EUROPE UOMO (of which FEFOC is a member fundacional), the European organization that is on the point of celebrating his fifth year of functioning, there adheres a Week Urológica Europea that begins next September 14, organized by the Europaean Association of Urology (EAU).

The central topics of this year are the prostate problems and the erectile malfunction (OF). It is a question of making aware on these problems, especially between the men of more than 50 years.

Let's attend on the following information:

*El prostate cancer is the second cause of death in the western world.

*Cada year, and only in Europe, there are detected approximately 346.000 new cases of this cancer.

*Más of 50 % of men on 50 years they have problems urológicos due to benign conditions.

*Datos epidemiologic they indicate that that OF es a significant problem between the men in the whole world. About the year 2025 it is anticipated that 42,8 million Europeans will suffer OF.

*La shame and non-giving importance to certain symptoms do that many men do not come to his doctors when they experience problems urológicos.

POINTS FIX FOR THE WEEK UROLÓGICA OF 2009

CANCER OF PROSTATE:

1. Many men develop benign prostate problems and many will have problems for which he gets ready of medical and surgical treatments and both are very effective.

2. The prostate cancer alone priest if it is detected in his initial stadiums, that is to say, when it is limited to the prostate gland. PSA and kinetics of the PSA (PSA speed or time of folding of the PSA) the patients help to detect at the risk of having prostate cancer.

3. The cancers diagnosed in the programs of precocious detection not always need treatment. Active alertness in chosen patients is a reasonable option that even allows, if it is that it needs, his treatment during the pursuit of the patient.

4. The hormonal treatment affects severely the quality of life but, when it is necessary, his side effects can diminish by means of physical activity, nutrition and psychological support.

5. New bioscoreboards are developing for the diagnosis and the prognosis of the cancer of prostate.

6. Recent results of the essay randomizado screening European say to us that the screening saves lives but the study still remains opened.

7. A familiar history of cancer of prostate is not an anecdote: watch his children and brothers if you have had this cancer.

ERECTILE MALFUNCTION (OF)

1. OF puede to be the symptom of presentation of hypertension, hiperlipidemia, diabetes and hormonal changes. It is important that all the men with OF sean valued if they present these pathological conditions.

2. The urologist is the specialist who better can advise him on the prevention and the control so much of the symptoms of the low urinal device as of that OF, that are associated often one with others.

The patients with cancer of prostate of low aggressiveness can decide in favor of the so called strategy "to Wait and to see" that is to say to defer the treatment but there are complications. Martin Sanda, of Beth Israel Deaconess Medical Center and other hospitals (Brigham and Women's Hospital, Harvard School of Public Health and the University of California, San Francisco) 3331 men have checked with prostate cancer, diagnosed between 1986 and 2007. 10 % of the same ones, 342, chose not to talk each other initially. Between 10 and 15 years later, half of these patients still had not needed treatment.

As for mortality, between 342 men who chose not to talk each other initially and who had tumors of low risk, only 2 % of deaths took place, for 1 % between those who, with tumors also of low risk, preferred to talk each other initially.

The authors attract attention to the fact on that the patients with tumors of low risk who preferred not to talk each other, avoided the serious changes in the quality of life that depend on the treatments (powerlessness, incontinence of urine, etc).

The sugerente conclusion to which the authors come is the following one: 1. Thanks to the PSA one has progressed very much in the precocious diagnosis of the cancer of prostate. 2. Instead of leaving the PSA - as so many studies of his value in the masses screening suggest, since it is a cause of an excess of diagnoses and treatments - they propose to keep on using it to differ between tumors of low risk (and after these do not treat them but to spend them to the waiting strategy, while those cases would keep on treating only with tumors of average and high risk).

According to FEFOC, this work is very suggestive and it is necessary to value it deeply. To know the system of risk of the cancer of prostate, it is explained extensively on the page exclusive FEFOC for the prostate cancer (www.recaf.net).

Diverse publications happen without it clearing up definitely if the screening by means of PSA is a cost / cash in prostate cancer. The basic topic is that in many investigations it has not been demonstrated taxativamente that by means of the screening it diminishes the mortality for prostate cancer, although someone point at the opposite.

In an extraordinary titled leading article "The screening for prostate cancer - The controversy that rethirty-second note to die" and published in The New England Journal of Medecine (volume 360, nº 10. in March, 2009), the doctor Michael J. Barry was offering us a magnificent review and putting on the day of the problem. He was telling that, in USA, although the information of the screening is contradictory, most of men of more than 50 years have realized one day the PSA; also: 95 % of urologists and 78 % of doctors of primary assistance:. And that the percentage of mortality for this cancer has been diminishing from 1992, five years later that the PSA was interfering.

On the other hand, the model of presentation of this cancer has gone on from most of patients with metástasis, especially bony, to a more predominant illness like located cancer. The detractors of the screening say that, in fact, the improvement in the prognosis that is observed in prostate cancer stems from the improvement in the treatments. But existing account that these little have been modified in his extract, FEFOC thinks that it is more probable than the benefit in the survival stem from the increase of the precocious diagnosis.

And since it has improved the precocious diagnosis if the administrations do not recommend do they usually carry out the public screening by means of PSA?. Since it is clear: because while the question is solved, most of persons and many doctors have decided for his account to realize the PSA, as it gets rid of the information exhibited by the doctor Barry and that we all observe in our daily practice.

In screening for prostate cancer we are in what Thomas Khun had classified of course under the prescientific stage, before to the paradigm. In effect, at present there coexist in competition diverse schools or ways of tackling this topic. There is no homogeneous scientific community and there are difficulties to be understood mutually.

There are, in short, two fundamental official lines, that of those who are against of the screening for cancer of prostate (according to them it does not improve the survival and produces a big number of patients sobrediagnosticados and on agreements) and those who recommend it from 50 years.

