Diseases & Longevity · File 24

Prostate cancer. The most nuanced screening conversation in oncology.

Prostate cancer is the 1st cancer incidence cause in men globally — but its biology has a particularity: a significant proportion progresses very slowly, to the point that many men die with the cancer and not from it. PSA has high sensitivity but limited specificity — the screening decision is nuanced and shared (USPSTF 2018, 55-69). Active surveillance in low risk avoids overtreatment. That is the modern conversation.

Why the PSA conversation demands nuance, not automatism

The biology of prostate cancer is heterogeneous: a significant proportion progresses very slowly (Gleason 6, ISUP 1) and does not cause mortality in patient's relevant life span. Another proportion is clinically aggressive (Gleason 8-10, ISUP 4-5) with real risk of metastasis and death. PSA detects both without distinguishing — and that is the root of the screening dilemma.

USPSTF 2018 recommends shared decision on PSA in men 55-69 (not automatic universal screening). Clinical trials (PLCO 2009, ERSPC 2014) showed modest mortality reduction by screening, but with significant cost: overdiagnosis and overtreatment (incontinence, erectile dysfunction). In low-risk cancers, active surveillance (Klotz 2015 JCO) has proven valid option — avoids unnecessary treatment without increasing mortality.

PSA is not an automatic universal screening — it's an informed conversation with risk-benefit balance. That's what the conventional system rarely has time for.
New cases · 2022 global

The global weight, in numbers

Data come from GLOBOCAN, USPSTF, ERSPC, and meta-analyses on active surveillance. They reflect the complexity of the modern conversation.

  • Global incidence

    1ra en hombres

    GLOBOCAN 2022: ~1.5 million new cases. It's the 1st cancer incidence cause in men globally, and top 5 of male cancer mortality (not top 1 — most don't die from the disease).
    — GLOBOCAN 2022

  • PSA — shared decision

    USPSTF 2018

    USPSTF 2018: PSA screening in 55-69 is shared individual decision. In >70, routine screening is NOT recommended due to risk-benefit imbalance.
    — USPSTF, JAMA 2018

  • Active surveillance in low risk

    Klotz 2015

    Klotz 2015 (JCO) and other trials confirm active surveillance (follow-up without immediate treatment) in low-risk prostate cancer is safe — specific survival >97% at 15 years — and avoids treatment morbidity.
    — Klotz et al., JCO 2015

  • BRCA2 and other germline

    Factor hereditario relevante

    BRCA2 increases aggressive prostate cancer risk. Genetic testing indicated in metastatic prostate cancer, high-risk at early age, or HBOC families. Changes therapeutic options (PARP inhibitors: olaparib).
    — Pritchard et al., NEJM 2016

Chap. 03 · Post-treatment trajectory

Treatment comorbidities and trajectory

When treatment is chosen, treatment comorbidities are the modern longevity conversation — incontinence, erectile dysfunction, sarcopenia, and bone health under hormone therapy.

  • Incontinence and erectile dysfunction

    Post-prostatectomía / RT

    Radical prostatectomy and radiotherapy have significant side effects: urinary incontinence, erectile dysfunction. That should weigh in initial decision, particularly in low-risk cancers where active surveillance is an option.
    — Hamdy et al., NEJM 2016

  • Hormone therapy and sarcopenia

    ADT prolongada

    Androgen deprivation therapy (ADT) — used in high-risk or advanced cancer — induces sarcopenia, bone loss, metabolic cluster, depression, cognitive decline. Longevity medicine complements oncologic management by systematically addressing these comorbidities.
    — Saylor & Smith, JCO 2009

  • Bone health and fractures

    Bajo ADT prolongada

    Prolonged ADT increases osteoporosis and fracture risk — requires DEXA screening, vitamin D, calcium, strength exercise, and consideration of denosumab / zoledronic acid when indicated. Decision in oncology coordination.
    — Smith et al., NEJM 2009

  • ADT cardiotoxicity

    Riesgo CV aumentado

    Prolonged ADT is associated with increased cardiovascular risk (MI, stroke, HF). Intensive cardiometabolic surveillance is modern standard — particularly in patients with preexisting cluster. Cardiology-oncology coordination.
    — Albertsen et al., Eur Urol 2014

What we don't offer — and what we do

Wellness Care does not perform prostate biopsy, prostatectomy, radiotherapy, or oncologic therapy. Biopsy, treatment decision (active surveillance, prostatectomy, radiotherapy, ADT, PARP inhibitors) are urology and oncology responsibility. What we do: informed PSA decision, risk stratification, risk-benefit balance conversation, and management of systemic comorbidities in survivors.

We evaluate men with: 55+ considering PSA screening, family history of prostate / breast / ovarian / pancreas cancer (HBOC / BRCA2 suspicion), already treated prostate cancer under oncology follow-up wanting to optimize post-treatment trajectory, or patients under prolonged ADT with emerging metabolic / bone / cardiovascular comorbidities. Coordination with urology, oncology, genetics, and cardiology when indicated.

