Prostate cancer could double in the world by 2040, is Colombia prepared?

Live longer, with the extension of life expectancy in countries like Colombia, brings challenges for people and the health system. The dynamics of care and diseases that affect an aging population are new, and in the case of men a critical point is found in a small gland (the size of a lemon) located in the lower part of the pelvis: the prostate.

When things go wrong there, as in the case of cancer, sometimes there are warning signs such as urinary obstruction, blood when urinating, pain when ejaculating, among others. However, it is a largely silent disease and, if not treated properly, could have fatal consequences.

Also read: Prostate cancer cases will double by 2040. Why?

A recent report from The Lancetone of the world’s leading medical journals, indicates that by 2040, detected cases of prostate cancer in the world are expected to double, from 1.4 million in 2020 to more than 2.9 million in the next 16 years. years.

The detection of more cases would come with an alert: a possible increase in up to 85% mortality due to this disease, mainly in low- and middle-income countries (LMIC), such as Colombia, whose population pyramid is beginning to change.

This situation is already worrying certain members of the country’s medical community. To put it in figures, prostate cancer in Colombia, according to data from the Ministry of Healthit is a pathology with which they live one in three men over 50 years old. Furthermore, according to the Global Cancer Observatory of the International Cancer Agency of the World Health Organization, by 2022, prostate cancer represented nearly 30% of the two cancers detected in Colombians. Its mortality was 12%.

The truth is that it is largely an inevitable disease: “We know that there are related factors such as being over 50 years old, being a man and a family history with this disease, but it is not something that can be avoided through interventions or a healthy lifestyle, explains Nick James, senior author of the study and professor of Prostate and Bladder Cancer Research at the Institute of Cancer Research in London. “In the next few years there will be an increase in cases and we need to start planning and taking actions, this is especially like Colombia and other middle-income countries that could register the majority of future cases.”

Despite this warning, prostate cancer is not the most lethal of cancers (compared to gastric or lung cancer). Even so, it is a disease that affects the functioning of a gland responsible for sperm nutrition and movementas well as the production of important hormones, such as dihydrotestosterone and estrogens.

The difficulty of detecting cancer

Much of the debate around how to confront this disease focuses on its detection, and how this should be adjusted to the vulnerabilities faced by different populations in the territory.

To understand this issue we have to review what the prostate cancer, and how its characteristics allow doctors to detect it. Cancer is, in a very abbreviated way, the uncontrolled proliferation of malignant or abnormal cells that, in most cases, leads to the appearance of tumors in tissues or organs.

In the case of the prostate, this occurs in 70% of cases in the peripheral area and the 30 remaining in the central area, which is where a key substance for detecting cases is produced: prostate specific antigen (PSA). When you suspect cancer, or want to differentiate processes such as benign prostatic hyperplasia, a blood test is performed to determine its levels. However, this can lead to overdiagnosis.

“It is a challenge with nuances, since the PSA is a low-cost test that allows a first screening with patients, which, when it produces high results, is an red flag that a patient needs attention. Even so, it is a test that can give high levels after a biopsy, having had a sexual relationship, a seminal stone, among other factors,” indicates the doctor specializing in urology and member of the Institute of Cancerology, Iván Patiño.

In addition, there is also the digital rectal examination (which in fact has greater efficiency than PSA. These two can be confirmed with methods such as MRI, or biopsy to confirm the disease. The authors of The Lancet recommend using an informed mix of these given family history of the diseasethose of African origin and carriers of the BRACA2 gene mutation, which are the main risk factors.

“There is a genetic component in this disease that generates greater vulnerabilities for some people, but there are also epigenetic factors (the mechanisms that regulate the expression of genes) such as a plant-based diet, which would reduce these risks,” explains Nick James, author of the study. “What is clear is that we cannot wait for people to feel unwell and seek help: we must encourage those who feel well but are at high risk of suffering from the disease to undergo testing in order to be able to detect lethal prostate cancer early. ”

For his part, the Minister of Health, Guillermo Jaramillohas expressed, in public statements, his objections to the opportunity provided by the EPS to authorize this type of exams in the country, which are key to early detection.

Faced with this, CArolina Wiesner Ceballos, director of the National Cancer Institute, explained a few months ago that “Colombia has a sufficient supply of oncological services. What happens is that you have to have the system organized so that the diagnosis, anywhere, is quick and is sent to the treatment center, which will always be in the big cities. We have problems of fragmentation, of lack of opportunity, because the buildings are not organized. “It depends a lot on the contracts that the insurers have.”

What are the recommendations?

“Unfortunately, in Colombia, particularly in rural areas, there is a sexist culture or lack of knowledge, which leads us to not go for a check-up, which is crucial to avoid reaching cases in very advanced or metastatic states. This especially affects depressed populations and those with vulnerability factors such as San Andrés, which has the highest incidence of this disease due to its genetic composition linked to African populations“explains Patiño, member of the Colombian Cancer Institute, which advocates for better education in the population.

Thus, one of the main recommendations is to undergo testing constant after age 45, and even earlier t rigorously if you have risk factors. For its part, paying attention to the warning symptoms of this disease can also help to reach adequate treatment in time.

In addition to this, this cancer calls for improved availability of specialized personnel and infrastructure to support diagnosis, surgery and radiotherapy to treat localized prostate cancer, and radiotherapy and hormonal therapy for metastatic disease.

You might be interested in: WHO publishes new definition of airborne diseases, why?

“Prostate cancer is also an indicator of a broader need to adapt future healthcare to address the rise in several diseases, as the number of men entering middle and old age increases around the world.” , conclude the authors of the Lancet study.

For his part, Patiño concludes that “the fact that one has this cancer does not mean that one is going to die, since there are high survival rates in the first ten years. Still, in a health system like ours, where $200 is invested per person, what we do to treat people is truly magic. Other health determinants such as water quality and other preventive factors must be improved to avoid future increases in cases.”.