Sweden's most common cancer

The prostate is a gland that plays a crucial role in the male reproductive system, with its main function being to produce and release a fluid that mixes with sperm to form semen. The prostate is located below the bladder and surrounds the urethra, the channel that carries urine and semen out of the body. The prostate can be affected by aging and various diseases, including prostate cancer.

Cancer is a medical condition where cells in the body begin to grow uncontrollably, forming tumors. These tumors can be malignant, meaning they have the potential to spread to other parts of the body, or benign, indicating that they are non-cancerous and do not spread. Cancer can affect various parts of the body, including the prostate gland in men.

Advancements in diagnosis and treatment have spanned several centuries. Methods such as surgery, radiation therapy, hormone therapy, chemotherapy, and immunotherapy have played a central role. Technological advancements, including imaging and molecular biology, have improved diagnosis and targeted treatments. Mortality from prostate cancer has decreased, and the future looks hopeful with the potential to make it a manageable disease.

Prostate cancer is the most common cancer among men in Sweden, but its prevalence varies internationally. Research has not yet identified clear risk factors, with both genetic and environmental factors likely playing a role. Lifestyle factors such as diet, physical activity, and obesity can influence disease development, with an emphasis on lifestyle over several decades rather than the years leading up to the diagnosis. Prostate cancer is common in Scandinavia, North America, and certain other regions, while it is rare in Southeast Asia.

Heredity plays a significant role in prostate cancer. Men with a family history of the disease, especially if a father or brother was affected before the age of 75, have an increased risk. Guidelines recommend PSA tests at 1-2 year intervals for these men from the age of 40. If the PSA value rises above 2 mg/L, they should consult a urologist. Genetic factors may also be relevant, especially if other forms of cancer occur in the family. Discuss any heredity with a doctor.

rostate cancer is the most common cause of death among Swedish men. Mortality has halved for men under 85 in the last 15 years, thanks to early detection and improved treatments. However, approximately 2,300 men still die annually in Sweden.

Prostate cancer in its early stages typically does not present specific symptoms. As the disease progresses, symptoms affecting urination may arise, including a weak urine stream, frequent urination, difficulty starting and stopping urine flow, and a feeling of incomplete bladder emptying. Other possible symptoms may include blood in the urine or semen, weight loss, fatigue, and pelvic, back, or hip pain. However, these symptoms can also be caused by conditions other than prostate cancer, highlighting the importance of medical evaluation.

Prostate cancer is diagnosed through palpation, PSA blood tests, magnetic resonance imaging (MRI) scans, and tissue biopsies. MRI is used to locate the tumor. Tissue samples are assessed according to the Gleason score. The extent of prostate involvement is described with T-stage, and microscopic examinations determine spread.

The discussion regarding general prostate cancer screening is complex. Early detection can reduce mortality but also carries the risk of overdiagnosis and overtreatment, which can reduce quality of life. Thus, Sweden does not have a national screening program. Instead, the National Board of Health and Welfare recommends that men be informed about the pros and cons of screening to make informed decisions. New research has suggested improved diagnostic methods, such as the Stockholm3 test, which provides detailed information about treatment needs.

Organized prostate cancer testing (OPT) has been implemented in some Swedish regions. This involves actively providing information about the benefits and drawbacks of testing to men in specific age groups and regularly offering PSA tests from the ages of 50 to 74. The OPT office administers testing and investigates high PSA values.

Standardized care pathways (SCP) were introduced to reduce disparities in evaluation across different parts of Sweden. They are initiated if a man has a PSA value above the age-specific threshold or if a doctor feels a hardening in the prostate.

Prostate Cancer Without Spread
There is usually no urgency to treat prostate cancer in its early stages, and there are various treatment options to consider.

Active surveillance may be appropriate for men with less aggressive forms of prostate cancer (Gleason score 3+3=6). This involves regular monitoring of the disease with checks and only transitioning to curative treatments like surgery or radiation therapy if necessary.

Watchful waiting is a similar strategy in which hormonal treatment is planned if the disease becomes more advanced or if the PSA value becomes high.

Surgery, also known as prostatectomy, involves removing the entire prostate gland and possibly nearby lymph nodes. The procedure can be performed using traditional open surgery or robot-assisted laparoscopic surgery (RALP). The choice of surgical method can affect recovery time and side effects.

Radiation therapy is also a common treatment method for localized prostate cancer. It can be delivered as external beam radiation or internal radiation therapy (brachytherapy). External beam radiation directs beams at the prostate from an external source, while brachytherapy involves placing small radioactive capsules directly into the prostate. Both methods aim to kill cancer cells and can be as effective as surgery.

