Prostate cancer prevention

Prevention is always the best way, even for prostate cancer.

There are some tricks, some simple habits that can help safeguard prostate health, preventing, for example, the prostate cancer, even in the presence of certain risk factors, such as the presence in the family of relatives who have dealt with this disease.

Primary prevention

Here are some simple steps to reduce the risk of developing prostate disorders:

• Diet rich in fibre, antioxidants and omega-3. Whole-grain flours, fresh fruit and vegetables are therefore recommended (especially the less sugar-rich fruits such as apples and pears, orange vegetables, fennel, turnips and cabbage), blue fish, extra virgin olive oil and legumes. A healthy diet protects the function of the prostate and delays the ageing process and the risk of related abnormalities;
• Foods to be reduced are sausages, fried foods, very fatty cheeses and foods that contain a lot of simple sugars (such as sweets and sugary drinks). These promote inflammatory states, as well as leading to cardiovascular problems and increasing the risk of becoming overweight;
• Maintaining a healthy weight. We visited as obesity constitutes a risk factor for prostate cancer.
• Do exercise on a regular basis reduces both the risk of benign prostatic hyperplasia and prostate cancer. 
• Do sex habitually. Frequent ejaculations maintain good prostate function, improve health of body and mind.

Secondary prevention: controlling the prostate

Maintaining a healthy prostate means having regular check-ups, especially after the age of 50, although it is recommended to visit a urologist as early as the age of 40.

What tests and examinations are recommended for early detection of any abnormalities, dysfunctions or diseases that may affect the prostate?

• Urinalysis. Urine culture is useful for detecting infections or bleeding;
• PSA (prostate-specific antigen)is a blood test that detects levels of a protein produced solely by the prostate. Normal levels range from 0.0 to 4.0 ng/ml (nanograms per millilitre of blood), but can increase due to various causes, including tumours, benign prostatic hyperplasia and prostatitis. It is generally recommended to perform it in the presence of symptoms suggesting the presence of one of these diseases. If the value is above 4 ng/mL, or is constantly rising, further tests may be necessary.
• PSA ratio: ratio of free to total PSA. In the blood, the PSA protein is normally found bound to other substances, not “free” except in minute concentrations. However, in the presence of a malignant tumour, these values fall even further. For this reason, when the PSA test gives “suspicious” results, the doctor may also prescribe the dosage of PSA free (also called free PSA or fPSA). The free PSA/total PSA ratio is used to interpret the data. Normal, i.e. non-pathological, values are around 0.20%. Values different from this percentage may indicate the presence of prostate pathology, for which the doctor will prescribe other tests;
• Digito-rectal exploration (DRE)The urologist manually checks the condition of the prostate by introducing a finger through the rectum, after lubricating the part. This exploration makes it possible to discover an enlargement, the presence of nodules or prostatitis. It can be annoying, but it is harmless; the greatest discomfort is psychological, which it is good to point out to the doctor so that he can reassure the person.
• Uroflowmetry. The person must urinate into a device, similar to a toilet, that measures the speed and volume of the urine flow. An ultrasound is usually prescribed after this test;
• Transrectal prostate ultrasound. A quick and harmless examination to assess the morphology of the prostate and thus detect dilatation or possible neoformations. It is carried out by inserting a probe into the rectum, which is lubricated, that emits ultrasound that can be converted into static or dynamic images. Sometimes a biopsy of the prostate is associated with this examination.

If these examinations give results that lead to the suspicion of prostate cancer, it may be necessary to undergo a prostate biopsy. The operator inserts a tube with a small rectal probe, to explore before the operation; then, through the same tube, he inserts a needle which is used to take small pieces of prostate tissue. These will be analysed to detect any abnormalities in the cells and, if positive, the aggressiveness of the cancer. The procedure, which is very quick, is painless as it is performed under local anaesthesia.

Currently, the PSA test is the mainstay of preliminary examinations to monitor the risk of prostate cancer. However, its low reliability as a single parameter makes it of little use as a screening test.

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Read the AIOM guidelines: https://www.aiom.it/linee-guida-aiom-carcinoma-della-prostata-2019/