MIAMI.- Approximately 1 in 8 men will be diagnosed with prostate cancer during their lifetime, says a study from the National Cancer Institute. If we expand this statistical map, we see that the incidence rate is about 120.2 cases per 100,000 men per year.
If we look at the pattern of diagnosis, it is concentrated in older ages, since the majority of cases are detected in men over 65 years of age. However, the main international guidelines agree that the starting age for prostate cancer risk assessment depends on the individual profile of each man. Now, as for those at average risk, entities such as the American Urological Association (AUA) and the European Association of Urology (EAU) advise starting the prostate-specific antigen (PSA) test around age 50, taking into account the life expectancy and preferences of the patient.
According to the American Cancer Society (ACS), men without significant risk factors can also start this discussion at age 50, since it is from this age that the incidence increases steadily. These recommendations are based on evidence that PSA should not be used automatically, but rather within an informed and personalized screening approach.
For men at higher risk, the guidelines adjust the age of onset. Both the AUA and the EAU recommend starting around age 45 if there is a family history of prostate cancer or African descent, since these groups have a higher incidence and mortality.
The ACS adds that men at very high risk (such as those with two or more affected first-degree relatives or with mutations such as BRCA1/BRCA2) should start even earlier, around age 40.
An early diagnosis
For decades, the diagnosis of prostate cancer was associated almost exclusively with digital rectal examination, which is a quick and useful examination, but limited in terms of results.
Today, thanks to technological advances and a more precise vision of risk, medicine has entered a new era where early detection combines more precise analysis, high-resolution images and tools capable of distinguishing between aggressive tumors and those that will probably never affect the patient’s life.
This change not only improves diagnostic accuracy, but also reduces interventions that are not really necessary and allows for more personalized treatments.
Reading the PSA
The first step to understanding this evolution is to understand that prostate-specific antigen (PSA) is no longer interpreted as before, according to the European Association of Urology. That is, an elevated PSA does not automatically mean cancer and a normal PSA does not exclude its presence.
As a study by the National Library of Medicine emphasizes, today it is considered a dynamic risk marker, influenced by age, gland size, annual increase rate, and family history. In fact, many international guides recommend starting the conversation about PSA around age 50, or earlier if there is a family history or Afro-descendant ancestry.
Multiparametric MRI
One of the most relevant advances has been multiparametric magnetic resonance imaging (mpMRI). This is stated in a study published in The New England Journal of Medicine. This exam allows you to visualize the prostate in enormous detail, identifying suspicious lesions before performing a biopsy. Its use has significantly reduced unnecessary biopsies—invasive procedures with risk of bleeding and infection—and increased the detection of clinically significant tumors. A negative mpMRI result, in many cases, allows the patient to continue under surveillance without needing to undergo an immediate biopsy.
Biopsies
Added to mpMRI are biopsies directed by image fusion, a technique that combines resonance with ultrasound in real time, notes the National Library of Medicine.
This allows the urologist to precisely access suspicious areas, decreasing the chance of missing aggressive tumors.
Gone are the times when biopsies were “blind” and depended exclusively on chance.
Biomarkers
Likewise, advanced biomarkers have emerged in blood, urine and prostate tissue. Tests such as the 4Kscore, PHI or PCA3 help estimate the probability of an aggressive cancer, better guiding clinical decisions, estimates the World Journal of Men’s Health.
Although they do not replace traditional studies, they provide an additional layer of information that can avoid unnecessary interventions.
artificial intelligence
On the other hand, medicine is gradually incorporating artificial intelligence tools capable of analyzing images and molecular patterns to predict the behavior of a tumor. These technologies promise more objective and consistent interpretation, which translates into benefits for patients.
More precision
We can glimpse the future of prostate cancer diagnosis, which is heading towards a personalized, precise and less invasive approach. The goal is that early detection does not mean anxiety or excessive procedures that can frighten the patient and even delay check-ups, but rather clear information and decisions based on evidence.
For men, this represents an invaluable opportunity to know their risk, act at the right time and avoid unnecessary treatments.
