Age therefore plays a central role at the epidemiological level. Prostate cancer is a cancer that is rarely serious.

Over 99% of cases of prostate cancer can be cured if caught early. In other words, only a minority of patients will develop an aggressive and potentially fatal form of this form of cancer. The reason is that tumors in the prostate often grow very slowly and in most cases remain harmless. The great difficulty for the doctor is to know whether or not the tumor requires a medical intervention such as surgery.

Baldness at 20, prostate cancer at 40?

Men who suffered from prostate cancer are twice as likely to experience premature baldness (from the age of 20). The latter can be a warning sign and should encourage screening from the age of 40. Prostate cancer has no clearly defined causes. But it is believed that certain factors can promote its development such as genetic or external causes such as tobacco, lack of exercise or an unhealthy diet.

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Diagnose prostate cancer

The typical symptoms of prostate cancer are often imperceptible (asymptomatic) at first. They can be confused with those of benign prostatic hyperplasia (BPH) with urinary difficulties. In advanced stages, the symptoms are more marked and may include bone pain or even blood in the urine.

Diagnosis and prevention, essential in the management of prostate cancer, are always done by a doctor and are generally based on a digital rectal examination and sometimes by a PSA (Prostate Specific Antigen) assay. Please note that the PSA test is still more controversial as a means of prevention in healthy men. The doctor will confirm the diagnosis by performing a biopsy. From the age of 45 (40 for men at risk), every man should have an annual prostate check-up with his doctor. Because the earlier prostate cancer is detected, the higher the chances of recovery.

Genetic tests, carried out on a sample from a prostate biopsy and which analyze up to 17 different genes, increasingly make it possible to assess the aggressiveness of prostate cancer. This helps the doctor and patient make the best treatment decision (eg whether or not to have surgery).

The treatment of prostate cancer depends in particular on the stage of the disease. It can be a surgical act, hormonal and drug therapies or even radiotherapy.

One in 8 men affected by prostate cancer

It is estimated that one in eight men is, has been or will be affected by prostate cancer (as a reminder, it is estimated that one in eleven women will be affected by breast cancer). From 50 to 70% of people diagnosed with this cancer are already at an advanced stage (more difficult to treat than in an earlier phase). Hence the interest of regularly (every year from the age of 45) prostate exams with your doctor. A 2016 study published in the New England Journal of Medicine showed that the 10-year or greater survival rate for prostate cancer in people diagnosed early with higher than normal PSA levels was 99%.

Prostate cancer: the value of early detection

Over 82,000 UK men aged 50-69 who had a PSA test were included. The researchers focused on men with early-stage prostate cancer. That is, the disease is uncommon and confined only to the prostate.

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Among these men suffering from this initial form of cancer, 1,643 agreed to receive randomly either surgery, radiotherapy or no treatment but with active follow-up. In the latter case, the patient had to submit to blood tests carried out every 3 or 6 months, medical advice and treatment only if signs showed the deterioration of the disease. This study showed 10 years later that this 99% survival rate was the same or almost the same in patients who had surgery or who underwent radiotherapy as those who had not received treatment.

Among the 1,643 patients followed, it is true that more patients with active follow-up, ie 112, saw their cancer worsen, compared to 46 for those who underwent surgery or 46 with radiotherapy. But surgery and radiotherapy led to more side effects (eg incontinence, erectile dysfunction). The study’s lead author, Dr Freddie Hamdy of Oxford University, believes there is no serious evidence that treating the disease at an early stage can make a difference. Indeed, it is currently very difficult to know which patient with, for example, an abnormal PSA level will develop a severe form of the disease. This is why the Oxford researchers are wondering whether all treatment (surgery, radiotherapy) should not be avoided at an early stage of the disease.

Prevention of prostate cancer

Some medicinal plants can help prevent prostate cancer such as green tea. In the same way, some good useful advice such as regular physical exercise, maintaining a healthy weight, can have a preventive effect on the occurrence of prostate cancer.

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