Prostate Cancer Diagnosis and Treatment – Dr. Kadir Tepeler

Prostate Cancer

The prostate is a walnut or chestnut-sized gland that secretes fluid into the semen, which surrounds the urethra under the bladder. It is found only in males.

Uncontrolled proliferation of prostate cells leads to prostate cancer. With the increase in diagnostic tools, prostate cancer is the most common tumor in men today.


Who is at Risk?

Elderly men: It is very rarely observed under 40 years of age, while the risk increases after 50 years of age. Most of the patients are over 65 years old.

Those with prostate cancer in their family: The risk is increased if there is prostate cancer in first-degree male relatives (father, brother, uncle). If there is only one person in the family with cancer, the risk increases 2 times, and if there are more people, the risk increases 6-11 times.

Black race: Studies conducted in America have found that it is more common in African-Americans. In addition, it has been observed that prostate cancer progresses more severely and rapidly in these people.

What Complaints Make?

Prostate cancer usually does not show any symptoms until it reaches advanced stages. When the mass in the prostate enlarges, it presses on the urinary tract and the complaints we see in benign prostate enlargement or the spread of prostate cancer to other organs are seen:

  • Difficulty urinating
  • weak urine stream
  • frequent urination,
  • Bleeding from urine or semen
  • pain during ejaculation,
  • Waist-hip-bone pain,
  • Erectile dysfunction (impotence) problems.

It should be noted that there are no specific complaints or symptoms for prostate cancer. External urinary canal (urethra) diseases, bladder diseases and prostate diseases give the same complaints and findings.

Therefore, routine urological examination is recommended at regular intervals in men.

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How is Prostate Cancer Diagnosed?

Today, the diagnosis of prostate cancer can be made at an earlier period and before the disease spreads, with screening. There are two basic methods for screening or diagnosis: PSA (prostate specific antigen) and digital prostate examination.

PSA (Prostate specific antigen): It is a protein produced in the prostate gland. It is a test done by measuring the amount in the blood. Although it is used in the diagnosis of prostate cancer, it can also be elevated in cases such as prostate infection and benign prostate enlargement. Apart from the diagnosis of the disease, it is also used in the follow-up after the treatments.

Prostate examination: The urologist positions his patient appropriately and places his finger on the rectum (breech, last part of the bowel) and examines the prostate with his finger. The size, shape, consistency-hardness of the prostate, and whether there is a tissue protrusion on it, which we call a nodule, are investigated.

Prostate biopsy: It is applied to patients with elevated PSA or abnormal findings in the examination. It is usually applied under local anesthesia. An ultrasound probe is inserted into the rectum and 12 pieces are taken from the prostate with a needle. The pieces taken are subjected to pathological examination and whether there is cancer in the tissues, and if there is cancer, the grade of the cancer (aggressiveness) is examined and reported.

Prostate MRI: In recent years, suspicious foci of prostate cancer in the prostate can be identified with magnetic resonance imaging (MRI). Multiparametric prostate MRI can identify cancer foci in the prostate, especially in patients who have had a biopsy before and have high PSA levels.

Biopsy can be taken from the foci with suspicion of cancer detected in the prostate with MRI, by the method called fusion biopsy. For this method, MRI images are combined with the ultrasound to be used during the biopsy (fusion) and a piece is taken from the lesions identified in MRI. Even recently, biopsy can be performed from the area called the perineum between the ovaries and the anus without placing the ultrasound probe in the last part of the intestine. In this way, while it is possible to get more precise results by combining MRI images and ultrasound, biopsy is performed comfortably and without the risk of infection without placing any instrument in the anus.

Apart from these methods, additional imaging methods are needed to find out whether the disease has spread outside the prostate (especially to the bones and lymph nodes) in patients diagnosed with prostate cancer. For this purpose, bone scintigraphy, PSMA PET, abdominal CT or MRI may be required depending on the situation.

How is Prostate Cancer Treatment?

The patient and the stage and aggressiveness of prostate cancer play an important role in the selection of treatment for prostate cancer. Other accompanying diseases of the patient (heart diseases, diabetes, neurological and respiratory diseases), general condition, age, previous diseases, drugs used (especially blood thinners) are evaluated in detail.

PSA level associated with prostate cancer, prostate cancer grade (aggressiveness degree) as a result of biopsy, and stage of the disease (dissemination) are also determined before treatment selection.

It is necessary to repeat here once again that today's modern medicine aims to treat the patient, not the disease.

What we mean here is to determine the type of treatment that is suitable for the person and that the person will get the highest benefit and the least harm from the treatment.

So personalized treatment comes to the fore in this case.

The treatment modalities of two different prostate cancer patients can be completely different.

Different treatment methods in prostate cancer can be given alone or in combination.

Active follow-up: It can be applied for patients who are detected in the early period, have low aggressiveness, and have low PSA values. Patients are followed up with PSA values ​​at regular intervals. The course of the disease is monitored with annual prostate biopsies. In patients with increased PSA value and increased prostate cancer aggressiveness and tumor prevalence, the next treatment methods are started.

Radiotherapy: It is aimed to destroy the prostate and the cancer focus in it by irradiation. It can be applied to patients who avoid the risks of prostate surgery or whose general condition cannot afford the surgery. It can be applied in cases where the disease relapses after surgery or in painful bone spread.

Radical prostatectomy: It is an operation where the prostate and lymph nodes are removed and the urinary tract and bladder are reconnected. Open surgery can be performed using laparoscopic or recently popular robot-assisted laparoscopic methods. These methods are not superior to each other in cancer removal. However, robotic and laparoscopic surgery is superior to open surgery, especially in terms of urinary retention and preservation of sexual functions.

Hormonotherapy: Prostate cancer (male) is a type of hormone-sensitive cancer. Therefore, in advanced disease, male hormone production is suppressed by drugs. Sometimes it can be given in addition to radiotherapy or after surgery.

Chemotherapy: It is especially applied in patients who have become resistant to hormone therapy and spread to organs.

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