Orthostatic Hypotension
Excessive drop in blood pressure on changing body position. Updated guidelines recommend reassessing orthostatic hypotension within the first minute after standing.
Excessive drop in blood pressure on changing body position. Updated guidelines recommend reassessing orthostatic hypotension within the first minute after standing.
Vladimir Gershman
Prostate cancer is one of the most common cancers in men. Although it develops slowly, thousands die from it every year.
On average, one in six men may be diagnosed with prostate cancer, with the likelihood increasing with age.
Thanks to modern diagnostic methods, prostate cancer can be detected today at an early stage, but does it always require intensive treatment, complex diagnostic procedures, and even surgery?
A new revolutionary method of diagnosing the disease and determining its risk to life allows a person to be spared from unnecessary worries and, most importantly, from unnecessary surgical or other interventions.
This is what the leading urologist-surgeon of the Galilee Medical Center in Nahariya and the Haifa hospitals "Elisha" and "Assuta", Vladimir Gershman, talks about today. - First of all, I would like to note that the prostate gland - the prostate, as it is customary to say - although a very small organ, plays a critical role in the male body.
It is located below the bladder, through which the initial part of the urethra passes. The main function of the prostate gland is the production of secretion, which is an integral part of sperm; in addition, it plays the role of a valve - closing the exit from the bladder during erection.
Unfortunately, prostate cancer ranks third among other oncological diseases in men, which underscores the special importance of timely and accurate diagnosis. Why do I emphasize the accuracy of the diagnosis? The fact is that in 80 percent of cases, diagnosed prostate cancer, strange as it may sound, has no clinical significance, does not have a noticeable impact on the quality of life and its duration. - ?! - Yes, yes, do not be surprised.
Let me give such an example: about a quarter of a century ago, at one of the medical centers in Europe, an examination of the prostate was carried out in several hundred men who died for various reasons. The results were stunning: malignant tumor cells were found in the prostate gland in many of the examined.
Moreover, their number increased depending on the age of the person almost in geometric progression: in 90-year-old men these cells were present in 90 percent of cases. I want to emphasize that we were not talking about all these people suffering from oncological disease, they were simply carriers of tumor cells that did not manifest themselves in any way. The person did not even know they lived in his body. - This is reminiscent of the situation with hepatitis C virus: a person can be its carrier for many years and not become ill throughout his life... - Exactly so.
In our case, many carriers of malignant tumor cells in the prostate die not from them, but together with them, without suspecting anything. And if the disease does arise, in most cases it progresses slowly, does not affect life expectancy and gives no clinical manifestations.
This is the very case I mentioned above: the vast majority of diagnosed cancer in our patients has no clinical significance. - And what follows from this conclusion? - For more than two decades, we - doctors, medical scientists, specialists in related fields - have been trying to find a solution to the problem, to figure out how to distinguish a clinically significant form of prostate cancer from a clinically non-significant one and, consequently, one that does not require aggressive treatment.
The fact is that when cancer is suspected, we are obliged to conduct a complete and thorough examination of the patient. Early detection of prostate cancer begins with prostate-specific antigen (PSA) screening. If the test result is high, the doctor may recommend a biopsy. However, since the test cannot distinguish aggressive prostate cancer from other less serious conditions, many men often undergo an unnecessary and complex biopsy procedure.
How is it complex? Imagine a tangerine - this is exactly the size of a healthy prostate gland. And into this small organ, about five centimeters in diameter, we insert a needle one and a half millimeters thick, and we insert it at least 12 times, and in complex cases twice as many.
That is, we take biopsy samples from ten or more places of the gland. Naturally, the procedure is performed under anesthesia and under the strict control of the doctor, with the image on the computer screen, but even in one case in hundreds of thousands, an error is possible.
