Prostrate Cancer
Prostate cancer is generally a low-risk type of cancer with a slow-growing
tendency and relatively limited aggressiveness. Diagnosis is often delayed
because it does not show symptoms in the early period. As the disease
progresses, conditions such as weakness, anemia, bone pain, paralysis
(paralysis) after metastasis (splash) to the spinal cord and kidney failure due
to bilateral urinary tract obstruction may occur.
For this reason, it is important for men to have prostate cancer screening at
regular intervals for early diagnosis. Because the earlier the disease is
diagnosed, the higher the treatment and survival rate. For screening, a
biochemical parameter called PSA is checked in the blood analysis and
prostate examination is performed with a method called rectal digital
examination.
What are the symptoms of prostrate cancer?
• Prostate cancer symptoms usually begin to appear in the later stages of
the disease and can manifest itself with many symptoms. Since the
disease progresses insidiously, it is possible to diagnose it in
asymptomatic (asymptomatic) people at an early stage, but with
regular screening. Disease symptoms are uncharacteristic and can be
seen in other prostate diseases. There are many common symptoms of
prostate cancer:
• Difficulty urinating
• Frequent urination
• Presence of blood in urine or semen
• Erection problems
• Pain during ejaculation
• Involuntary weight loss
• Because prostate cancer often metastasizes to the bone (it can spread),
it can cause severe pain in the lower back, hips or legs.
• Because the prostate gland is located just below the bladder, the most
common symptoms are urinary system problems. After the
enlargement of the prostate due to the tumor, pressure on the prostate
gland, bladder and urinary tract may cause symptoms such as frequent
urination, intermittent and slow flow of urination, and bleeding during
urination, which is expressed as hematuria.
• Erectile dysfunction, defined as erectile dysfunction (impotence),
should also be taken into account because it can be among the
symptoms that occur in people due to prostate cancer.
• These symptoms can also occur in other conditions such as benign
prostatic enlargement, inflammation of the prostate (prostatitis) and
are not obvious signs of prostate cancer. Only one in ten people with
these signs and symptoms has prostate cancer
What is Benign Prostatic Hypertrophy?
Benign prostatic hypertrophy (BPH) is a benign prostate gland
enlargement, commonly known as prostate, which is common in
men with advancing age. The tissue growth here does not tend to
spread or spread to other organs as in cancer and causes complaints
about urination.
Differential diagnosis (differentiation of the two diseases) is
important because prostate symptoms give similar symptoms to
prostate cancer. The development of BPH may occur due to various
risk factors and the effect of sex hormones such as testosterone on
the prostate tissue. The testosterone hormone synthesized from
the testicles is converted to its form called dihydrotestosterone
(DHT) in the prostate gland, and this form of the hormone directly
affects the proliferation of prostate gland cells. After the increase in
the hormone level, there is an imbalance between the production
and destruction of prostate gland cells. This results in benign
enlargement of the gland.
How is the diagnosis of prostate cancer?
Prostate cancer is a disease that does not cause obvious symptoms in the
early stages. With the enlargement of the prostate gland, symptoms such as
an increase in the frequency of urination, getting up at night, difficulty in
starting to urinate and maintaining the flow, blood in the urine and painful
urination may occur. In addition to symptoms related to urination, sexual
function and performance may be adversely affected over time.
In prostate cancer patients, pain felt in bones such as the spine, hips and ribs
may indicate that the disease has begun to spread outside the gland.
In people who apply to health institutions with these symptoms, the
physician first evaluates the patient’s medical history and physical
examination for the diagnosis of prostate cancer. Among the physical
examination applications, rectal digital rectal examination is at the forefront
for the diagnosis of prostate cancer. Thanks to the digital rectal examination,
abnormalities, asymmetries and suspicious nodular structures in the patient’s
prostate gland can be detected.
Prostate cancer is detected in approximately 1 in 5 patients with abnormality
in digital rectal examination. During this examination, the physician wears
examination gloves and proceeds through the rectum of the person and
examines the prostate surface with his index finger.
