Cancer Therapy & Oncology International Journal ISSN: 2473-554X Review Article Cancer Ther Oncol Int J Volume 17 Issue 5 - December 2020 Copyright © All rights are reserved by Adrian Pablo Hunis DOI: 10.19080/CTOIJ.2020.17.555972 Prostate Cancer, Update of its Diagnosis and Treatment, with Special Emphasis on its Management in Argentina Adrian Pablo Hunis1* and Melisa Hunis2 1Assistant Professor of Internal Medicine, University of Buenos Aires, Argentina 2Head Professor of Oncology, Maimonides University, Argentina Submission: December 02, 2020; Published: December 22, 2020 *Corresponding author: Adrian Pablo Hunis, Assistant Professor of Internal Medicine, University of Buenos Aires, Argentina Abstract Prostate cancer is the second most frequent tumor in men in Argentina. Since the work of Charles Huggins, in 1941, in which he demonstrates that the suppression of the male sex hormone-testosterone-through surgical castration, many years have passed and many advances have been made in terms of diagnosis and treatment of this disease, paradigm of a hormone-dependent tumor. In this work, we intend to summarize the advances and the problems of the disease in the Argentine Republic. Keywords: Prostate; Prostate cancer; Castration; Hormonal treatments Introduction the prostate represents 9% of new case in the country (GLOBOCAN Prostate carcinoma is one of the most frequent tumors in 2018;) (Figure 1). Argentina. As incident cases grouped expressed in percentages, Figure 1: Globocan 2018. Cancer Ther Oncol Int J 17(5): CTOIJ.MS.ID.555972 (2020) 001 Cancer Therapy & Oncology International Journal highly higher than that of White Americans (150 per 100,000), United States have the highest incidence in the world (224 cases Western Europeans (39.6 per 100,000), Japanese (8.5 per Its racial incidence varies significantly, Africans living in the per 100,000) (Figure 2). The incidence in African Americans is 100,000), and Chinese (1.1 per 100,000). (Figure 3). Figure 2: number of new cases in (2018) in males, all ages is 19%. Figure 3: The incidence in African Americans is highly higher than that of White Americans (150 per 100,000), Western Europeans (39.6 per 100,000), Japanese (8.5 per 100,000), and Chinese (1.1 per 100,000). Through the last half of the twentieth century, the annual a cellular level, however, the onset of prostate cancer is an early incidence of prostate cancer increased slowly but steadily, probably process, it has been detected in autopsies in the prostates of men due to an increase in life expectancy and hence an increase in the population of men of susceptible age (older than 50 years). microscopic amounts of low-grade carcinoma, found incidentally of 20 and 30 years of age. Thus, prostate cancer is defined as small, Other factors have also contributed, such as the introduction and in the prostate. In one study, 20% of men younger than 40 had histological widespread use of PSA (prostate specific antigen) measured in evidence of prostate cancer. with prostatic carcinoma, the so-called prevalent cases [1-10]. blood. The PSA identifies a large number of asymptomatic patients In contrast, clinically detected prostate cancer at age 40 Associated Risk Factors is rare. The prevalence of both latency and clinically detected The etiology of prostate cancer is not known. But associated risk factors are known such as: family history, age, race, diet, 50 years of age and probably 50% of men over 80 years of age cancer increases significantly with age: 20 to 30% of men over hormonal levels. The more advanced the age, the more possibility may have prostate cancer. The majority of clinically detected there is of suffering from this pathology. Analyzed the process at prostate tumors are in the seventh and eighth decade of life. The How to cite this article: Adrian Pablo H, Melisa H. Prostate Cancer, Update of its Diagnosis and Treatment, with Special Emphasis on its Management 002 in Argentina. Canc Therapy & Oncol Int J. 2020; 17(5): 555972.DOI: 10.19080/CTOIJ.2020.17.555972 Cancer Therapy & Oncology International Journal relationship between latent and clinically detectable is uncertain. Molecular Biology It is not known whether they represent two different entities, or Prostate cancer is a heterogeneous and complex disease that whether latent prostate cancer is a clinically detectable precursor results from a series of genetic events at the level of the epithelial to cancer. Other determining risk factors in prostate cancer are prostate cell. These genetic events and many of the environmental race and geographic origin. As we saw earlier, African Americans factors that promote tumor development or progression are still have the highest incidence. In contrast, the lowest incidence rates are found in Japan and China. As in other tumors, when members the inheritance of one of several important genes that predispose of a racial community move from regions of low incidence to poorly defined. A small