Prostate Cancer

Prostate cancer is one of the cancer types mostly seen in men and its incidence rate is 28 per hundred thousand in the world, while it is 37 per hundred thousand in our country. The American Cancer Society data reveal that the lifetime risk of prostate cancer for men is 16.7 percent, and the risk of loss of life is 2.5 percent. One out of every 5-6 men has a lifetime risk of developing prostate cancer. While one person is diagnosed with prostate cancer every 3 minutes in the world, there is a loss of prostate cancer every 14 minutes.

Prostate cancer is among the cancer types with high treatment success when caught at an early stage. Since it is usually an asymptomatic cancer in its initial stage, every man from the age of 40 should have an annual prostate examination and blood tests. With the “da Vinci Robotic Surgery System”, which is revolutionary in the medical world, among surgical applications in the treatment of prostate cancer, the patient gains significant privileges in terms of a cancer-free life and quality of life. With robotic surgery, the nerves that provide urinary retention and the continuation of sexual life can be better protected.

Where is the Prostate Gland Located and What Functions Does It Have?

The prostate is a gland that surrounds the outlet of the urinary bladder, just below the urinary bladder, in front of the intestines, and is a part of the male reproductive system. Producing the fluid that protects the sperm and keeping the sperm in this fluid in a healthy way is the main task. It is surrounded by a capsule, and the prostate capsule, which is divided into three regions, separates the prostate from other parts of the body.

What is Prostate Cancer?

Prostate cancer develops in the prostate, a small walnut-shaped gland that is part of the man’s reproductive system, and occurs when cells in the prostate gland grow out of control. Cancerous cells extend into the prostate and then into the capsule surrounding the prostate. It pierces the capsule and spreads outward from the prostate. Prostate cancer, unlike benign prostate gland enlargement, does not originate from the center of the prostate, but from the distant region of the center, close to the capsule. Urinary complaints in prostate cancer cause discomfort to the patient at a later stage and may spread to nearby organs, lymph system and other parts of the body through blood circulation during the growth and spread period. In addition to the slow course of prostate cancer, it is also possible for the tumor to show a very aggressive character and spread to the bones and other organs.

Prostate Cancer Symptoms

Prostate cancer is an insidious disease that depends on the progression of the disease. In the early stages, no signs and complaints may be seen. Regular doctor check-ups are very important in the success of the treatment, as the patient may lose some of their treatment opportunities when symptoms of prostate cancer occur.

Prostate cancer symptoms can be listed as follows;

• difficulty urinating
• Decreased strength in urine flow
• Blood in the semen or urine
• pain during ejaculation
• Discomfort in the groin area
• bone pains
• erectile dysfunction

It is also the case that these symptoms, which are the harbingers of prostate cancer, are sometimes an indicator of benign prostate enlargement. Similar symptoms and complaints can be seen in benign prostatic hyperplasia (benign enlargement of the prostate) that develops due to enlargement of the prostate gland. If prostate cancer has spread to other parts and organs of the body, it may also give symptoms related to that area, such as bone pain if it has spread to the bone.

Prostate Cancer Risk Factors

The cause of prostate cancer is unknown. It occurs when some prostate cells grow out of control due to genetic defects at the cellular level and replace normal cells, and then it may spread to surrounding tissues and to distant organs at advanced levels.

Prostate cancer causes and risk factors can be listed as follows;

Inherited or Genetic Factors

9 percent of prostate cancers are inherited, in 15 percent of those with prostate cancer, the disease is inherited from first-degree male relatives. It has been observed that a mutation in the BRCA2 gene, which is known to be associated with breast and ovarian cancers in women, also increases the risk of prostate cancer in men.

Non-Genetic (Environmental) Factors

Environmental factors are more effective than genetic factors in prostate cancer. For example, a Chinese living in China has a much lower risk of developing prostate cancer than an American, while the same Chinese individual has a similar risk of prostate cancer to an American when they live in the United States for a long time.

• Effect of Age: The risk of prostate cancer increases with age. Prostate cancer, which is rare in men under 50, is more common in men over 55. It is known that 1 out of every 6 men will be diagnosed with prostate cancer during their lifetime.

• Race Factor: Race factor also plays an important role in prostate cancer. Rarely, it is also seen in males living in Asia/Pacific islands.

• Nutrition: It has not been proven whether nutrition has a direct effect on prostate cancer. While previous research has shown that selenium and vitamin E may reduce the risk of prostate cancer, clearer results from subsequent research have shown that neither provides benefits. However, consuming unhealthy foods can directly increase the risk of prostate cancer.

Prostate Cancer Diagnosis

If there is a possibility of prostate cancer according to the results of the patient’s PSA blood test and/or rectal finger examination, this suspicion should be confirmed by biopsy. Prostate cancer is diagnosed as a result of one or more biopsies of the prostate gland. The biopsy reveals the patient’s prostatic hyperplasia, cancer, or other existing medical problems. During the biopsy, a few small pieces of prostate tissue are sampled by entering the rectum with the help of a needle, and these tissue samples are examined under a microscope.

