“I have prostate cancer, and I still want to live!”
In Latvia, male mortality from malignant tumours is several times higher than female mortality. Still, unlike women, men are diagnosed with the disease at much more advanced stages, and prostate cancer is the leading cause of male mortality in Latvia. This fact is particularly harsh because it has now been proven that people do not have to die from prostate cancer: it can be successfully treated, since, compared with other malignant tumours, prostate cancer has a relatively “benign” course. This means that, if detected and treated in time, up to 90% of patients can be cured. Unfortunately, men in Latvia continue to avoid prostate cancer screening because they do not know how it is performed, are afraid of learning the harsh diagnosis because they do not know that prostate cancer can be treated and even cured, and are not informed about the treatment process itself. Many also believe that prostate cancer treatment will cause irreversible consequences and side effects in a man’s life that will affect him for the rest of his life. But is that really so? To dispel and refute the myths about prostate cancer, encourage and motivate Latvian men to fight this now-treatable disease, and familiarise them with its treatment process, at the end of Men’s Health Month, medical professionals, patients and state organisations joined in a discussion about life after a diagnosis of “prostate cancer”.
Prostate cancer is successfully treatable today. As Juris Plonis, a member of the Board of the Latvian Association of Urologists, head of a department at the PSKUS Urology Centre, and a urologist, points out, prostate cancer detected in time is very successfully treatable: “The average age of a prostate cancer patient today is already 65– 69 years, although only 10–15 years ago it exceeded 70, which means that increasingly younger men are developing prostate cancer. In Latvia, there are between 1,000 and 1,200 new patients each year. That is one man in 1,000, which is a great deal against the background of Latvia’s population. Every year in Latvia, 300–400 men die of prostate cancer, although in fact nowadays no one should die of this disease. Early diagnosis and professional treatment are major achievements of medicine that make it possible to combat this disease successfully and in time. Today, various treatment options are available in Latvia, which can be tailored to patients’ individual needs. When preparing a prostate cancer treatment plan, a doctor certainly takes into account the progression of the disease, how quickly it is progressing, the patient’s age, as well as the general state of health. What I recommend that patients remember is that, as after any serious therapy, prostate cancer treatment may also have consequences, but they are not irreversible, and with appropriate treatment and rehabilitation these can be reduced to a minimum.”
Active surveillance
One of the most important things that many people do not know is that even when a diagnosis of prostate cancer has been made, it is often not necessary to begin any medical procedures immediately; instead, the patient should visit the doctor regularly and have the cancer monitored. Ten to 15 years ago, when reading about cancer treatment guidelines around the world, a term such as “active surveillance” or “deferred therapy” did not yet exist. This concept emerged 10 years ago, when doctors observed that, unlike other malignant tumours, prostate cancer has a relatively “benign” and slow course. A large proportion of patients whose tumour is not treated but actively monitored live for up to 15 years or more. As Dr Plonis explains, the active surveillance method is possible and applicable when the tumour is detected at an early stage and its “composition” is favourable for active surveillance. Unfortunately, when the diagnosis is made, no one calls the patient and reminds him to visit his urologist and undergo the necessary examinations every three months. Therefore, active surveillance is possible only with the patient’s active involvement and personal persistence—regularly remembering to attend medical check-ups and submit blood tests.
Surgical treatment
Depending on the specifics of the tumour and the course of the disease, surgical treatment, or “removal” of the tumour, is sometimes necessary. Surgical treatment, or surgery, is performed on patients with stage I, II and sometimes stage III prostate tumours, as well as on men whose projected life expectancy is more than 10 years. During the operation, the prostate is removed completely, while in cases of high-risk tumours, the lymph nodes next to it are also removed. As after any surgical intervention, following prostate cancer surgery the patient may experience postoperative side effects such as urinary incontinence and erectile dysfunction, but these side effects are not irreversible. Urinary incontinence can be reduced by training the perineal muscles using a biofeedback rehabilitation course. On the other hand, potency problems can be reduced with medication.