Multidisciplinary conferences (MDC) with a team of specialists are crucial for discussing and planning treatment. It’s important to take medical advice with a grain of salt and be aware that different doctors may have different opinions on treatment options. Patient associations are also a resource that can provide information and support. There is a special curriculum for those who want to participate in circle meetings organized by study associations.

Prostate Cancer With Spread
The overall goal of treating metastatic prostate cancer is to slow the cancer as effectively as possible while preserving quality of life. Metastatic prostate cancer cannot be cured, but there are many treatment options that can alleviate symptoms and prolong survival.

All men recently diagnosed with metastatic prostate cancer receive some form of hormone therapy. Hormone therapy aims to reduce the production of male sex hormones, which can slow the growth of cancer cells.

Assuming the man is fit enough, additional cytostatic drugs and/or other forms of newer hormone therapy in various combinations are now recommended, depending on the extent of the spread. Combinations of different treatment strategies can be effective, but they can also increase the risk of side effects.

Many factors need to be considered when making treatment decisions, including any other medical conditions and medications the patient is taking. Treatment decisions are therefore difficult and require open communication and close contact between the patient, their loved ones, and healthcare professionals. The patient’s own thoughts on quality of life, practical consequences, and side effects weigh heavily in treatment decisions.

Research and development of new treatment methods are ongoing. The future may involve new treatment strategies based on increased knowledge of cancer cell growth and spread.

Treatment side effects are common and require attention and management. Open communication with healthcare professionals and partners is important for getting the right support and treatment. It is also important to plan activities and take breaks to manage fatigue, as well as to maintain a balanced diet and drink enough fluids when experiencing bowel and urinary problems. Many side effects can naturally improve as the body has time to heal. It is important to be aware of, report, and seek support for side effects.

Side Effects of Hormone Therapy
* Hot flashes: Use cool clothing and keep the bedroom at a cool temperature. They can be uncomfortable but usually improve over time. Medications can reduce hot flashes if they become troublesome.
* Decreased sexual desire and impotence: Be open and communicate with your partner about any sexual changes. Medications or other aids can manage side effects.
* Fatigue and decreased energy: Do not overexert yourself and give yourself time to rest.

Side Effects of Surgery and Radiation Therapy
* Fatigue: Some experience severe fatigue during or after treatment. Physical activity can help.
* Sexual problems: Both surgery and radiation therapy can affect the sex life, impacting erectile function, sexual desire, orgasm, and ejaculation.
* Pelvic floor training: Pelvic floor exercises can be effective in treating urinary incontinence. In some cases, medications and surgery can also be used.
* Bowel problems: Radiation therapy can irritate the bowel lining, leading to changes in bowel habits. There are various treatment options to manage these problems, including medications and bulking agents.
* Bleeding: Some patients may experience rectal bleeding due to radiation treatment.

Support and rehabilitation for prostate cancer are crucial. Open communication with healthcare reduces stress during evaluation. After a cancer diagnosis, questions about treatment and consequences arise. Psychological support is necessary, especially during an acute crisis. Bringing a loved one to healthcare appointments can facilitate understanding and provide support. The healthcare team should include specialists who provide written information.

Acute crisis reactions to a cancer diagnosis include anger and physical reactions. Anxiety and worry can be overwhelming, but information about the disease and treatment alleviates these feelings. Loved ones are affected and need support, especially children. Cultural differences in information management and the role of the family can affect healthcare discussions.

Strong emotions may dominate the first few weeks after a cancer diagnosis. Prehabilitation helps patients prepare. After treatment, rehabilitation needs affect the patient’s well-being. Relapse can cause as much stress as the initial diagnosis. Living with prostate cancer requires managing stress, worry, anxiety, and depression. Therapy sessions and professional help are important.

Patients with prostate cancer should be offered support by healthcare counselors. These specialists can identify risk factors for crisis or stress reactions and provide individualized support for psychosocial problems and mental health issues. Conversations should address various aspects of the patient’s life, including past experiences, social networks, finances, and mental health. The goal is to help the patient understand how the cancer diagnosis affects them and what resources might be helpful. Conversations with a partner can facilitate communication and reduce emotional stress. Counselors can help create better conditions for family discussions. Use mindfulness to reduce anxiety and depression and find ways to shift focus away from the difficulties.

There are various resources for support, including patient associations like the Prostate Cancer Association, municipal Family Care Centers, and information on legal and financial matters related to the disease.

Document sick leave in ”My Care Plan” for financial compensation and rehabilitation at working age. Review personal insurance and any diagnosis-related insurance to see if there is eligibility for financial support related to the diagnosis.