PSA demands conversation, not automatism. And post-prostate-cancer survival demands more than just oncologic follow-up — longevity complements.
How we measure it

How prostate risk is evaluated
at Wellness Care

Informed PSA decision + hereditary risk stratification + modifiable factors + post-treatment management. In coordination with urology, oncology, and genetics.

Advanced biomarkers

21 specialized panels across 8 clinical categories — biological age, inflammaging, metabolic profile, functional hormonal, microbiota. The quantitative layer.

Explore →

Functional medicine

Shared root causes — mitochondrial dysfunction, inflammaging, neuroendocrine dysregulation — before organ pathology.

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Bioregulatory medicine

Autonomic regulation, HRV, stress response. The functional trajectory that precedes clinical diagnosis.

Explore →

The Longevity Program

How this assessment integrates into the full program — from initial valuation to individualized protocol design under medical judgment.

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Featured evidence

Key evidence supporting this approach

Four publications — USPSTF shared decision, ProtecT (treatment vs surveillance), active surveillance, hereditary BRCA2.

«El cribado con PSA en hombres de 55-69 años es decisión individual compartida — informada por balance riesgo-beneficio personal.»
JAMA · 2018
USPSTF, JAMA 2018
Decisión compartida PSA
«La vigilancia activa en cáncer de próstata de bajo riesgo tiene sobrevida específica superior al 97% a 15 años — evita tratamiento excesivo sin aumentar mortalidad.»
JCO · 2015
Klotz et al., JCO 2015
Vigilancia activa segura
«BRCA2 aumenta el riesgo de cáncer de próstata agresivo y cambia opciones terapéuticas — pruebas genéticas indicadas en cánceres metastásicos y familias HBOC.»
NEJM · 2016
Pritchard et al., NEJM 2016
BRCA2 en próstata

Frequently asked questions about prostate cancer

The most recurrent questions about prostate cancer — PSA decision, active surveillance, BRCA2, and why longevity medicine complements urology and oncology.

01

Should I do the PSA or not?

It's shared decision.

USPSTF 2018 recommends informed individual decision in men 55-69 — not automatic universal screening.

Factors to weigh:

· Individual risk — age, family history, ethnicity (Afro-descendant men have higher risk)
· Life expectancy
· Value you give to early detection vs overdiagnosis / overtreatment risk (incontinence, erectile dysfunction)

In >70, USPSTF does NOT recommend routine screening.

Mandatory conversation with your physician before ordering it.

02

What is active surveillance and when is it indicated?

Active surveillance is structured follow-up without immediate treatment in low-risk prostate cancer:

· Gleason 6 (ISUP 1)
· PSA <10
· Clinical stage T1c-T2a

Includes:

· Periodic PSA
· Multiparametric MRI
· Follow-up biopsies

If documented progression, curative treatment is initiated.

Studies (Klotz 2015) show specific survival >97% at 15 years — avoids unnecessary morbidity.

03

I have BRCA1/2 — what does it mean for prostate risk?

BRCA2 (and to lesser extent BRCA1) increases prostate cancer risk, particularly aggressive cancer.

Men with BRCA2 should consider:

· PSA screening from earlier (40-45)
· Higher frequency screening

Genetic testing is indicated in:

· Metastatic prostate cancer
· High risk at early age
· HBOC families

Changes therapeutic options — PARP inhibitors (olaparib, rucaparib) have demonstrated benefit in BRCA-mutated cancers.

Decision in coordination with oncology and genetics.

04

I'm under ADT — what comorbidities should I monitor?

Under prolonged androgen deprivation therapy (ADT), monitor:

· Body composition and strength — sarcopenia induced by iatrogenic hypogonadism (requires strength training + protein)
· Bone health — baseline DEXA and follow-up, vitamin D, calcium, consider denosumab / zoledronic acid
· Cardiometabolic profile — HTN, dyslipidemia, glucose (increased risk of MI, stroke, HF)
· Mental health — depression and cognitive decline

Structured periodic screening and oncology-cardiology-endocrinology coordination.

05

When should I consult?

A structured assessment is worthwhile if:

· You're 55+ and want informed conversation about PSA
· Family history of prostate / breast / ovarian / pancreas cancer (HBOC suspicion)
· You're Afro-descendant with increased risk
· You've had elevated PSA and need pre-biopsy orientation
· You're a survivor of prostate cancer under oncology follow-up
· You're under ADT with emerging comorbidities

The assessment complements urology / oncology.

Conversation, not automatism

PSA is not an automatic universal screening — it's an informed conversation with individual risk-benefit balance.

Informed PSA decision by individual risk, identify BRCA2 when suspected, active surveillance in low risk when applicable, and intensive comorbidity management under ADT — in coordination with urology, oncology, and genetics.

Informed PSA decision or post-treatment?

Book a prostatic risk and longevity assessment

We evaluate clinical history, family history (BRCA2, family breast / prostate cancer), informed PSA decision by age and risk, modifiable factors (diet, alcohol, obesity, physical activity), or post-treatment trajectory (cardiotoxicity, sarcopenia, bone health). The assessment does not replace urology / oncology — it complements them.

Book prostate assessment