CAPITAL: Prof. Deyan Anakievski: There is no prevention strategy for prostate cancer. Men over 50 are at risk

The majority of men are ashamed to go to the examination

Prof. Anakievski is the head of the urology clinic at the high-tech hospital complexes Heart and Brain. He graduated from the Medical University – Varna in 2004. In the same year he started specialization in surgery and in 2013 he acquired a second specialty in urology. She defended her dissertation for the degree of Doctor of Medicine in 2015 on the topic “Evaluation and validation of some preoperative and postoperative prognostic models in prostate cancer”. In 2021, he defended the academic position of Professor of Urology. He is the main author and co-author of more than 200 scientific papers.

Is there a prevention of prostate cancer and what should young men do in an attempt to avoid the disease? From what age onwards and at what intervals should they see a urologist, and is there any prevention?

– Prostate cancer is the second most commonly diagnosed cancer in men, with an estimated 1.4 million diagnoses and 375,000 deaths worldwide in 2020. In Europe, it is the most commonly diagnosed cancer in men and the third most common cancer-related cause of death in men. It is a major health concern, particularly in developed countries, due to the higher proportion of older men in the general population and the potential risk of overtreatment after early diagnosis. Unfortunately, there is no prevention for RP. There is screening, which is still used in this country to detect new cases, but it is not sufficient on its own to diagnose prostate cancer, so it is not used in most countries around the world. There are three well-established risk factors for prostate cancer: increasing age, ethnicity and genetic predisposition.

There are a wide variety of exogenous factors (environmental factors) that we associate with the risk of developing prostate cancer or identify as etiologically important in the progression from latent (dormant) to clinical prostate cancer.

However, there are currently no known effective preventive dietary or pharmacological agents. However, it is important to mention a few risk factors for prostate cancer development that should be given special attention, which are: metabolic syndrome, obesity, smoking, excessive alcohol use, and intake of hormonal drugs. Family history (burden) and ethnicity are associated with an increased incidence of prostate cancer, suggesting a genetic predisposition. Generally, both the European and American Urological Associations have proposed recommendations for individualised early detection through early PSA (prostate-specific antigen) testing in men at increased risk of RP:

– Men over 50 years;
– men over 45 with a family history of RP;
– men of African descent over 45 years of age;
– men carrying breast cancer gene 2 (BRCA2) mutations after age 40 years.

A risk-adapted strategy (based on initial PSA level) has also been devised in recent years, with 2-year follow-up intervals for those initially at risk. These are men with a PSA level >1ng/ml at age 40 and men with a PSA level >2ng/ml at age 60.

What are the symptoms of prostate changes? How are they diagnosed? At what age do they most commonly occur?

– Localised prostate cancer is usually asymptomatic. Local progression can cause symptoms such as more frequent urination, night-time getting up, erectile dysfunction (ED), urinary retention (retention), pain on urination, blood in the urine (haematuria) or in the semen.

Prostate cancer is usually suspected based on high PSA levels and/or a positive rectal exam, and if there is a family history of a deceased with prostate cancer. The diagnosis of prostate cancer is most often based on a positive MRI, which is currently the standard and is analyzed as the initial test along with a positive rectal exam and high PSA levels. In addition to suggesting the presence of prostate cancer, imaging also allows for targeted biopsy (Fusion) of the prostate and provides information for staging the patient. As previously mentioned, age ranges from 45 to 70 years and depends on whether anyone in your family has a burden of prostate cancer.

How would you motivate men to see a doctor, what are your patients afraid of? At what stage of the disease do they come to you?

– We have noticed for years that the majority of patients are ashamed to visit a urologist – a sort of Bulgarian phenomenon. The other part are afraid of finding a malignant process, which would disturb their quality of life. I always tell men that it is better to detect a growth in time to treat it properly than to wait and live in ignorance. With the advancement of technology in medicine today, in most of the cases, we are able to cure the patient even though it is a malignancy. Unfortunately, about 30-40% of prostate cancer patients come in at an advanced stage and yet that does not mean they cannot be treated. Prostate cancer is a disease that allows for multimodal treatment, namely surgery, radiation and hormone therapy.

What is the treatment for prostate cancer detected at different stages?

– The gold standard treatment for localized prostate cancer is radical removal of the prostate, regardless of the method used – open, laparoscopic or robot-assisted surgery. The best functional results (preservation of continence and erectile function) are achieved with robot-assisted surgery. For advanced RP and local lymph node metastases without bone involvement, depending on the patient’s age and general status, robotic-assisted surgical treatment combined with subsequent radiotherapy and hormone therapy may be considered. Of course, there are other treatments for prostate cancer, such as radiotherapy with its variations.

What are the innovative and bloodless treatment methods for prostate cancer? What methods do you and your team use?

– At Heart and Brain hospitals in Pleven and Burgas we perform robot-assisted surgery for prostate cancer – we apply the most advanced approach, with the best results for the patient and minimal recovery time. I will not hide that we are currently a leading centre for robotic-assisted surgery for various urological diseases, including prostate cancer.