Prostate cancer is an individual journey with many decisions to be made, depending on the variations of the disease. Receiving a cancer diagnosis can be shocking, but it’s essential to be informed and take time to make decisions. You can learn to live with cancer as a part of life and promote your health through exercise and a healthy lifestyle. Set daily goals for your well-being.

Sexuality and potency are essential aspects of our personality that can provide vitality, joy, and attraction. Many men experience a decline in their sexual desire as they age, and the prostate plays a role in this. Both psychological and physical factors, including surgery and medication, can affect potency. Restoring sexual function requires patience and practice, and professional support is often inadequate. Many men hope for quick fixes with potency drugs, but it requires more than that.

The ability to maintain continence can weaken with age, and prostate surgery and radiation therapy can affect this. Urinary incontinence can become a chronic problem with a significant impact on quality of life. Besides those with prostate cancer, other men also have issues with continence, but care is often lacking and inconsistent. Improving care may require patients to demand more and establish men’s clinics focusing on urinary and sexual problems.

When receiving a cancer diagnosis, feelings of hopelessness and despair can arise. But people have the capacity to adapt to losses and difficult changes. What initially feels negative can be replaced over time with more positive perspectives. Trying and not giving up is crucial. If the darkness still feels overwhelming, seeking professional help is important.

A prostate cancer patient faces a series of difficult decisions that require the patient’s active participation in order to ask questions of the healthcare provider in the end. An informed and engaged patient often receives better care. It is important to make treatment decisions in consultation with healthcare providers and not simply delegate responsibility. Active involvement in care can lead to better outcomes and a more personalized care plan.

When cancer recurs or is detected late, curative or palliative treatment occurs. Recurrences are relatively common, and regular PSA tests are important. The news that the disease can no longer be cured is traumatic, but modern treatment options can extend life and halt tumor growth. Collaboration between healthcare and the patient is crucial. A healthy lifestyle, physical activity, and social interaction are valuable for managing treatment side effects and maintaining quality of life. For some, accepting that nothing more can be done after many treatments can be difficult. Transitioning to palliative care must be handled smoothly, and breaking point conversations may be needed. Patients and their loved ones should be proactive in this regard.

Prostate cancer is often asymptomatic in its early stages and painful in later stages. Side effects and injuries can occur as a result of treatments. Laws regulate Swedish healthcare, but patients have few rights in relation to healthcare. Sweden has 21 autonomous regions that provide care according to different standards. Patients are usually limited to receiving care in their own region, with the exception of publicly funded outpatient care that can be sought throughout the country. Seeking care in other regions for inpatient care often requires a referral and is at the discretion of the referring physician and the patient’s home region. Patients’ ability to seek care in other EU/EEA countries is an absolute right, but regulations and reimbursements can be complicated.

The loved ones and social network of cancer patients are affected by the diagnosis. These loved ones can include family members, friends, and colleagues. Prostate cancer can lead to changes in relationships, roles, and communication.

Children are especially important loved ones and need information and support, especially when a parent is diagnosed with prostate cancer. Children can experience anxiety and sleep difficulties. Older children may be more interested in the facts about the disease and need clearer information. Health and social care counselors can provide qualified counseling for children and their families. School health services and social services can also offer support. Naracancer.se is a website suitable for young people and provides information about cancer as well as the opportunity to ask questions of healthcare professionals and communicate with other young people in similar situations.

After prostate cancer treatment, especially surgery and radiation therapy, various issues can arise, including erectile problems and urinary leakage. These problems can be treated, and it’s important to seek help and guidance from healthcare providers.

Prostate cancer can affect one’s sex life with issues like erectile problems and reduced desire being common changes. Various treatments and aids are available, including erectile-stimulating medications, vacuum pumps, and penis rings. Sexual rehabilitation is also available. It’s important to discuss changes in your sex life and relationship with your partner. Communication, patience, and a willingness to experiment can be helpful. Integrating sexual rehabilitation and counseling, such as sexological support and digital rehabilitation programs, early in the treatment process and obtaining long-term support is crucial.

Fatigue is common during or after treatment and can be managed through physical activity. Conversations with healthcare providers are important if the fatigue does not improve, as there may be other causes, such as depression.

Rehabilitation is individual and can last for several years. The healthcare team may include various professionals who offer support and counseling. ”My care plan” can help identify individual needs. It’s important to understand that the physical and emotional impact of prostate cancer treatment can vary, and support and rehabilitation are essential for a positive recovery.

Early detection of prostate cancer is crucial for effective treatment, but early stages rarely have symptoms. Many men, therefore, wish to test themselves early, and over two-thirds of Swedish men in their 70s have taken a PSA test. Here, you can read about the PSA test, who according to national guidelines should consider testing, and why general testing is not recommended by Socialstyrelsen. 

