Prostate Cancer: Symptoms, Stages, Diagnosis and Treatment Methods – Comprehensive Guide

What is prostate cancer? An expert guide to early symptoms, PSA testing, risk factors, and the latest treatment methods (robotic surgery, radiotherapy). Early diagnosis saves lives.

Introduction: The Most Important Issue in Men’s Health

Prostate cancer is one of the most common types of cancer in men worldwide and ranks second in cancer-related deaths after lung cancer. However, beyond the alarming statistics lies a promising reality: when diagnosed early, prostate cancer is one of the most treatable types of cancer.

In this comprehensive guide, you will find everything you need to know, starting with the anatomy of the prostate, through to the subtle symptoms of cancer, modern diagnostic methods (PSA, MR Fusion Biopsy) and advanced technology treatment options such as robotic surgery. Our aim is to prevent information overload and guide you in making the most informed decision about your health.

What is the Prostate and What is its Function?

Before understanding cancer, it is necessary to understand the organ. The prostate is a small gland found only in men, approximately the size of a walnut and weighing an average of 15-20 grams. It is located just below the bladder (urinary bladder) and surrounds the urinary tract (urethra).

The primary functions of the prostate are as follows:

Sperm Viability: It produces a large portion of the fluid component of semen. This fluid nourishes the sperm and enables their movement.

Contraction Function: It contracts during ejaculation to help expel semen.

Hormonal Balance: It converts the testosterone hormone into dihydrotestosterone (DHT), a more effective form.

What is Prostate Cancer and How Does it Develop?

Prostate cancer begins when cells in the prostate gland multiply uncontrollably and replace normal tissue. Most prostate cancers are of the ‘adenocarcinoma’ type, meaning they originate from glandular cells.

This type of cancer usually progresses slowly. In some men, the cancer grows so slowly that it causes no problems throughout their lives and does not require treatment. However, some types are aggressive and can spread rapidly to bones or other organs (metastasis).

Do not confuse with Benign Prostatic Hyperplasia (BPH)

Prostate cancer is not the same as Benign Prostatic Hyperplasia (BPH), commonly known as prostate enlargement. BPH is not cancer and does not turn into cancer, but it can show similar symptoms. Differential diagnosis must be made by a urologist.alıdır.

What are the symptoms of prostate cancer?

The most dangerous aspect of prostate cancer is that it often shows no symptoms in its early stages. Therefore, routine check-ups for men over 50 are vital. As the cancer grows and begins to press on the urinary tract, the following symptoms may appear:

Urinary Tract Symptoms

Frequent Urination: Especially at night (nocturia).
Difficulty: Difficulty starting or stopping urination.
Weak Stream: Intermittent or weak urine flow.
Feeling of Incomplete Emptying: Feeling that the bladder is still full after using the toilet.
Burning and Pain: Burning sensation during urination.

More Advanced Symptoms

Blood in semen or urine.
Pain during ejaculation.
Erectile dysfunction (difficulty achieving or maintaining an erection).
Bone pain: If cancer has spread to the bones (metastasis), persistent pain, particularly in the back, hips or ribs.
Swelling or numbness in the legs.

Important Warning: Many of these symptoms may also be caused by non-cancerous conditions such as prostate enlargement or infection. It is essential to consult a doctor for a definitive diagnosis.

Risk Factors: Who is at Risk?

Although the exact cause of prostate cancer is unknown, certain factors increase the risk of developing it:

Age: This is the strongest risk factor. The risk increases after the age of 50, with most cases occurring in people over the age of 65.
Family History and Genetics: If a man’s father or brother has prostate cancer, his risk increases by 2-3 times. Furthermore, the risk of prostate cancer is also high in families carrying breast cancer genes (BRCA1 and BRCA2).
Race: The incidence of prostate cancer and the risk of aggressive disease progression are higher in black men than in white men.
Nutrition: A diet rich in red meat and high-fat dairy products and low in vegetables and fruit has been associated with an increased risk.
Obesity: In obese men, the disease tends to be more aggressive and the risk of recurrence after treatment is higher.

Diagnostic Methods: How is it Diagnosed?

For early diagnosis, urology specialists typically use two main screening methods together:

A. Rectal Examination (Digital Rectal Examination – DRE)

The doctor checks the back surface of the prostate through the rectum with a gloved finger. They look for hardness, nodules or irregularities. It is a short procedure and is usually painless.

B. PSA Test (Prostate-Specific Antigen)

It is a simple blood test that measures the PSA level in the blood.

Normal Values: Generally, below 4 ng/mL is considered normal, but this limit may vary depending on age.

High PSA: It raises suspicion of cancer but is not definitive proof. Infection (prostatitis) or BPH can also elevate PSA.

C. Multiparametric Prostate MRI

It enables detailed imaging of the prostate in suspicious cases. It identifies areas that may be cancerous as ‘targets’.