For FEFOC the situation is clear, in this prescientific stage, while the persons do not clarify the facts to themselves and many doctors have taken for the enmedio street and are realized by his account the PSA. In fact, the precocious diagnosis has improved. We will continue with this exciting topic.

Other one of a lot of polemics that make a detour to the cancer of prostate (CP) is the duration of the hormonal treatment after the local treatment (surgery or radiotherapy) in patients with CP locally advanced (that is to say, when the tumor has spread from the prostate to the textiles of around over contiguity, but they have not taken place metástasis).

(Known like deprivation or suppression androgénica, on having inhibited the production and function of the testosterone) one usually applies the hormonal treatment after the local treatment for the purpose of supporting in the possible thing far from the stimulus of the masculine hormone to the tumor textile that could have remained after the surgery or the radiotherapy. Diverse studies have given different information on the duration that has to have the hormonal treatment in these cases. For some, 6 months they are enough, for others, it is better three years.

To decide this question it is necessary to shuffle two information: one, the survival of the patients with a system or other; other, the quality of life of the patients. The hormonal treatment modifies negatively the quality of life, since the patient experiences sexual powerlessness, suffocations, more risk of bony breaks, feminización (loss of hair, increase of weight, especially in hips, sometimes I increase of painful size of the breasts). Given such unpleasant consequences, they have to demonstrate to us that the benefits on the survival are really notable if the hormonal treatment extends very much.

The last work that has attracted attention on this matter is published in The New England of Medecine, in one a work of the Europaean Organization for Research and Treatment of Cancer (EORTC) and led for M. Bolla, in that there is studied the preferable duration of the hormonal treatment in cases locally advanced of CP, after radiotherapy.

Bolla and cols they included 970 patients. Deprivativo applied for 6 months theirs hormonal treatment to all. Later, the patients were randomizados between not more hormonal treatment (hormonal suppression to short term) or two more years and a half of hormonal treatment (long suppression). They followed the patients with a median of 6,4 years. Of the first group there died 132 patients (47 of CP) and of the second group, 98 (29 of CP). But the global mortality for the first group was 19 % compared with 15,2 % for the second group.

The proper investigators appreciate that "the difference in mortality at the age of 5 was modest between both groups". Despite it, they recommend the long treatment.

FEFOC values very much the damaged quality of life of the patients with CP under hormonal treatment and thinks that the studies results like this one, with so modest differences, are not the best support to extract conclusions.

One of problematic the most common related ones to the cancer of prostate and his treatment is undoubtedly everything what concerns the sexuality and the communication between the couple. A study realized in the University of Texas shows the need to put attention to these aspects as part of the recovery of the patient.

The sexuality remains spoiled in the patient with cancer of prostate, with estimations with regard to numbers that go of 33 to 98 % according to the studies. The problematic ones go from the loss of the impulse or desire, up to the incapability for supporting the erection, the ejaculation and reaching the orgasm. This topic is b in mind in the approach to the multidisciplinary treatment of the patients, together with his couples.

In the Department of Behavioural sciences of the University of Texas of the M.D. Anderson has realized a study interviewing 116 affected patients of cancer of prostate and his couples. The authors of the study administered the participants, a few questionnaires with regard to his sexuality, proving that really there are a few high valuations of sexual malfunctions in this group. Comparing between patients and his couples, the agreement valuation with regard to the sexual functioning, it turned out to be of moderate to high, that is to say that, in general, there was an agreement grade in this sense. When the problems in particular was with regard to the difficulties of erection of the man, his couple had more tendency to show communication difficulties on this matter, with clear avoidance it was doing this topic. This, according to the information found in the same study it was clearly related at high stress levels on the part of the couple of the patient.

On the other hand, the couples that presented a high level of constructive communication, counted also well as for his mutual understanding as couple, independently of the shown sexual satisfaction.

The results of this study show the need for a psychosocial intervention that facilitates the healthy communication between the couple and that also goes to the needs for sexual rehabilitation on the part of the patient and his couple. Although there are studies that they confirm that the couples that have happened for the experience of the cancer in one of his members, are unwilling to speak about the sexual topic, these conversations might help to relieve very much the negative impact that the prostate cancer in this case, has in the sexuality but also in the good general functioning of the couple.

The study belongs to Hoda Badr and Cindy Taylor, and it is published in the magazine Psychooncology, vol. 18, number 7, pages 735-746.

In FEFOC we surprise the absence of persons' protest movements with cancer of prostate (CP) and men in general. And motives are not missing. 1. Neither the sanitary authorities nor the administrative ones clarify if the PSA is effective in the precocious diagnosis of the CP. But, the reality, the fact is that nowadays most of men, when they are diagnosed of CP, it are in initial stadiums. Probably it is due to the fact that many general practitioners request it for his account as well as many men for his. It does not stop being a strange situation. 2. The treatments have not evolved in the last 40 years, in any case there is sophisticated one. But, if in the 60s of the XXth century the surgical castration was practised to eliminate the principal source of production of testosterone, nowadays one proceeds to the chemical castration by means of medicines. But the base of the treatment is the same, the castration. 3. The surgical eradication (prostatectomía) produces in a majority of cases sexual powerlessness, because the essential nerves are cut for the erection. But he gets ready of a surgical form that tries to avoid the section of the above mentioned nerves. 4. Most of patients receive neither information nor sufficient support.

A movement for the CP should gather these, and of course other points. 1. To clarify the situation of the PSA. 2. To investigate and to obtain effective medicines in CP not based on the castration. 3. To make the prostatectomía obligatory preserving the nerves of the erection, whenever it was possible. 4. To promote the groups of support and information for patients and his relatives.