Men who want to test for prostate cancer can have a simple blood test (PSA test) to measure PSA levels. Recommendations vary, but the test is usually offered to well-informed men aged 50–75, or earlier for those with a family history or specific gene mutations. Pros and cons should be considered, and asymptomatic men can decide for themselves if they want to take the test. Despite improved diagnostic methods, Socialstyrelsen has discouraged a national prostate cancer screening program since 2018, but implementation of the program may be considered in the future. 

The PSA blood test, which measures the level of prostate-specific antigen (PSA) in the blood, is used to identify prostate cancer. PSA is a protein produced by the prostate gland, and its levels increase in conditions such as prostate cancer, benign enlargement, and infection. A normally growing prostate can elevate PSA levels, and a larger prostate size results in higher PSA levels. To assess the risk of prostate cancer, PSA density is also used, which is the ratio between the PSA level and the prostate size. For PSA values above the threshold (3-7 micrograms per liter depending on age), further examinations are recommended to exclude or confirm cancer.  

Men often consider the PSA test as a ”prostate check” to detect early cancer. However, there are both advantages and disadvantages to this, and the decision to undergo testing should be individual. Men between the ages of 50 and 75 should particularly consider PSA testing, while those under 50 rarely experience prostate cancer. For individuals over 75 years old, if asymptomatic, there may be a lower likelihood of developing serious prostate cancer. In cases of confirmed cancer, the PSA value is related to the cancer’s spread and the effectiveness of treatment. Monitoring the PSA value after treatment is crucial to detect any potential recurrence or remaining cancer cells. 

Socialstyrelsen discouraged a national prostate cancer screening program in 2018 due to risk of overdiagnosis and overtreatment. Newer research suggests better diagnostic methods, which may reduce overdiagnosis. The EU Council recommends member states to evaluate organized screening for prostate cancer, similar to what has been ongoing in Sweden since 2018. 

Although Socialstyrelsen advises against a national screening program, they recommend that men be offered information about the pros and cons of testing. Benefits include the opportunity to detect serious prostate cancer early, while drawbacks include overdiagnosis and unnecessary treatment.  

Despite the advice, the majority of Swedish men undergo spontaneous PSA testing. Some regions have introduced ”organized prostate cancer testing” to standardize the process and inform men about pros and cons. Experiences with organized testing can facilitate the transition to a national prostate cancer screening program.
 

Treatment of prostate cancer often affects sex life, where both desire and erectile function may decrease. The extent of the impact depends on the type of treatment and the individual’s prior sexual life. After surgery or radiation, erectile function can worsen because the nerves around the prostate gland are damaged, while hormone therapy can lead to significantly reduced erectile ability and decreased sexual desire. Desire and erection can also be affected by fatigue, stress, and anxiety. Orgasm ability remains after both surgery and radiation but may feel different as seminal fluid decreases or disappears. Radiation therapy can also affect the bowel and bladder, which indirectly can impact sex life, especially due to urinary leakage or an increased need to empty the bowel and bladder. For those in relationships, it is important that both the patient and partner adjust to the new sexual conditions, which can take time.

Sexual rehabilitation aims to support and improve sexual function and well-being after prostate cancer treatment. Important aspects of rehabilitation include setting aside time for intimacy, being patient with physical and mental recovery, and daring to explore and resume sexual activities in new ways. Communication with the partner is central to avoiding misunderstandings and strengthening the relationship. For many, planning of sex life may be necessary, especially after cancer treatment.

Erection treatment is an important part of sexual rehabilitation after surgery, radiation, and hormone therapy. The treatment can include various medications and aids, such as tablets, injections, vacuum pumps, and penis rings. Recovery of erectile function depends on several factors, such as preserved nerves during surgery and the individual’s previous function. Treatment should begin early to improve the chances of recovery, especially with nerve-sparing surgery. Research shows that regular use of erection pumps can improve results, while regular intake of erection tablets does not necessarily promote spontaneous recovery.

Access to help varies across the country. Sexological expertise is often lacking at treating health units, so patients may need to seek help through external sexual advisors available through the Swedish Association for Sexology. Healthcare information services (1177.se) offer digital rehabilitation programs, providing structured support through eight modules focusing on different aspects of sexual rehabilitation. These programs are designed for both couples and singles and include exercises and reflection questions to help patients manage changes in their sex life after treatment.

Caring for one’s health through good habits is also an important part of the rehabilitation process. The goal is for patients to regain or find new ways to experience sexual pleasure and intimacy, even with changed physical conditions.