Prostate specific antigen (PSA) is an important biochemical parameter of
diagnostic importance for prostate cancer. The level of this substance in the
bloodstream of the person is detected as high in approximately 80% of
prostate cancer patients. PSA is a protein substance produced by the prostate
gland.
The transition to the biopsy procedure, which is the next stage of diagnosis, is
decided by considering the patient’s physical examination findings, PSA value
and other values related to this marker. If the total PSA value is determined
between 4-10 nanograms per milliliter as a result of the analysis, the free PSA
value is checked. A percentage of free PSA greater than 25% indicates that
the risk of cancer is lower than 10%, while if this value falls below 10%, there
is a risk of prostate cancer of up to 50%.
Ultrasonography and magnetic resonance imaging (MRI) are among the
important radiological examinations for the detection and diagnosis of
prostate cancer. Transrectal ultrasonography (TRUS) allows the detection of
suspicious areas in the prostate tissue and the determination of the biopsy
site. MRI, another radiological examination, has the power to detect up to
90% of the suspicious area.
If prostate cancer is suspected after the examinations, a biopsy can be
performed. Prostate biopsy is performed with ultrasound guidance and
samples are taken equally from each region. The biopsy procedure, which is
performed by taking two samples from the base, middle and upper part of
the prostate, is called 12 core biopsy. Thus, it can be ensured that the
developing tumor tissue is not missed and its spread can be detected
accurately.
As with other types of cancer, staging of prostate cancer examines the extent
and size of the tumor, whether there is involvement in the lymph nodes, and
whether the cancer has metastasized to other parts of the body. Stages for
prostate cancer are expressed in numbers 1-4. The most advanced stage of
cancer is stage 4 prostate cancer.
Stage 1 prostate cancer refers to the period when the disease is in one half of
the prostate and no spread to the surrounding tissues is detected. During this
period, the PSA values of the errors are usually below 10.
Stage 2 prostate cancer is divided into 2 substages, A and B. In stage 2A, the
cancer is still limited to one half of the prostate, but a person’s PSA ranges
from 10 to 20. If the tumor is detected in both halves of the prostate, stage
2b prostate cancer can be mentioned.
The condition may progress over time and become stage 3 and stage 4
prostate cancer. In these stages, there is an involvement in the capsule of the
prostate and in the surrounding tissues. In patients with stage 4 prostate
cancer, there is also bone involvement.
What are the prostate cancer treatment methods?
• Prostate cancer treatment options vary according to the growth rate
and spread of the cancer, and the patient’s general health. It also
depends on other factors, such as the potential benefits and side
effects of treatment.
• Treatment options include surgery, chemotherapy, radiotherapy,
hormonal therapy or different combinations of these. If the disease is
diagnosed at an early stage, follow-up may be recommended for a
while without any treatment. The most common and effective
treatment option is surgery and usually involves complete removal of
the prostate (prostatectomy).
• Prostatectomy refers to the process of removing prostate tissue
affected by cancer. Radical prostatectomy is the surgical removal of the
entire gland. This surgical procedure can be performed as open or
closed surgery.
• In open surgical interventions, it is aimed to reach the prostate gland by
making a large incision in the lower abdomen by the operator
physician. The perineum region between the rectum and the scrotum
(testicle) is another region that can be preferred in open surgical
procedures for the treatment of prostate cancer.
• Closed prostate surgery is performed laparoscopically. In this
procedure, the prostate gland is removed piece by piece by means of
cameras and surgical instruments inserted into the body through small
incisions.
• Laparoscopic interventions are less invasive than open surgical
procedures (degree of intervention) and the incisions are smaller in this
surgery. In both open and laparoscopic surgery, the surgeon performing
the surgery examines whether there are traces of the disease in the
lymph nodes and other tissues around the prostate.
• After the removal of the prostate, the amount of semen produced
decreases. This may cause a complaint called “dry orgasm” in
postoperative patients