The doctor Bruce Montgomery and collaborators, of the University of Washington, have checked information of approximately 320.000 men with cancer of prostate (CP). The work is published in Cancer. Of his study it is deduced that the advanced CP is more aggressive when it presents to itself in young patients that in major, with minor percentages of survival in the youngest.

This information advises to check the treatment of the young patients, on having talked each other of patients with high risk. Little studies have studied the patients' survival with CP in wide age groups.

In his study, Montgomery and collaborators introduced patients of all the ages, with a life expectancy of 68 years. In the patients with Gleason between 5 and 7, at major age less survival, which was the awaited thing. But, in an unexpected way, they observed that the young patients with tall Gleason and stadium III of the illness had 5 more probabilities of dying of CP that the patients of major age with the same risk
.
The paradox is established so in the above mentioned patients. It was thought, in general, that the young people had better life expectancy that the biggest, in any clinical situation, that is to say, with independence of the risk that they had, it was low, average or high. But it is not like that, at least as for the patients of major risk

These facts make precise a deep review of the CP advanced in young people and the investigation of new treatments that could improve his prognosis.

The doctors A. Pantuck (of the Departament of Urology, David Geffen School of Medecine, University of California) and collaborators have presented in the annual meeting of American Urological Association, a study in 48 persons with prostate cancer, which they followed for 6 years. The participants had prostate cancer, with a PSA in increase after the local treatment (surgery or radiotherapy), a PSA superior to 0,2 ng/ml and lower than 5 ng/ml and a Gleason (to see in www.recaf.net) of 7 or less. These patients were treated drinking every eighth ounces of juice of grenade.

The investigators compared the results in the patients who stayed active in the protocol with that others that were leaving it. In the active group they observed that the time of folding of the PSA was extending of a way as per statistics significantly and that the decrease in the average PSA was major than in the persons who left the study. Also, at laboratory studies level with cells of the patients there was observed a decrease of 12 % in the procentaje of cellular proliferation and with an increase of 17 % of the apoptosis (programmed cellular suicide), positive information that show the inhibiting effect of the growth of the juice of grenade.

Some patients proved to be particularly sensitive to the positive effect of the juice of grenade. The authors think that some day will be discovered probably that the grenade juice is really active in persons with prostate cancer and whose treatment has not been a cash. Also it can become a good way to prepare the prostate cancer. At present it keeps on valuing his effect, in a wider study.

The doctor Gary M. Onik, the director of the Center for Safer Prostate Cancer Therapy, in Orlando, Florida, USA, has presented to the SIR (Society of Interventional Radiology) 34th Annual Scientific Meeting, an interesting work in 120 men with cancer located in the prostate, agreements by means of crioablación focused in the tumor. It is a question of a very little aggressive intervention and with excellent results, as tells his author.

Onick treats only the tumor, instead of the whole prostate. The radiologists insert a pipe across the skin in the periné (between scrotum and year), using images (3-D transperineal) to direct the inserted needle in the probe. Once in the tumor, along the probe there circulates extremely cold gas that destroys the tumor textile. The alone treatment affects to the tumor, respecting the healthy adjacent textiles. The patient can go to his house the same day of the treatment and the treatment, if it needs, it is possible to repeat in the later years.

Onick names this method "the tumorectomía of the man", making her similar to the conservative treatment of the breast cancer (to see in www.cancermama.org), treatment that exists sustituído largely to the mastectomy. In contrast to the breast, a tumorectomía in prostate cancer is difficult technically. Therefore, to treat only a portion of the prostate the minimally invasive crioablación is needed. This skill, which does not go, as the classic crioterapia, to the whole prostate, limits the effects on the sphincter vesical and the nerves of the erection, diminishing the risks of incontinence and of powerlessness.

This way, of 120 agreements, 85 % retained the sexual function. All those who previously had not been treated by prostate surgery, did not have urinal incontinence. Also, 112 patients (93 %) did not have cancer evidence, although 72 of the same ones had average and high risk for relapse.

This conservative treatment, thinks FEFOC, of be verifying in more patients, opens the door for the hope of a future for the patients with cancer of prostate who do not have to pay the terrible toll of the incontinence and the powerlessness for his healing.

Sreekumar A. Poisson and collaborators, investigators of the Michigan Center for Translational Pathology, in Ann Arbor, with the support of National Cancer North American Institute, publish in Nature, of February 12, the results of an important work in prostate cancer. Although the studies genómicos and proteonómicos they have characterized to many proteins related to the cancerización process, little is known on the metabolic changes that mark the tumor progression.

The metabolism, on which this study is based, is the study of the chemical trace that the cellular process leaves behind, what the cancerización can help the scientists to interpret. One of the challenges that the scientists confront is of integrating the information genómica, proteómica and metabolic, to possess a more finished picture of the living organism and of the illnesses that affect him.

Using a skill well established in the laboratories, the spectrometry of mass, which classifies the chemical compounds for his molecular weight, the investigators outlined more than 1126 metabolitos proceeding from 262 clinical samples related to the cancer of prostate. These metabolitos were selected up to staying with six, of which one, the sarcosina, showed to be significantly raised during the progression from a benign prostate growth to a cancer of prostate located even to one metastásico. For this characteristic, sarcosina was selected by it for more studies.

Then they practised them with cells cultivation. They observed that the sarcosina levels were more raised in invasive cells of cancer of prostate than in the benign ones. And even that the sarcosina addition to the cellular cultivation towards which benign cells were transforming in invasive.

It is possible that the sarcosina serves for the diagnosis, the prognosis and the therapeutic interventions of the patients with prostate cancer.

The doctor James Carmody and collaborators, of the University of Massachusetts Medical School, in Worcester, have published in Urology a study in 36 men with cancer of prostate confirmed by biopsy, treated locally more than 6 months earlier and that they were presenting increase of the PSA.