And in one percent of cases, sepsis, a bacterial infection, can develop. Thank God, our procedures are well-established and pass without incidents, but after receiving the result, we tell 80 percent of patients that they have cancer cells, but there are few of them, they are practically not developed and therefore not dangerous to life, although there is a minimal risk of their further development.
Of course, after such a statement, a man, as a rule, wants to undergo treatment to prevent the worst. And the doctor himself, often unwilling to take responsibility for the patient's life, offers treatment. - And what does it consist of? - As a rule, cardinal treatment is removal of the prostate or its irradiation.
But it entails a number of physical and emotional inconveniences - impaired erectile function, partial urinary incontinence. - What are the first symptoms that indicate the possibility of cancer? Not everyone is immediately recommended for biopsy... - Of course. But a man after the age of 50 is simply obliged to undergo an annual check with a urologist.
This is just as mandatory as periodic visits to the gynecologist for women of this age. During the examination, the urologist can detect certain problems with the prostate in the patient and in this case directs him to a specific blood test and other studies.
If the analysis reveals a high level of PSA antigen, this indicates a possible disease process in the prostate, which gives the doctor grounds to send the patient for a deeper examination - laboratory, ultrasound, computed tomography (MRI), and biopsy.
It should be noted that elevated PSA does not necessarily indicate the presence of a malignant disease. This level can rise due to other reasons - after physical impact on the perineum (for example, when cycling or massaging the prostate), as a result of ordinary inflammation, or simply after recent intimate contact.
But this analysis does not give us the exact cause of the increased PSA, and therefore, to avoid mistakes, we perform a biopsy. - But you said that in most cases this procedure can still be avoided? - Yes, and today this problem is finding its solution. OPCO, one of the leading US medical companies headquartered in Miami, has discovered markers that allow, on the basis of a blood test, even before the biopsy, to determine with up to 95 percent accuracy the probability of dangerous prostate disease.
Blood for this analysis, called 4KSCORE, can be taken in any laboratory and sent to the specified medical center. Here, specialists test four proteins, which are markers of the presence of a cancerous tumor with the risk of aggressive malignancy.
These markers are summed using an algorithm that gives a clear result: what are the patient's chances of having prostate cancer and, equally important, what is the risk of death from this type of cancer in the next 20 years. America has already accumulated extensive experience in conducting such testing - over 100 thousand people with suspected prostate disease take it annually.
And just recently, a few months ago, we, Israeli doctors, also received the opportunity to conduct such a test. If prostate disease is suspected, we take blood from our patient - of course, with his consent - send it the same day by plane to the USA and within three to four days receive a result indicating the statistical possibility of dangerous cancer. - And what do you decide based on it? - Prostate cancer has several risk levels - from low to medium and high.
Until recently, a patient who received a "label" of a cancer patient based on biopsy results was treated regardless of the risk level. In fact, a low level of disease does not require it - with the presence of cancer cells, a person can live, as I noted, until old age without noticing them.
At the same time, it is worth remembering that prostate treatment itself is accompanied by many side effects - urinary incontinence, dysfunction of the genitals... The 4KSCORE test identifies only high and medium risk tumors, that is, only those cancer tumors that need to be treated and that pose a danger to life.
Thus, it is possible to prevent unnecessary biopsies, excessive diagnosis of cases that are not clinically important, and refuse unnecessary methods of treatment. - Is this analysis included in the "health basket"? - Not yet, but patients with additional medical insurance from health funds receive a significant discount on such a test. - At what level is oncological care in urology in Israel?
At one of the highest by world standards. Unlike many other countries, this assistance is available not to the elect, but to all citizens. The basis of any medical care is diagnostics, and we are witnessing a colossal breakthrough in early and accurate diagnosis of dangerous forms of prostate disease.
This will allow us in the near future to apply more organ-preserving therapeutic measures. If today, with a severe diagnosis, we are sometimes forced to remove the entire organ, now we are on the verge of revolutionary discovery of active methods of local treatment of affected parts of the organ, preserving its healthy part intact.
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