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It started with back pain
The 47-year-old Storm’s illness struck unexpectedly: in the fall of 2015, an annoying back pain began to appear. At first, the man tried to rescue him with painkillers, but they didn’t help. Then he went to the family doctor: he received stronger medications, but they did not change the situation either. Audrius decided then that the cause of the disease should be sought. He visited neurologists, rehabilitators, nephrologists until finally one of them recommended that he see a urologist, who sent him for a prostate-specific antigen test.
“The study data was tragic: the indicators exceeded the norm several dozen times. Well, and it happened …” – recalls the man.
He was diagnosed with advanced prostate cancer. “No matter what I wanted, the doctors didn’t promise a recovery,” says Audrius. However, the man was determined to obey all the instructions of the doctors and now, after surgery, radiotherapy, medication, five years later, he claims to have stopped the disease.
“I don’t feel any particular inconvenience, but I’m checking the PSA” clockwise. “Sometimes you have to see a urologist for some additional tests. But it’s just a trifle. After all, I told myself that I would not give up, “says the man.
Avoid checking
The Prostate Cancer Early Diagnosis Program has been in operation in Lithuania for fourteen years. It is intended for 381,000 Lithuanian men aged 50 to 69 and men over 45 if their parents or siblings have prostate cancer.
“This program is important because it helps us fight this common and often threatening disease. The earlier we detect cancer, the more opportunities we have to cure it. Recently, mortality from prostate cancer has stabilized. We hope that the program will help to significantly reduce mortality from this disease in the long term ”, says the head of the Oncourology sector of the Urology Clinic of Kaunas Clinics, Assoc. Dr. Stasys Auškalnis.
According to the program, men of a certain age must regularly undergo a simple blood test that shows the amount of prostate specific antigen (PSA) in their blood. Men with PSA levels above the norm are referred to a urologist by a family doctor. This specialist performs a prostate biopsy and other tests to detect or rule out prostate cancer, if necessary.
Last year, more than € 2 million was allocated to the program, but only one in four men was screened with a check.
Last year, more than € 2 million was allocated to the program, but only one in four men was screened with a check, up 15 percent. less than the previous year. Elevated PSA levels were found in one in 10 subjects, and half of the men who underwent biopsy were diagnosed with prostate cancer. Some men see the doctor too late, between 6% and 7%. for those diagnosed for the first time, prostate cancer is already common.
The order is broken
The onset of the COVID-19 pandemic has slowed down a large proportion of scheduled medical services, including four cancer screening programs. These services increased in the summer, but with the start of the second wave of coronavirus transmission, scheduled services resumed at a slower pace.
Mainly due to the limited activities of family practitioners, they try to provide as many services as possible remotely and are therefore less likely to encourage men to get screened for prostate cancer. Many men have not been invited to have a PSA test this year. Among them are those who should carry out this study for the first time this year. Some patients have difficulties accessing the labs and need to register. And patients themselves limit planned preventive visits to doctors.
“In my opinion, people’s attention to the risk of prostate cancer has decreased in recent years and the incentives to go for a preventive check-up have diminished. Now fear of seeking medical treatment for COVID-19 infection has contributed. Whether this will lead to more neglected cases of the disease will be calculated over time. I think there is a real threat that those who need it most and who may have aggressive and poorly differentiated prostate cancer will not get help. For example, the patients have advanced or metastatic cancer and the disease has not been diagnosed due to quarantine restrictions, ”says S.Auškalnis.
When to wait and when not to?
The specialist says that the European Association of Urologists has issued guidelines on how doctors should behave during a pandemic and especially during quarantine. The guidelines establish the cases in which patients may or may not postpone testing.
During a pandemic, when the disease is suspected but not detected, and when a man is examined, the rise in PSA is not great, aggressive, advanced-stage prostate cancer and invasive procedures such as biopsy of the prostate are not suspected. prostate can be safely delayed up to 3 months. Therefore, these men can delay the PSA test until the end of their quarantine. Testing can also be delayed in men who have already seen a urologist and found that the increased PSA may have been caused by non-cancerous causes. Other cases are anticipated.
If a PSA test has been performed and the antigen level has been found to be elevated, further testing may be delayed, depending on the physician, depending on the individual patient’s medical condition. For example, if a man is being examined for the first time and is found to have a small increase in PSA levels, it may be worth repeating this test after a few weeks to determine if the increase in PSA was due to causes other than cancer. . Another situation is if the PSA is elevated and the prostate is not enlarged. In this case, it is recommended to perform an MRI first and only then, if necessary, a prostate biopsy, as it is an invasive procedure.
Low-risk prostate cancer patients account for about 60 to 70 percent of them. In all patients, follow-up tests can be safely postponed because cancer develops slowly in them. When there is low-risk, non-aggressive prostate cancer, planned treatment can also be safely delayed.
“If we decide to treat the patient with hormone therapy radiation therapy, during quarantine we can delay radiation therapy for three to six months so that the patient does not have to go to the hospital every day. During a pandemic, hormone therapy drugs may be prescribed from long acting, some for a month, some for three and a third for six. Unfortunately, we cannot prescribe them to patients who are being treated for the first time. I think it would be wise to remove these quarantine restrictions. Prescriptions for these drugs can be written online. Patients will not have to go to the hospital, “says the doctor.
Unfortunately, when the aggressive course, poor differentiation, advanced prostate cancer cannot be delayed, hormone therapy treatment should be started as soon as possible to stop the progression of the disease.
Genetic diagnosis and genetic counseling are now increasingly important. Therefore, there are different recommendations for men who may have inherited mutated BRCA1 or BRCA2 genes from prostate cancer. These men should take part in the prostate cancer early diagnosis program starting at age 45 because they can get sick earlier and the disease is often aggressive and spreads rapidly; metastases can occur in just half a year. These genes can be inherited from men whose fathers or brothers have prostate cancer and whose mothers or sisters have breast, uterine, or ovarian cancer.
Make time
There are situations in which it is possible to act slower, with more caution, but there are situations in which doctors cannot delay decisions. Men with high-risk aggressive prostate cancer in particular should monitor their health closely and have timely follow-up tests. For these patients, both examinations and treatment must be performed in a timely manner, according to a physician-recommended schedule. A control study that shows the disease is manageable and notices that it has returned is also a PSA test. If the disease has reappeared, in some cases the examination and treatment may not be delayed, it should be started as soon as possible.
Under the current regimen, after radical treatment, patients are referred by a family physician for a PSA test, but this does not require a patient visit; the doctor may prescribe the referral after a remote consultation. Also, patients can take the PSA test in private, only then will they have to pay for the test.
In order for doctors to be sure that the treatment is effective and the disease is controlled, these men must have PSA tests on time.
“During the PSA test during the COVID-19 pandemic, it is not always necessary to go to a urologist, many things can be solved by remote consultation. The urologist will tell you if you need to go for any additional procedure or not. If an additional examination is needed, the patient will be able to come, ”says S.Auškalnis.
The doctor says there is nothing to fear and a PSA test is necessary even during a pandemic: “The risk of COVID-19 infection in laboratories is no greater than anywhere else if all protection guidelines are followed against viral infection “.
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