Feeling well and having no urinary problems does not necessarily mean that everything is fine with the prostate. In fact, one of the most common mistakes among men is waiting until symptoms appear before seeing a urologist. Prostate cancer, particularly in its early stages, can develop without causing any warning signs.

To mark European Prostate Health Day, which is observed this Tuesday, Dr Estefanía Linares, a specialist in Uro-oncology and Robotic Surgery, as well as in the Diagnosis and Focal Treatment of Prostate Cancer at the Department of Urology of Hospital Ruber Internacional — part of the Quirónsalud Group — headed by Dr Antonio Allona and Dr Juan Ignacio Martínez-Salamanca, stresses the importance of approaching prostate health through prevention and an understanding of each patient’s individual risk, without causing unnecessary alarm.

"One of the main mistakes is waiting until symptoms appear before seeking medical advice. Many prostate conditions can significantly affect quality of life and, moreover, prostate cancer is often asymptomatic in its early stages," explains the specialist.

At what age should prostate check-ups begin?

High resolution image. This link will open using lightbox, there may be a context switchDra. Estefanía LinaresRather than establishing a single age at which all men should undergo the same tests, Dr Linares considers it essential to assess each person’s individual risk.

For men without risk factors, an initial prostate-specific antigen (PSA) assessment should be considered from the age of 50. This may be brought forward to the age of 45 when there is a relevant family history, and to the age of 40 for carriers of certain genetic mutations, particularly BRCA2.

"Looking after your prostate does not mean living in fear of cancer. It means understanding your risk and seeking medical advice at the appropriate time," says the urologist.

It is also important to pay attention to certain urinary changes. A progressively weaker urine stream, difficulty starting urination, a feeling that the bladder has not emptied completely, urinary urgency or repeatedly having to get up during the night to urinate should be assessed when they persist or affect quality of life.

Blood in the urine, recurrent urinary tract infections or urinary retention also require specific medical assessment.

However, having urinary symptoms does not necessarily mean having prostate cancer. "Most urinary symptoms in adult men are related to benign conditions," Dr Estefanía Linares explains.

One persistent misconception is that an enlarged prostate necessarily indicates the presence of a tumour. The specialist points out that benign prostatic hyperplasia and prostate cancer are different conditions. They can coexist, but having an enlarged prostate does not mean that a patient has cancer.

A raised PSA does not necessarily mean cancer

Another common concern involves PSA levels. This test remains an essential tool for assessing prostate health, but the result must always be interpreted within the context of each individual patient.

"PSA is a marker of the prostate, not a cancer-specific marker. It allows us to estimate risk and decide whether a patient requires further investigation, but a single value can never establish either the diagnosis or the aggressiveness of a tumour on its own," explains Dr Linares.

Benign prostatic hyperplasia, inflammation or infection of the prostate, urinary retention, certain urological procedures and even, temporarily, ejaculation can cause PSA levels to rise.

For this reason, in cases of moderately elevated PSA levels, it may be preferable to confirm the result and assess it alongside other factors before recommending more invasive tests.

MRI has transformed the diagnosis of prostate cancer

One of the major advances in recent years has been the incorporation of prostate magnetic resonance imaging (MRI) into the diagnostic pathway.

MRI can identify suspicious lesions before a biopsy is performed and subsequently guide tissue sampling towards these specific areas. This improves the ability to detect clinically significant tumours and, in certain low-risk patients, can help avoid unnecessary biopsies.

Dr Linares explains that MRI has transformed diagnosis: "We have largely moved away from the concept of performing prostate biopsies ‘blindly’. Today, we can specifically target samples towards lesions that have previously been identified."

The current trend is therefore towards increasingly personalised diagnosis. Age, family history, PSA and PSA density, clinical examination, MRI and, in selected patients, biomarkers or risk calculators can help determine which men require further investigation and how intensive that investigation should be.

These advances are complemented by PSMA PET imaging in patients for whom it is indicated, which has helped improve disease staging.

The challenge is no longer simply to detect more cancers, but to determine which ones need treatment

Greater diagnostic precision is also changing the way prostate cancer is approached. Detecting a tumour does not necessarily mean that it must be operated on or treated immediately.

"The real challenge is to identify clinically significant cancer at an early stage without overdiagnosing and overtreating indolent tumours that would probably never compromise the patient’s life expectancy," says the specialist.

For this reason, active surveillance is now the standard management strategy for many low-risk tumours and may also be an option for carefully selected patients with favourable intermediate-risk prostate cancer, always within a strict follow-up protocol.

Treatment decisions must take into account the specific characteristics of both the tumour and the patient.

"We are not simply treating a biopsy result; we are treating a particular patient with a particular tumour. Histological grade, extent of disease, PSA, imaging findings, age, life expectancy, comorbidities and personal priorities must all be considered before choosing a strategy," explains Dr Linares.

Focal treatments: treating the tumour while attempting to preserve the prostate

The move towards increasingly individualised treatments has also made it possible for certain patients with localised prostate cancer to benefit from focal therapies.

Unlike radical treatments, this approach targets only the area of the prostate containing the tumour, with the aim of controlling the disease while preserving urinary and sexual function as much as possible.

Not all patients are suitable candidates. One of the main limitations is the potentially multifocal nature of prostate cancer, which makes accurate patient selection and tumour characterisation essential before considering this alternative.

For patients in whom surgery is indicated, robotic surgery provides an enlarged three-dimensional view and highly precise movements, facilitating meticulous anatomical dissection. It may also reduce blood loss and contribute to faster postoperative recovery.

"Technology is a tool, but oncological and functional outcomes depend to a large extent on the surgeon’s experience and not exclusively on the robot," the urologist emphasises.

In addition, MRI-based planning and a greater understanding of anatomy make it possible, whenever oncologically safe, to preserve structures involved in urinary continence and sexual function — two of the main concerns for patients facing treatment for prostate cancer.

Three key recommendations for looking after prostate health

To mark European Prostate Health Day, Dr Linares summarises the main messages that men should keep in mind in three recommendations: understand your personal risk and undergo PSA testing when appropriate; do not ignore persistent urinary symptoms or warning signs; and maintain an active lifestyle and a healthy weight.

"There is no specific food or supplement that can prevent prostate cancer, but maintaining a healthy weight, exercising regularly and following a balanced diet are sound health recommendations," she says.

And particularly for men who have not attended a check-up for years because they feel well, the Hospital Ruber Internacional specialist points out that the absence of symptoms does not rule out localised prostate cancer.

"It is not about carrying out tests indiscriminately, but about assessing each man’s age and risk factors and deciding with his doctor when regular monitoring should begin. Today, we can diagnose prostate cancer much more precisely and, above all, better distinguish between those who need treatment and those who can safely avoid it," concludes Dr Estefanía Linares.