The following scans are performed to diagnose prostate cancer;

PSA Blood Test: The level of PSAs in the blood of the patient diagnosed with prostate cancer is equal to the amount of cancer in his body. PSA (Prostate Specific Antigen) is a protein produced by cells in the prostate, and the higher its amount in the blood, the more advanced prostate cancer is. At the same time, the PSA level is extremely helpful in monitoring the success of the given treatment or in determining post-surgical regeneration.

digital rectal examination: It is one of the most widely used prostate cancer screening tests. By touching the patient’s prostate with a finger, abnormalities are checked according to its size and characteristics.

Transrectal Ultrasonography: During transrectal (rectal) ultrasonography, a small probe is inserted into the rectum and the probe emits high-frequency sound waves that produce echoes and bounce back on the prostate. The computer uses these echoes and creates the picture with a sonogram that can show abnormal areas.

Advanced PSA Testing: Studies are underway to develop the PSA test for more specific results on pancreatic cancer. The clearer the PSA results, the less the patient worries and the less need for other tests.

Insulin-Like Growth Factor: Insulin-like growth factor (IGF) is an important growth and anti-apoptotic (cell death-inhibiting effect) factor for cancer cells in many types of cancer. Insulin-like growth factor binding protein-3 (IGFBP-3) inhibits growth by stimulating IGF-1-independent apoptosis (cell death). Recent research shows that elevated IGF-I and low GFBP-3 levels, or both, are associated with an increased risk of prostate cancer.

Early Detection of Prostate Cancer

In prostate cancer, as in other cancers, early detection can reduce the rate of death. Another benefit of early diagnosis is the minimal side effects associated with prostate cancer treatment. To detect prostate cancer early, a blood test measuring the level of the protein known as Prostate Specific Antigen (PSA), digital-rectal examination and/or transrectal (rectal) ultrasound techniques are used. However, screening in prostate cancer is a complex and controversial issue, we do not have enough evidence yet that it reduces the vital risk factor. The potential benefits, uncertainties, and risks of screening tests should be discussed together. Then it should be done or not done according to the personal preference of the patient.

Prostate Cancer Stages

Stages of prostate cancer are based on the extent of its spread. The most important criteria in staging are whether the prostate tumor has spread to surrounding tissues such as the bladder or rectum, and whether it affects the lymph nodes and bones. Gleason score, which indicates the tumor grade, and PSA level are important in determining prostate cancer stages.

1. Stage: In stage 1, the tumor is only in the prostate. Sometimes it may be too small to be felt on rectal examination. A Gleason score of 6 or less. PSA level is below 10.
2. Stage: In stage 2, the tumor is in the prostate. However, the structure of the tumor has become aggressive. It can be clearly felt on digital examination or the tumor grade may be high.
3. Stage: In stage 3, prostate cancer has spread beyond the prostate. It has usually spread to the seminal sacs. However, it has not spread to the bones and lymph nodes.
4. Stage 4: At this stage, prostate cancer has spread to the bladder, rectum, or surrounding tissues (other than the seminal sacs). It may also spread to nearby lymph nodes and bones.

Prostate Cancer Treatment

In the treatment of prostate cancer, different treatments may be preferred depending on the growth rate of the cancer, the spread of the cancer, the general health status of the patient and the effectiveness of the treatment, as well as possible side effects. If prostate cancer is at an early stage, follow-up rather than immediate treatment may be recommended. The surgical option is one of the most common and effective treatment methods in prostate cancer. There are robotic, laparoscopic and open surgical methods, but each surgical method should be preferred according to the patient. In the surgical approach, the aim is to remove the entire prostate. In appropriate cases, the nerves that help erection in the penis around the prostate can be preserved.

Laparoscopy is the surgery of choice for early-stage prostate cancer. Prostate radiation therapy (radiotherapy) in the early stage is also an important treatment option for suitable patients. Laparoscopic surgery provides the patient with a comfortable operation and has high success rates in terms of cancer control. After these operations performed through 4-5 small holes, the patient has less pain and can return to his daily activities in a short time. Since there is no surgical incision, it also provides cosmetic patient satisfaction.

Treatment by Prostate Cancer Stage

In the 1st and 2nd stages, prostate cancer can be treated with surgery or radiotherapy, then hormonal therapy can be started or the patient can act according to his condition. In the treatment of prostate cancer, the third stage plan should be either surgery or radiotherapy. Studies have determined that 5 months of chemotherapy after surgery and radiotherapy prolongs survival in prostate cancer. In patients with a PSA greater than 40, lymph node involvement, or a Gleason score greater than 7, chemotherapy should be considered in addition to hormonal therapy after surgery or radiotherapy. The main treatment for stage 4 prostate cancer is hormonal therapy. With hormonal therapy, the patient’s testicles can be surgically removed or the male hormone can be blocked with injections every 1-3 months. After 2010, there have been many innovations in the treatment of stage 4 prostate cancer, and it has been observed that some drugs and chemotherapy significantly increase the life expectancy at stage 4. In addition, although some agents used in cases where traditional hormone blocker drugs do not work, have been developed and prostate cancer vaccine has been tried, but it could not show the expected effect. The efficacy of radiotherapeutic agents has been demonstrated only for patients with bone metastases. In addition, treatments with PSMA combined with radioactive Lutetium in prostate cancer are also performed in our country.