The investigators assembled the participants and his couples. Then, the randomizaron in two groups: the first one attended on 11 classes on feeding and kitchen, emphasizing in the same ones the importance of a diet rich in food vegetable and fish; the second one, was a group control that did not receive this formation.

The investigators controlled the quality of life of both groups, levels of PSA (to the beginning, at the age of eleven weeks and at the age of three months).

The informed group consumed signficativamente less unsaturated fats, more proteins vegetables and less proteins of animal origin, including dairy products, that the group control. The first ones also communicated improvement in his quality of life.

Although there were no significant differences in the percentage of increase of PSA between both groups, the average time of folding of the PSA of the informed group was substantially more long 3 months after study than the correspondent to the group control.

The authors recommend that future studies should examine the effect of a healthy diet for the prostate in a wider patients sample and with major learning time.

In case of having being diagnosed of prostate cancer, of course he will want to speak with his doctor to find out everything what he is interested in.

We gather of Guardian.co.uk an interesting relation of questions on this matter:

1. Does he well be sure that I have cancer? (Are sure the tests that it has realized to me?).

2. What size does my tumor have?

3. Has my cancer spread?. Cúal be his stadium?. It is well sure of that this is my stadium?

4. Do I need other tests to know if my cancer has gone on to the lymphatic ganglions of the abdomen or to other parts of my organism? Are these tests of confidence?

5. Is Cúal the grade of my tumor? (The grade says to us how aggressive the tumor and the probability is of that spreads)

6. What importance is had by my age and my general health state? Will this affect what is going to happen to me?

7. Although now I have no symptoms: can it go so far as to have them?. In what can these symptoms consist?

8. Every when I will have to check myself?

9. Is Cúal the best treatment for me? Do I have several alternatives?

10. Explain the side effects of the treatment to me?

11. What possibilities do I have of recovering? How long will I live?

12. What can I do to help myself? Do I have to change any aspects of my life style?

13. How can I tell to my family that I have cancer?

Lauren P. Wallner and collaborators, of the University of Michigan, publish in Cancer Epidemiology, Biomarkers and Prevention an interesting study realized in 2247 males in ages understood between the 40 and 79 years. They were interrogated if they had familiar history of cancer of prostate (CP), fear of enduring it and the marital state.

The men with familiar CP history preferred in more 50 % to take part in the precocious diagnosis of the CP, compared with those who did not have this precedent. Those who worried about the CP, twice more than not worried.

But the probability of which a man with familiar history was accepting the precocious diagnosis was going down very much if the above mentioned person was living alone. Specifically, the men who were living alone were inclined to the screening in 40 % less than that they were living with feminine couple. In the study it was not analyzed which it was the cause of this difference, but it seems opportune, to improve the acceptance of the screening for CP, to speak to the couples apart from to the men.

OPINION OF FEFOC. This work confirms something that we have observing for a few years, in the groups of support. In these we stimulate the patients who come accompanied by his couples. The CP is a cancer of the couple, both before the diagnosis and in the treatment and after the same one.

Jay H. Fowke and collaborators, of Vanderbilt University, have presented in the 7th Conference ("Borders in the investigation of the prevention of the cancer") Internationally Annual of American Cancer Research, a study for which the influence of the aspirin is valued and anti-inflamamtorios not steroids (ANES). They included in the study 1277 participants who had been sent to the urologist for prostate biopsy., for diverse illnesses as regards this one. Approximately 46 % was taking AINES, especially aspirin (37 % of the whole of persons).

The investigators observed that the use of aspirin was accompanied of minor levels (9 % lower) of PSA compared with men who were not taking it. They thought that perhaps aspirin was reducing the volume of the prostate and, therefore, perhaps of the volume of this gland. But it was not like that, the volumes of the prostates of the persons were not changing because they were taking or not asprina. Also, this effect, of diminishing the PSA, was more marked in those with cancer of próstaa than in those who had other illnesses of the prostate.

This information raises two hypotheses, to verify: one, that the aspirin has a protective effect against the prostate cancer, diminishing his activity; the second one points that the aspirin diminishes the PSA level for another different, not well-known mechanism, but that it can have harmful consequences. In effect, if the aspirin reduces the level of PSA - without effect on the tumor - it can delay the diagnosis, what would be negative.

The investigators conclude in the need to clarify the mechanisms by means of which the aspirin modifies the PSA, for aclrar if really it reduces the risk of cancer of prostate or simply it reduces the PSA level without antitumoral effect.

More and more patients with cancer will meet in the situation to decide which is for them the best treatment to be continued. In this decision several factors have his influence, between them the personality features, as it demonstrates a recent study.

The anti-cancer treatment offers more and more diverse possibilities to the patients. And so, in the future the patients will meet increasingly in the tessitura to have to choose between two or more treatments once well informed on the part of the doctor. In the decision making, one of the factors that, undoubtedly, influence is the personality of the subject.

An American group (Orom and others) they have published a study in the magazine Psycho-oncology, in the number of September in which they analyze what characteristics of a group of patients with prostate cancer can lead to them to a decision and to his satisfaction with the select option.

The authors have interviewed a group of 202 men suffering from cancer of prostate, of whom it was refilled properly by 78,71 % (159) of the sample. In the administrated questionnaires there were included measurements of optimism, car efficacy perceived at the time of choosing the treatment, satisfaction with the elected option and difficulties in choosing the treatment.

The results show several interesting information: in the first place the optimism changes according to the level of studies of the patient: the patients with more occupational training grade are more optimistic. The autoefficacy perception collaborated significantly to the capacity of decision and to the satisfaction with the select treatment option. In this sense, it is necessary to say that 31 % of patients considered to be difficult or very difficult to take a decision. Both factors (optimism and autoefficacy) weighed significantly, as well as the side effects of the treatments to be chosen. The characteristics sociodemográficas had no influence in the results of the study.

