Dr. Kamen Nedev is the business manager “Brachytherapy” in Acibadem City Clinic Mladost and one of the leading radiation therapy specialists in Bulgaria. His work in the field of brachytherapy is widely recognized, and recently became the only doctor in the Balkans, certified to apply an innovative method to reduce the side effects of radiotherapy for prostate cancer.
Prostate cancer is the second most common cancer among men in Bulgaria, after lung cancer. Have men learned to go for regular checkups?
The latest data show, that it is the most common malignancy, as one in four men with newly diagnosed cancer, has prostate cancer. Its development is rather a consequence of advancing age. Of course, there is also hormonal and hereditary conditioning, but generally age is the main factor. In the hereditary forms, we are talking about men over 50 r. or even 45 years, who had a direct relative with prostate cancer in their family. This is also the group of men, who, crossing that age limit, should schedule their annual preventive examination with a urologist. I say “them”, because in Bulgaria there is no screening program for early diagnosis of prostate cancer and the disease. I.e. reliance is placed on the personal responsibility of patients and their GPs, which often turns out to be insufficient. Unfortunately, this leads to the late detection of cancer – the patient comes for examination, when there are already pronounced symptoms and the cancer is in a more advanced stage of development.
Fear or ignorance is the reason why men avoid the examination?
It's complex. We men are more careless about our health. And we rarely seek our personal doctor for prevention. The lack of a screening program is also a big factor, which yes “looking for” healthy men at increased risk. The truth is, that even now there is a quick and easy blood test, which would show pathological changes in the prostate. It's called PSA and it's a tumor marker, the increase of which would be a reason for examination by a specialist.
Does an elevated tumor marker always mean cancer??
An elevated tumor marker does not mean cancer. Indicates a reason to visit a specialist. This specialist should assess whether there is a need to order further imaging studies, to determine the cause of the marker elevation.
If cancer is found?
An accurate diagnosis must be made, right to “stages” the disease and to plan its individualized treatment. And there are a few important things here, which I would like to draw attention to.
Once a diagnosis is made “prostate cancer”, it should be determined how far and where the disease has spread. In the last few years, a new method has appeared in practice, which we also apply in our hospital – the PSMA method. It shows the most initial changes, even before there were any changes, that lead to the patient's symptoms and changes that are “invisible” for standard imaging methods . Gives accuracy at 95% from the patients, incomparable result on standard imaging studies. It is important, because treatment without proper diagnosis and accurate staging of the patient, would be a compromise.
And a friend accent, which I would like to draw attention to – the presence of cancer does not always mean the start of treatment. Many patients are treated unnecessarily. That is, they have clinically insignificant carcinoma, from which they will not die and can remain without treatment, but simply on active tracking.
But they are often treated?
Yes, are treated, they even undergo surgery. AND, in fact, they have a reduced quality of life afterwards, which they did not have before treatment. It must be strictly assessed whether the disease would lead to death in the patient concerned. If considered, that the disease will not progress, it will be confined to the prostate, at an early stage, these patients are preferred not to be treated, but to be tracked over the years. Already, if necessary and, if the carcinoma shows aggressiveness, then radical treatment is already applied.
What is brachytherapy??
Prostate cancer brachytherapy is a type of radiation therapy, in which the tumor cells are attacked from the inside with specially placed small radioactive elements. In addition, it protects adjacent healthy tissues from radiation, the method can save surgery and removal of the prostate. The procedure is quick, painless and highly effective. Patient tolerance is excellent. Most men retain their quality of life and erectile function. Again, we aim to preserve the patient's good quality of life.
You are the only certified doctor, which applies a new method in the treatment of prostate cancer. What it is and how it helps patients?
One of the main problems with radiotherapy for prostate cancer is, that the rectum, located immediately behind the gland, receives the dose of ionizing rays, prescribed for the prostate, which can cause problems later. The new method is the application of a special hydrogel, which distances the two organs from each other thus eliminating the irradiation of the rectum. Thanks to this men, who are about to undergo radiation therapy to the prostate, can undergo it without fear of discomfort, associated with the rectum, which usually occurs as a result of radiation. We apply the method successfully in the department and already have indisputable results: 75% less radiation to the colon and almost zero side effects for patients.