Radiation therapy
Radiation therapy (radioactive radiation) kills or weakens cancer cells, so during radiation therapy the prostate is irradiated externally with a powerful dose of radiation. Radiation therapy is often recommended for patients whose tumour has not spread beyond the prostate, as well as for older men or those who decline surgical treatment. External irradiation is similar to a CT scan. The prostate is an organ that moves as a result of bowel activity and smooth muscle activity, and this process cannot be controlled externally. Therefore, during therapy it is not possible to focus perfectly only on the prostate—the treatment site that needs to be irradiated—and the nearby organs are irradiated as well. For this reason, radiation is usually administered 35–45 times over several weeks, with the necessary radiation dose limited to the minimum required to reduce discomfort after therapy.
Hormone therapy
It has been proven that the development of prostate cancer is promoted by the production (presence) of the male hormone testosterone. Therefore, one treatment method is to reduce the amount of testosterone in the body, thereby weakening the tumour and causing it to gradually shrink. Hormone therapy affects the amount of testosterone in all cancer cells, including cancer cells in metastases, if any have developed. This means that this treatment method can also affect cancer in its later stages. Unfortunately, hormone therapy does not completely cure the patient, but it successfully makes it possible to control the disease for 3–4 years. In more severe and advanced prostate cancer cases, this type of treatment is combined with other methods, such as radiation therapy.
CyberKnife or hypofractionated radiation therapy
In recent years, hypofractionated radiation therapy using the robotic radiosurgery method “CyberKnife” has also been introduced worldwide and in Latvia. This radiation therapy can treat tumours in the prostate much more precisely, reducing irradiation of the healthy tissues surrounding the prostate and thus also reducing the unpleasant side effects of treatment. Radiologist-radiotherapist Māris Mežeckis of Sigulda Hospital explains the treatment process using CyberKnife: “The prostate is a mobile organ, so even with the most advanced technology it is difficult for the beams used in conventional therapy to hit the cancer-affected cells precisely. For this reason, during the widely known radiation therapy used up to now, the necessary radiation dose is divided into 35–45 irradiation sessions so as not to expose the patient to severe side effects. By contrast, robotic radiosurgery, or the CyberKnife, can track the movements of the prostate gland, delivering the entire radiation dose significantly more precisely. It requires only 4–5 irradiation sessions, making the course of treatment shorter, higher-quality and more effective, reducing the likelihood of side effects and causing considerably less trauma to the tissues and nerves near the prostate, which also makes it possible to preserve full sexual function.” It has also been proven that, compared with conventional radiation therapy, this robotic radiosurgery results in fewer side effects affecting the urinary tract and the gastrointestinal tract.
“I have prostate cancer, and I still want to live!”
Each patient’s treatment process is developed individually, in consultation with a urologist, and tailored to the patient’s age, lifestyle, the specifics of the cancer, the characteristics of its development and other factors. However, the most important thing is that, to avoid a fatal outcome and serious consequences of the disease, the tests and other examinations necessary to detect prostate cancer must be performed regularly, while if it is detected, treatment must be started immediately. It should also not be forgotten that each person must primarily take care of their own health. Seventy-three-year-old prostate cancer patient Visvaldis Bergmanis, sharing his life experience, urges men not only to undergo the necessary examinations in time, but also to gather information about the course of the disease themselves: “In 2006, my back hurt, and I repeatedly talked about it with my family doctor, who finally referred me for PSA tests. If the normal unit value for the test is 4, my figure was 200—50 times higher than normal. I went to a urologist, who told me not to worry but to stay in hospital for three days. Unfortunately, no one warned me that it could be prostate cancer, so I left. In 2010, after various health problems, I had PSA tests again, and the result now exceeded the normal value by 146 times. I was diagnosed with prostate cancer already at stage III. I was treated with both radiation therapy and hormone therapy and other methods, but unfortunately the cancer did not recede. Metastases appeared in three locations. I am currently continuing active treatment. The diagnosis is like a blow, and it is no secret that cancer takes lives. I urge every man to think about his health! I am 73 years old, and I still want to live. But it must be remembered that this disease can also affect someone in the prime of life—at the age of 40 or 50. I still wonder how my life would have turned out if treatment had been started in time.”
Blood tests for prostate cancer can be performed at any medical laboratory. These tests are recommended once a year for men over the age of 40.