These results are important, since they throw light on a topic much of actuality, as it is the decision making in the anti-cancer treatments. Increasingly, the patients with cancer are going to turn out to be exposed to an informative offer consisting of diverse types of treatments or combinations of the same ones. It is logical to think that this process is going to be influenced by diverse characteristics of the subject. Between the same ones, and according to this study, there is the perception of autoefficacy (until point the patient feels effective at the time of deciding) and other one is the optimism (like positive attitude before the illness). These results must be studied more thoroughly, so they would imply a way to promote psychologically the safety of the subject at the time of deciding with certain self-confidence.

One of the big problems of health of the man in the XXIst century is the prostate cancer. Despite it, one speaks little of this cancer and less his problems. For it, we exhibit here a set of realities and recommendations to help the men, his couple and the Society, to face as a whole with the reality of the cancer of prostate (CP).

1. THE INCIDENCE OF THE CP INCREASES YEAR AFTER YEAR. AT PRESENT ABOUT 13.500 NEW / YEAR CASES REGISTER IN SPAIN AND APPROXIMATELY 6.000 PERSONS / YEAR DIE FOR CP, BOTH NUMBERS AT THE LEVEL OF THE PROPER ONES OF THE BREAST CANCER (CM)
2. AFTER HIS FUNDAMENTAL CAUSE IS IGNORED, THERE IS NO POSSIBLE PREVENTION.
3. SOME WELL-KNOWN FACTORS THAT CAN INCREASE THE RISK OF ENDURING IT ARE FAMILIAR PRECEDENTS OF CP, SEDENTARISMO, EXCESSIVE CONSUMPTION OF MILK DERIVATIVES AND DEFICIT IN VEGETABLES AND FRESH FRUITS.
4. ON THE CONTRARY, THE DAILY PHYSICAL EXERCISE, THE MEDITERRANEAN DIET AND IN A CONCRETE WAY, THE SEED OF LINEN AND THE LICOPENO CONTAINED IN THE TOMATO, THEY WOULD ACT FAVORABLY DIMINISHING HIS RISK.
5. THE PRECOCIOUS DIAGNOSIS OF THE CP HAS IMPROVED IN A SPECTACULAR WAY WITH THE SIMPLE DETERMINATION IN THE BLOOD OF A SUBSTANCE KNOWN AS PSA, PRODUCED BY THE PROSTATE AND BY THE TUMOR. IN EFFECT, BEFORE THE PSA, MOST OF PATIENTS WERE DIAGNOSED BY WIDESPREAD ILLNESS (METÁSTASIS), INCURABLE.
6. NOWADAYS, IN CASE OF ENDURING CP, MOST OF PERSONS TO THOSE THAT THE PSA PRACTISES ON ITSELF, PRECOZMENTE IS DIAGNOSED WITH TUMORS LOCATED IN THE PROSTATE AND THEREFORE, CURABLE.
7. IT IS FOR IT WHY THE MEN OF MORE THAN 50 YEARS (OR OF MORE THAN 40 IF THEY HAVE FAMILIAR PRECEDENTS OF CANCER OF PROSTATE) MUST REALIZE AN ANNUAL PSA.
8. THE CONTROL OF THE PSA CAN REDOUND TO A PROBLEM OF ANXIETY SO CALLED ‘PSAITIS ’. IN MEN PERFECTIONISTS WITH TENDENCY, TO CONTROL EVERYTHING, IT CAN GO OVER TO OBSESSIVE FEATURES THAT CAN NEED THE HELP OF A PROFESSIONAL.
9. GIVEN THE BIG ADVANCE IN THE PRECOCIOUS DIAGNOSIS, THE TREATMENT OF THE CP LOCATED (SURGERY OR RADIOTHERAPY, BOTH EQUAL OF CURATIVE) IS VERY CURATIVE.
10. BUT THE PATIENTS PAY AN EXCESSIVE AND UNJUST TOLL, SINCE, ESPECIALLY THE SURGERY, IT CAUSES THEM TO THE MAJORITY DIVERSE GRADES OF SEXUAL POWERLESSNESS (BUT WITH CONSERVATION OF THE LÍBIDO!).Y A BASTANTES, URINAL INCONTINENCE.
11. THE HORMONAL TREATMENTS (THAT ARE APPLIED EARLIER AND AFTER THE LOCAL TREATMENT OR IN PATIENTS WHOSE ILLNESS RETURNS AFTER THE LOCAL TREATMENT OR IN PATIENTS WITH METÁSTASIS) KEEP ON BASING IN THE LAST 40 YEARS IN THE CASTRATION.
12. IF THE HORMONAL TREATMENT IS PROLONGED, APART FROM THE ABSOLUTE SEXUAL POWERLESSNESS, THE PATIENTS SEE AS THE VOICE SHARPENS THEM, HIS HIPS EXPAND, THEY LOSE THE HAIR AND EVEN THEY THE BREASTS GROW. IN A WORD, I KNOW FEMINIZAN.
13. THE CURRENT SITUATION OF THE PATIENTS WITH CP WHO NEED HORMONAL TREATMENT IS SIMILAR TO THAT OF THE ADVANCED CM 40 YEARS AGO. THEN, TO TRY TO RESIST THE STIMULUS OF CELLULAR GROWTH OF THE FEMININE HORMONE, MASCULINE HORMONE WAS PRESCRIBED TO THEM, WITH WHAT THEY WERE MASCULINIZED (THEY HAD TO SHAVE OFTEN, SERIOUS VOICE, ETC), WITH DEEP DETERIORATION OF HIS QUALITY OF LIFE.
14. THE CP AND HIS TREATMENT PROVOKE PROBLEMS IN THE MASCULINE SELF-ESTEEM AND, IN THE LONG RUN, DEPRESSION. THE FREQUENT COINCIDENCE OF THE CP WITH THE AGE OF THE RETIREMENT AND THE INDEPENCIA OF THE CHILDREN THEY CONTRIBUTE TO THE FEELING OF GAP, SADNESS AND SOLITUDE. IT TURNS OUT TO BE MORE DIFFICULT TO RECOGNIZE, TO LOOK AND TO ACCEPT PSYCHOLOGICAL HELP TO THE MAN.
15. THE CP TURNS INTO A PROBLEM OF COUPLE. IT IS NECESSARY TO ESTABLISH OPEN BONDS OF COMMUNICATION AND TO CONFRONT IT LIKE A COMMON PROBLEM. THERE MUST BE LOOKED ALTERNATIVE ROUTES THAT SATISFY BOTH, IF IT IS NECESSARY WITH THE HELP OF A PROFESSIONAL EXPERT IN SEXOLOGÍA.
16. SINCE THERE IS DEC HO OF OTHER SITUATIONS, IT IS NECESSARY THAT THE MEN WITH CP GO OUT OF THE CLOSET. IN EFFECT, AS WELL AS IT IS RELATIVELY EASY TO FIND READY WOMEN TO COLLABORATE WITH OTHER WOMEN IN HIS SITUATION AND TO GIVE PUBLIC TESTIMONY, THE AFFECTED ONES BY CP WITH BREAST CANCER USUALLY HIS SITUATION AND DENY PRETEND HIS TESTIMONY.
17. IT IS DUE TO A GREAT DEGREE TO THE FACT THAT THE TREATMENT OF THE CP AFFECTS DEEPLY TO THE MASCULINITY. BUT AS WELL AS BEFORE THE CM, THE WOMAN COLLABORATES, THE MAN, WITH CP, GOES AWAY, SOLITARILY, TO INTERNET.
18. THERE HAS COME THE MOMENT OF WHICH THE MEN WITH CP GO OUT TO THE PUBLIC LIGHT, COLLABORATE FEFOC-MOVEMBER AND FIGHT FOR RADICAL CHANGES IN THE TREATMENT OF THE CP.
19. IN THE XXTH CENTURY, IN THE 70S, SWEDISH WOMEN WITH BREAST CANCER WENT OUT TO THE STREET, TO THE MAGAZINES, TO THE TELEVISION, TO PROCLAIM THAT IF THE SURGEONS HAD BREAST CANCER THEY WOULD HAVE ALREADY FOUND THE WAY OF WHICH THEY WERE NOT CUTTING THE BREAST. THEY DID OF THE TOPIC OF THE CM A FEMINIST REINVINDICACIÓN. THIS WAY THERE BEGAN THE REVOLUTION OF THE TREATMENT OF THE CM, WHICH CULMINATED WITH THE CALLED CONSERVATIVE TREATMENT.
20. THE MOMENT HAS COME FROM THAT WE DO OF THE CP A TOPIC OF MASCULINITY OF GOOD. MEN WITH CP: GO OUT OF THE CLOSET, ASSOCIATE YOU WITH THE GROUPS OF SUPPORT OF FEFOC AND HELP US TO REVOLUTIONIZE THE SITUATION OF THE PRESENT PATIENTS AND YOUR PROPER FUTUROSPARA I AM OF BENEFIT AND SO THAT OTHERS DO NOT SUFFER WHAT HE HAS HAD YOU TO SUFFER!