group of prostate tumors may derive from to the malignant phenotype and, therefore, confer a high risk of regions of high incidence, the incidence of prostate cancer prostate cancer [21-30]. increases in that group. However, genetic factors can be operative as well. For example, the gene for the androgen receptor (encoded Familial prostate cancer constitutes an estimated 5-10% of on the X chromosome) contains a repeating polymorphic CAG all prostate cancers and probably as much as 50% of prostate sequence. Several studies indicate that individuals with fewer cancers in men under 55 years of age. Six candidate loci for repeated CAG sequences in the androgen receptor genes have a higher risk of developing prostate cancer. In African Americans, these loci, HPC-1 (hereditary prostate cancer-1), has been found familial prostate cancer have been identified; the gene at one of fewer CAG repeat sequences were found than in Hispanics and to be ribonuclease L (RNase L). The relationship with HPC-1 could Asians. Thus, part of the high incidence of this pathology in African be associated with a more malignant tumor phenotype. Several Americans may be due to this phenomenon. Family history is genes that participate in the regulation of the cell cycle and in related to prostate cancer. The risk increases with the number of the regulation of growth factor signaling (Rb, p53, and PTEN), affected relatives. Vasectomy increases the risk of prostate cancer. have been implicated in the development and progression of The relationship between diet and prostate cancer is probably prostate cancer. The prevalence of mutations in these genes has varied from study to study, and the role that genes play in the data come mostly from epidemiological studies, rather than development and progression of prostate cancer has yet to be very important, although it is difficult to prove given that the prospective studies. But diet could contribute to the dramatic difference between western and eastern countries. Important in the bio pathogenesis of this tumor [31-40]. studies maintain that the content of red meat, animal fat and its defined. Also, a variety of proto-oncogenes have been implicated Although there is strong evidence of a dysregulation of a high level of consumption increases the risk. Other factors such as variety of growth factors (IGF-1, EGF, PDGF, etc.), also as receptors lycopene, a carotenoid found in tomatoes, lower the risk. Among to them (Her-2 / neu, receptor to EGF and TGF beta) their exact the micronutrients and trace elements, selenium, vitamin E, soy roles are not well understood yet. (Figure 4). and vitamin D can lower the risk. Other risk factors are exposure to cadmium: welding, batteries or electrotypes [11-20]. Figure 4: Several genes that participate in the regulation of the cell cycle and in the regulation of growth factor signaling (Rb, p53, and PTEN), have been implicated in the development and progression of prostate cancer. How to cite this article: Adrian Pablo H, Melisa H. Prostate Cancer, Update of its Diagnosis and Treatment, with Special Emphasis on its Management 003 in Argentina. Canc Therapy & Oncol Int J. 2020; 17(5): 555972.DOI: 10.19080/CTOIJ.2020.17.555972 Cancer Therapy & Oncology International Journal Screening of Prostate Cancer unnecessary treatment for many men. Also, an elevated PSA lacks The purpose of screening for prostate cancer is to detect specificityDespite [41-50]. the possibility of prostate cancer in men with therapeutics. Historically, the investigation was performed by moderately elevated PSA levels (4 to 10ng / ml), biopsy in these tumor within the gland, potentially curable by definitive local digital rectal examination. But, due to the great variations that cases usually demonstrates benign prostatic hyperplasia rather exist with the latter, many tumors are not palpable, and most than prostate cancer. On the other hand, the majority of cases with of the tumors detectable by digital rectal examination are not serum PSA levels above 10ng / ml present with prostate cancer, and their tumors are surely already outside the prostate gland. confined to the prostate and therefore are not curable. Today antigen (PSA) in the blood, which greatly increases the detection the amount of PSA that circulates alone (unconjugated) in the The percentage free PSA coefficient is a blood test that measures screening is carried out with the measurement of prostate specific blood and the amount that is conjugated to other plasma proteins [51-60]. of diseasePSA is confined a member to the of gland. the kallikrein family, chemically a glycoprotein with serine protease activity. It is abundant in If the PSA test results are marginal and the percentage ratio semen, where it is responsible for dissolving the seminal clot. PSA of free PSA is low (25% or less), then it is more likely that we are is produced by both normal and malignant prostate epithelial in the presence of prostate cancer.