How common is prostate cancer?
Just over one in a hundred Dutch men has been diagnosed with prostate cancer. This makes it the most common type of cancer in men in the Netherlands. According to the Dutch Cancer Registry On January 1, 2021, there were approximately 90,500 men in the Netherlands who had been told that they had prostate cancer in the ten years before.
There is no way to prevent the disease with certainty. However, as with other cancer types, lifestyle (smoking, little exercise, unhealthy diet) has an influence on the risk. In a small proportion of cases (5 to 10 percent) heredity plays a role.
How serious is the disease?
Prostate cancer occurs when glandular ducts in the prostate grow unchecked. This usually happens unnoticed and slowly. The vast majority of men over 70 have non-metastatic, slow prostate cancer without even knowing it. So they die with prostate cancer, but they don’t die from it. Some men discover by chance that they have it, for example because they report to the doctor with pain or urinary complaints due to a swollen prostate.
Sometimes the cancer cells are more aggressive, allowing them to spread to other tissues, such as the bones or lymph nodes. In that case, it is usually no longer possible to cure, says urologist Joep van Roermund of the Maastricht Medical Center. ‘Nowadays there are many means to suppress prostate cancer. For example with hormone therapy and radiation and possibly chemotherapy.’ die annually about three thousand men with prostate cancer.
Does preventive screening for prostate cancer make sense?
Anyone who has metastatic prostate cancer wishes it had been discovered earlier. The Prostate Cancer Foundation therefore advocates PSA screening in men who are genetically at greater risk of prostate cancer. PSA (Prostate Specific Antigen) is a protein produced by the prostate. When the concentration of the protein in the blood is a bit higher than normal, this can indicate prostate cancer, but it can also be caused by a harmless enlargement.
Additional research, for example an MRI scan and a puncture, should then clarify more. The problem is that PSA screening carries a significant risk of false alarms, with all the stress that entails. In addition, it can lead to overtreatment. The tumors that come to light do not have to be life-threatening. From a large-scale international overview study 2018 shows that a thousand men must be screened for ten years to prevent one death. And that while a much larger number of men at that time would suffer from the side effects of overtreatment, such as incontinence and erection problems.
The Dutch Association of Urologists therefore considers the disadvantages of large-scale screening greater than the advantages. ‘When I ask at a lecture who would like to prevent metastatic prostate cancer with PSA screening, all hands go up’, says Van Roermund. “But when I next ask who is willing to hand in his prostate for his neighbor’s cure, the hands quickly go down again.”