The doctor Charles Scales and collaborators, of Duke University, Durham, North Carolina, USA, publish in the magazine August Cancer, a study realized in 58.511 men taking part in 2002 behavioral Risk Factor Surveillance System.

Globally, 22,5 % of men in ages between 40 and 49 years and 53,7 % of major than the latter age, communicated that in the previous year a PSA had been practised in to the year previous to the study. The statistical significance between both groups was p <0.001 in favor of the biggest of 50. As a whole, one of the five men younger than 49 years had practised the test on himself for more of one of every two of the biggest.

This topic is important in a moment in which many doctors consider important to extend the PSA to this group of young men.

There is so much contradictory information on the moment to initiate the PSA that is difficult to continue or to advise an agreed strategy. This way, American Cancer Society recommends to initiate it at the age of 45, and earlier if there have been familiar precedents of cancer of prostate. Others recommend, from 50 years, every person to value the risks and advantages of the annual PSA with his doctor. Also it is recommended the men not to do it to him from 75 years, but others think the contario.

We need more investigation on this matter to be able to provide clear and objective norms.

The authors conclude that it is necessary to intensify the study of strategies based on the estratigficación d elas persons according to risk factors.

FEFOC keeps on being impressed by the cmbio d emodelo of presnetación of the cancer of prostate in persons who were doing previously in a regular way this analysis to themselves. In effect, the located cases are the mayotría.

Doctor Jessica Campbell and collaborators, of the Universityty of Illinois, Urbana-Champaing, publish in Nutrition Research an interesting experimental study on licopeno and other fitocompuestos and his possible benefit in the prevention of the cancer of prostate.

The investigators fed for 30 days male mice by means of a diet based on tomato. They sacrificed later to the animals and analyzed where the compounds contained in the tomato were accumulating, with special attention to prostate and liver. Then they observed that, in addition to the licopeno, fitoene and fitofluene also they were accumulating in prostate and liver. Fitoene more in the liver that the second one and that the licopeno while licopeno it was concentrating mainly on the prostate, continued for fitofluene and fitoene.

This work provides a better comprehension relative to the accumulation of fitoene and fitofluene, compared with that of licopeno.

The licopeno is well-known for the place that it can have in the prevention of the cancer of prostate, cancer which incidence etsá increasing in the last 15 years.

