Prostate cancer: the effects of treatments “weigh” but there are remedies (little exploited)

A survey designed and carried out by patients for other patients, with a very specific purpose: measure the reality of the quality of life of men treated for prostate cancer. The results of the EUPROMS survey (Europa Uomo Patient Report Outcome Study), promoted by the Europa Uomo association and conducted in 32 countries including Italy, have thus highlighted a different reality from what had so far been revealed by medical studies. The difference in particular is felt in the side effects of treatments (incontinence, impotence, anxiety, depression and pain) which weigh, physically and psychologically, more than previously thought. There were 5,500 interviewees, aged 70 on average, and for the first time a collective story of men emerges which faithfully reflects their experiences after the treatments – he says Maria Laura De Cristofaro, president of Europa Uomo Italia —. It is essential to strengthen and improve early diagnosis strategies because, as we know, the earlier the neoplasm is discovered, the greater the chances. both to heal and to receive less invasive treatments. It is equally crucial to be followed by a Prostate Unit, within which a multidisciplinary team composed of several experts operates, the only one who can guarantee quality of care, avoid inadequate treatments and ensure a better quality of life, in addition to psychological support.

The results of the survey

What are the most significant data that emerged from the survey? More than 50% of those questioned received the diagnosis before the age of 65: therefore prostate cancer is not, as many think, a disease only of old age – he answers Cosimo Pieri, general secretary of Europa Uomo Italia —. More than half of the participants have sexual dysfunction problems and, specifically, 60% of those who underwent surgery and more than 47% of those who underwent radiotherapy. This is the problem most felt by patients, which follows incontinence (both post surgery and post radiotherapy). For both disorders there are several solutions available to reduce their impact on daily life, but they are used by only 30% of patients because they are not proposed adequately. 42% of those interviewed then suffer from anxiety or depression, but psychological support is not offered to most patients. Medicines, physical exercises, infiltrations and minimally invasive surgery offer many possibilities to stem incontinence, but too often this disorder remains a taboo subject. As well as impotence: medicines for erectile dysfunction can be prescribed free of charge to cancer patients, while penile prosthesis not yet. Talking to doctors is important to live better – he underlines Massimo Di Maio, director of Medical Oncology 1U at the City of Health and Science of Turin and general secretary of Aiom (Italian Association of Medical Oncology) —. The first step is to talk to your doctor, explain the side effects and ask for solutions. There is no need to be afraid or embarrassed, together we can manage the consequences of the treatments.

Side effects of hormone therapy

Fatigue, both physical and mental, weight gain, hot flashes, sweating, anemia, osteoporosis, reduction of muscle mass, reduction of libido and erectile dysfunction, as well as alterations in cognitive function, such as difficulty concentrating and memory loss. Although it is well tolerated by most, the list of possible unwanted consequences of hormone therapy is long, but even in this case there are strategies to guarantee patients a good quality of life. The goal of hormone therapy block the growth of an advanced stage carcinoma, in the presence of metastases, and has the aim of controlling the neoplasm for as long as possible, often for many years – clarifies Di Maio -. Furthermore, sometimes it is offered for a limited period of time even when the diagnosis occurred at an earlier stage and the patient has undergone surgery or radiotherapy. It is prescribed to thousands of Italians every year, generally for long periods: the oncologist must not underestimate the toxicity of the treatment and the ailments reported by the patient, who must be informed in advance of the possible inconveniences. I will be able to manage them better if it is prepared beforehand.

Active surveillance, better if possible

The one in the prostate the most frequent tumor in men and the new cases recorded in 2023 in Italy were approximately 40,500. Thanks to early diagnoses and increasingly effective therapies, today over 90% of patients are able to recover or live with the disease for decades. Also thanks to diffusion of the Psa testwhich allows for early diagnosis, 90% of cases are detected in the early stageswhen the carcinoma is localized and has not yet metastasized – he explains Giuseppe Procopio, director of the Prostate and Genito-Urinary Medical Oncology Program at the IRCSS Foundation National Cancer Institute of Milan —. In these circumstances there is no absolute “best treatment”, universally valid for everyone: surgery, radiotherapy and brachytherapy have proven to be able to offer very good results, but with active surveillance (reserved for people affected by small size and minimal aggression) that side effects can be completely avoided by carrying out only periodic tests and checks. In fact, the EUPROMS survey shows that active surveillance is the approach that best preserves patients' quality of life.

Psychological support

Of course, the diagnosis of prostate cancer inevitably establishes a before and after in a man's life. As with any tumor, the first emotional reaction is a strong disorientation combined with fear regarding one's survival – he says Lara Bellardita, psychologist and psychotherapist, member of the Scientific Committee of Europa Uomo —. The positive fact that we have been able to find in many years of practice is that, when the patient and family members begin to know what the possible therapeutic options available are, they are able to activate a series of individual resources, which allow you to deal with the disease and the diagnostic-therapeutic path. Those who carry out active surveillance, at least at the beginning, do not have to face invasive therapies and, although they experience a certain amount of anxiety about the checks, they maintain a good quality of life and he does not experience the monitoring protocol in a particularly worried way. And if every patient has a history as (not everyone needs psychological support), Vulnerability factors should always be identified in order to be able to offer adequate rehabilitation and healthcare responses. It is essential that people are supported in drawing on their personal resources to deal with the disease and treatments in the best possible way, concludes Bellardita.

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