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Cáncer de próstata, un tumor sin síntomas claros

Llegados los 50 años, a casi todos los hombres les empieza a preocupar la próstata. Tradicionalmente, se ha considerado el cáncer de próstata como un tumor de paciente mayor o anciano, «aunque cada vez estamos observando un mayor desplazamiento a edades más jóvenes, a partir de los 50 años», explica nuestro urólogo el Dr. Luis Llanes.

Síntomas

Los síntomas iniciales son muy variables, donde los miccionales, como son el sangrado en la orina, la dificultad miccional o el aumento de la frecuencia, son los más característicos. Pero hay que tener en cuenta que habitualmente son debidos al crecimiento benigno de la próstata que suele coexistir junto al cáncer. Sólo en fases avanzadas de la enfermedad puede aparecer dolor óseo secundario a metástasis óseas, u otros síntomas por afectación de órganos vecinos.

Ante estos síntomas, es recomendable acudir al urólogo para salir de dudas. La exploración física de la próstata a través de un tacto rectal y las determinaciones analíticas específicas, como el antígeno prostático específico, conocido como PSA, ayudan a diagnosticarlo. Nuestro urólogo dice que es importante resaltar que el PSA no es un marcador tumoral si no un marcador de órgano, de próstata, porque se eleva en todas las enfermedades prostáticas. Para determinar el diagnóstico también están las pruebas de imagen, sobre todo la ecografía y en los últimos tiempos se ha incorporado la resonancia magnética, que parece que va a ocupar un puesto predominante en el diagnóstico de al menos una parte de la patología prostática.

cáncer de prostata

Tratamientos

En cuanto al tratamiento, va a depender del estadio de la enfermedad y de la edad del paciente. Si está localizado puede realizarse vigilancia activa y tratamiento curativo si apareciera un empeoramiento de las características del tumor o tratamiento curativo de entrada mediante cirugía o radioterapia (externa o braquiterapia). En pacientes ancianos, otra opción terapéutica en estos tumores es la observación y el tratamiento paliativo ante la progresión del tumor.

En los tumores avanzados, el enfoque cambia de lo curativo a lo paliativo, y la primera opción es el tratamiento hormonal para evitar el crecimiento del tumor al bloquear el efecto de las hormonas sexuales masculinas. «Esta aproximación terapéutica fue novedosa desde los años 40 del siglo pasado ya que era la primera vez que se trataba un cáncer con terapia hormonal», apunta el Dr. Luis Llanes, quien añade que supuso la concesión del Premio Nobel de Fisiología y Medicina al urólogo Charles  B. Huggins en 1966. De hecho, éste año se conmemoran los 50 años del premio con numerosos actos en el mundo urológico.

Prevención

Se ha hablado mucho de los programas de cribado. Al igual que en las mujeres para detectar el cáncer de mama se recomienda hacer mamografías de forma periódica, los programas de cribado del cáncer de próstata están sujetos a una intensa discusión científica. De hecho, tanto la Asociación Americana de Urología como la Asociación Europea de Urología, no recomiendan el cribado masivo desde un punto de vista de salud pública. Sin embargo, la detección precoz a nivel individual puede hacerse mediante tacto rectal y detección del PSA, requiriendo el consentimiento después de una conversación detenida sobre los pros y los contras del procedimiento, teniendo en cuenta la edad y esperanza de vida del individuo.

 

Contenido validado por el Dr. Luis Llanes, Jefe de Servicio de Urología del Hospital Universitario de Torrejón



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