The FDA (Food and North American Drug Administration, says that the tomato reduces the risk of cancers of stomach, ovary, pancreas and prostate. But at the same time, this powerful and important institution has raised later you hesitate on the efficacy of the alone licopeno to protect against some cancers, saying that the scientific evidence does not support this assertion. On the contrary, the FDA thinks that the tomatoes take his protective effect as a different compound, which might be fitoene or fitofluene or to a synergy between several compounds.

The work of doctor Campbell would support again the priority importance of the licopeno in prostate cancer.

Task Force (panel of independent experts more important in prevention and primary health care) of USA, leads very rigorous studies and impartial evaluations on the scientific evidence of a wide bogey of clinical problems prevenctivos, including advice on screening and preventive medications. His recommendations are considerdas as the standard maximum for the preventive topics.

For this occasion they have valued the evidence or it does not demonstrate of the benefit of the screening in cancer of prostate (CP). The screening in CP is carried out usually by means of the determination of the PSA and the rectal tact. It is more probable that the cancer is detected by means of PSA than for rectal tact. But the CPs detected only by PSA take years before affecting the health. Many CP are late more than 10 years in causing the death.

A 75-year-old man has a life expectancy of 10 years and it is more probable that he dies of other causes than of CP, therefore it is slightly probable, according to Task Force, which the screening for CP could help in that he lives more.

At the same time, the screening hurts sometimes that I benefit, they point out (unnecessary biopsies, unnecessary treatments and false-positive results, which lead to anxiety). The treatment of the CP leads often to severe complications, like incontinence and powerlessness. These indolent CP (of slow growth) of course had never affected the health of the patient or his well-being but had been detected by the screening.

Current information shows that in USA more of the third part of men of more than 75 years practises the PSA on themselves but many medical organizations suggest that this determination to be discontinued in men of less than 10 years of life expectancy. Precisely the present study carried out by North American Task Force is the first one in that explicit specifically an age, 75 years, over which the screening or it will be infectivo or harmful.

As for men of less than 75 years, the information continues without being concrete as for his benefit, Task Force always continuing. They think that every person must consult with his doctor to value the risks and advantages of the screening for the sector of age of less than 75 years.

From the point of view of this FEFOC it is an important work, but it leaves a doubts sea. Especially as for the persons younger than 75 years or you present yourself hopefully of life of more than 10 years. The true thing is that the bogey of the CP has changed radically in the age PSA: in effect, most of patients are diagnosed in early stages of the illness, without metástasis, more easily controlables. At least in persons of less than 75 years we recommend the screening and, inviertiendo the terms, we believe that, from 75 years every person must consult with his doctor so that it values his individual case and his life expectancy and its own preferences.

In Urology Times I taken one to end gathers a study phase in the University of Iowa, Iowa City, USA, directed by the doctor Richard D. Williams and collaborators. 32 patients included with cancer of prostate placed in advanced stadiums D2 or D3. The target of the study was of valuing the presence or absence of toxicity of a vaccine at the same time that to try to be necessary which would be his ideal dose.

They prepared a vaccine PSA/adenovirus, sure for the being human and capable of provoking an immune answer of the proper organism, with production of anti-PSA antibodies and cells T. The patients in the essay were treated by only one subcutaneous injection of those who were arranging to themselves three levels as his aptitude to obtain answer. The patients, after the injection were controlled physics, clinic and analytically to 14 and 21 days and later 2,4,8 and 12 months later.

The medium survival of the patients was 18 months with a patient living almost 6 years (ambience between 2,5 months and 71 months). The time of folding of the PSA increased in 48 % of patients (positive fact because enlentecer the time of folding of the PSA is parallel to the decrease of activity of the tumor) and their 57 % lived through more of the awaited thing (utiizaron a series of parameters of survival to give this fact).

The vaccine works inducing the immune answer to the PSA in the cells of the cancer of prostate. When the vaccine is injected, the virus enters the cells in the place of the injection. In turn, these cells produce and secrete the protein PSA. The protein, with the virus as accompanist is taken cells with antigenic reaction. The cells emigrate to the regional ganglions, where they induce the cells formation T anti-PSA, that go out of the ganglions and PSA secretoras attack the tumor cells.

The investigators admit that his results come exclusively from an essay phase I, very initial stage of the clinical investigation, which, as was indicated at first, is a phase more faced to toxicity and dose that to value turned out. Nevertheless, it can help that understands better the active immunotherapy to treat the prostate cancer recidivante and resistantly.

The Bond doctor leads, from The Institute of Cancer Research and The Royal Marsden Hospital, both in UK, the investigation of a new medicine, Abiraterone, which can mean a big hope for patients with prostate cancer aggressively, resistant to the habitual hormonal treatments. The study is carried out in ten British hospitals.

The Journal of Clinical Oncology they have published the first results in. The alone medicine has been applied to 21 patients, by what the results, very important, must be confirmed by large-scale clinical essays. Really already there is in march one that will include 1200 patients, all of them with cancer of prostate advanced, aggressive, resistant to the current hormonal treatments and with a fatal prognosis in not long term.

In the preliminary study they emphasize the following clinical benefits: in 70-80 % of patients the PSA it diminished his levels and the tumors his size. The side effects were small. The patients were followed for two years and a half. Several patients could leave the morphine, which they were taking for enduring important bony pains.

Abiraterone, of application oral route, blocks the production of the sexual hormones in all the textiles, that is to say, not only in the testicles and in the adrenal glands but also the generation of hormones blocks for the proper tumor.

The investigators calculate that the general disposition of the medicine will be in the year 2011. Till then, to use it it is necessary to begin to be part of some of the clinical essays controlled at present in march. These essays are slow, if it is compared with the desperation of many patients, but essential to know thoroughly well the beneficial effects (not only on PSA and tumor but also on the survival of the patients) and also to observe other possible negative effects of the same one.