D. Prostate Biopsy (Definitive Diagnosis)

If the examination, PSA or MRI results are suspicious, a biopsy is performed. Today, with MRI Fusion Biopsy technology, the MRI image is combined with ultrasound, and a sample is taken directly from the suspicious areas. This method has increased diagnostic accuracy to over 90%.

Stages of Prostate Cancer and Gleason Score

If the biopsy result is cancer, staging is performed to determine the aggressiveness and spread of the disease.

Gleason Score (Cancer Aggressiveness)

The pathologist examines the cancer cells under a microscope and assigns a score between 6 and 10.

Score 6: Low-grade (slow-growing) cancer.

Score 7: Intermediate-grade cancer.

Score 8-10: High-grade (fast-growing/aggressive) cancer.

Stages of the Disease

Stage I: The cancer is very small, confined to the prostate and cannot be felt during a rectal examination.
Stage II: The cancer is still within the prostate but can be seen on imaging or felt during an examination.
Stage III: The cancer has spread beyond the prostate capsule and may have spread to the seminal vesicles, but has not spread to other organs.
Stage IV (Metastatic): The cancer has spread to the lymph nodes, bones, liver or lungs.

Treatment Options

The treatment plan is tailored to the individual based on the patient’s age, general health, stage of cancer and Gleason score.

1. Active Monitoring (Wait and See)

It is preferred in low-risk, slow-progressing cases and in elderly patients. To avoid treatment side effects, the patient is monitored regularly (every 3-6 months) with PSA tests and examinations. If the disease progresses, treatment is initiated.

2. Surgical Treatment (Radical Prostatectomy)

It is the most effective method when cancer is confined to the prostate. The entire prostate gland and seminal vesicles are removed.

Robotic Surgery (Da Vinci): It is the gold standard today. The surgeon controls the robotic arms from the console. Thanks to 3D imaging and high manoeuvrability, nerves are better preserved.

Advantages: Less blood loss, less pain, faster recovery, better preservation of urinary control and sexual function.

3. Radiotherapy (Radiation Therapy)

It involves killing cancer cells with high-energy beams. It is used in patients who are not suitable for surgery or who do not wish to undergo surgery. It can be performed externally or by placing radioactive seeds inside the prostate (brachytherapy).

4. Hormone Therapy

Prostate cancer cells require testosterone to grow. Hormone therapy aims to ‘starve’ the cancer by lowering testosterone levels in the body or blocking its effects. It is generally used in advanced stages or in combination with radiotherapy.

5. Chemotherapy

It is used in cancers that do not respond to hormone therapy or that have spread throughout the body (metastatic). The drugs are administered intravenously.

6. Smart Drugs and Nuclear Medicine (Lutetium Therapy)

In recent years, targeted atomic therapies (theranostics) such as ‘Lutetium-177 PSMA’ treatment have been successfully applied in advanced prostate cancer. This treatment aims to directly locate and destroy cancerous cells.

Life After Treatment and Side Effects

The two issues that patients are most concerned about are urinary incontinence and erectile dysfunction.

Urinary Incontinence: This may occur temporarily after surgery. With pelvic floor exercises (Kegel exercises), the vast majority of patients can regain full bladder control within 3-6 months.

Sexuality: This risk is minimised in nerve-sparing robotic surgeries. If problems occur, solutions such as medication, injections or a penile prosthesis are available.

Ways to Prevent Prostate Cancer

Although there is no sure way to prevent it, lifestyle changes can reduce the risk:

Healthy Diet: Eat tomatoes (contain lycopene), broccoli, cauliflower, green tea, soybeans, and pomegranate juice. Reduce animal fats.

Exercise: Walk or exercise at a moderate pace at least 3 days a week.

Ideal Weight: Maintain a balanced body mass index.

Vitamin D: Deficiency may be a risk factor; have your levels checked.

Frequently Asked Questions (FAQ)

Question: Can prostate cancer be completely cured? Answer: Yes, especially in cases of prostate cancer detected at an early stage (Stages 1 and 2), the 5-year survival rate is over 99%. Early diagnosis offers the chance of a complete cure.

Question: Does a high PSA level definitely mean cancer? Answer: No. PSA levels can also rise due to prostatitis, benign growth, urinary tract infection, or physical activities such as cycling.

Question: Can I have children after prostate surgery? Answer: After radical prostatectomy, semen does not ejaculate (dry ejaculation), so it is not possible to have children naturally. However, it is possible to have children through sperm freezing before surgery or in vitro fertilisation after surgery.

Conclusion: Have Regular Check-ups

Prostate cancer is one of the areas where modern medicine has been most successful. It is not the disease that should be feared, but delay. If you are over 50 (or over 45 if there is a family history), do not neglect to visit your urologist once a year and have a simple blood test called PSA.