Be as it is, a hope door is opened for the patients with advanced, aggressive and resistant prostate cancer.

The doctor Christian Nelson and collaborators, of the Brief Sloan-Kettering Cancer Center, New York, USA, have published in the number of July of the magazine Cancer an important study on hormonal treatment in case of cancer of prostate like cause of cognitive decrease. For it they have assembled the results of 19 studies on this matter.

The analyzed patients were diagnosed of prostate cancer and were receiving hormonal treatment (to see FEFOC, Types of cancer). The hormonal treatment produces a deprivation of the production of masculine hormone or testosterone.

Between 47 % and 69 % of the men under hormonal treatment showed deterioration in one or more cognitive areas. The most affected were the executive function (achievement of concrete tasks) and the visio-spatial one.

The authors based on studies on animals and on men of advanced age, deduce that the testosterone and his derivatives influence positively the cognitive area across diverse cerebral mechanisms. For example, the testosterone can modulate the neurotrasmisores and can stimulate connections neuronales.

They suggest studies mása finished, in that skills of cerebral image should be included, as it has been done in the studies that have demonstrated the adverse cognitive effects of the chemotherapy in the woman with breast cancer.

Also they alert the clinical ones so that there are conscious of these interrelations, in prostate cancer, between hormonal treatment deprivativo of testosterone and cognitive problems, since this type of treatment increases. The doctors must watch on this matter the patients and monitor them to detect if so worrying adverse effects appear.

FEFOC thinks that there is done a certain abuse of these hormonal treatments, which so many problems cause, apart from warned opportunely in the study that we comment. The most important is, of course, the sexual powerlessness. We say that there is a certain abuse because every time more long treatments are indicated, without it remaining completely clear that they benefit the patient more than less long hormonal treatments. In patients with advanced prostate cancer similar results are obtained by means of discontinuous hormonal treatment (to the demand as levels of PSA) than with the continued entire hormonal blockade, but that is a cause of much of the problems on that we comment.

Also it is true that the solution must be looked in treatments of the cancer of prostate that do not cause so many complications and that alter so much the quality of life of the patients.

The investigators and the industry farmacéuitca have here a big challenge, if they can gather it.

The nurses E. Ream, To. Quennell, L. Fincham and others, of six NHS Trusts (geographical regions of the System of Health of UK), hna published recently, in British Journal of Cancer online (gathered news 17-VI-08) an important study on the levels of psychological distrés, sexual malfunction and symptoms in the low urinal tract, in 741 men with cancer of prostate, who answered to the sent survey.

The treatment of the cancer of prostate (CP) is complex and it endures important consequences (to see in www.recaf.net). The CP is the most frequent cancer in the man. There is an increase of the valuations of survival. In effect, 71 % of patients lives through 5 years after the diagnosis. The intention of the treatments is the healing of the CP but every time there are more doctors who value previously the state urológico and sexually of the patient and then they take in consideration the points of view of the patient, to do a suitable balance between efficacy of the treatment and negative side effects.

There are known little the needs for support of the patients with CP (that is to say, the requests of care that should arise during the illness and the treatment to handle the possible best thing the consequences).

To try to know better the situation, And. Ream and collaborators invited 1848 diagnosed CP men in 3 months before to 2 years. There answered 820, to which there was sent a survey that, in the end 741 answered. 75 % of these had more than 65 years; the half (51 %) they had been treated hormonalmente; 25 % with prostatectomía radical and 28 %, with radiotherapy. 46 % said that his CP was in reference.

The study showed that the patients had a significant percentage of not covered needs for support. The areas of major need were related with distrés psychologically, problems related to the sexuality and to the handling of the symptoms of the low urinal tract. The patients who did not realize well his state as for the illness, had the biggest levels of psychological needs while those that were not in reference of the illness, had major information needs. 30 % of the whole was enduring moderate or extreme anxiety or depression. A similar percentage they had difficulties to tackle usual activities. 26 % was experiencing extreme pain and 22 %, problems of mobility.

During the month before the treatment, practically they all (97 %) had had urinal symptoms, including major frequency miccional and/or need to urinate at night (nicturia). These symptoms were modified by the treatment, reference and time passed from the last treatment. They were less severe in patients in reference, in those agreements by means of prostatectomía and/or in those that had completed his treatment between 19 and 24 months earlier d ela survey.

Needs not satisfied with regard to the sexuality were more frequent in young men and in the agreements by means of prostatectomía.

The authoresses conclude in the need to value better the needs of the patients with CP and from which they receive a major psychological attention.

Some experimental studies (of laboratory) have pointed out that the administration of high doses of vitamin D they can prepare the risk of cancer of prostate. So much it is like that, that in the general recommendations to prepare this cancer, and even for patients that it is already developing, the above mentioned vitamin has being included as beneficial.

But the laboratory works not always coincide with the studies that are done by patients or by persons without the above mentioned illness but at the risk of developing it.

On this matter, FEFOC wants to emphasize the results of an investigation directed by the doctor Jiyoung and collaborators (of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial Project Team) and published in the Journal of the National Cancer Institute (2008, 100, 796-804). In his study 749 men have compared with cancer of prostate and 781 without cancer. They observed two important facts:

1. That the patients with cancer of prostate and high levels of vitamin D in his blood whey, had more aggressive cancers. In effect, most of patients had Gleason grades (to see on this page online) aggressive, between seven and 10. Also III and IV were more the patients with advanced stadiums.

2. Nevertheless, the global risk of developing prostate cancer was not influenced by the vitamin level D.

Nevertheless, the statistical significance was not reached, what these results it is necessary to take them with precaution and to hope that they should be confirmed by means of wider studies.

On the other hand, to emphasize that, once again, the epidemiologic studies and the clinical essays with human beings not always coincide with those of laboratory.