Prostate cancer

What is prostate?

Prostate is the organ that is part of the urogenital system in our body. It is located under the bladder and the urinary tract passes through it. The function of the prostate in the body; It contributes to the volume of semen containing sperm. In addition, it adds an enzyme called prostate specific antigen (PSA) into the semen. This enzyme allows sperm to move more easily by thinning the semen.

What are the risk factors for prostate cancer?

The most important risk factor for the development of prostate cancer is aging. In addition, the probability of detecting prostate cancer is higher, especially in those who have a first-degree relative (father, sibling) with prostate cancer. In addition, prostate cancer is more common and has a more aggressive course in patients with changes in the BRCA1 and BRCA2 genes. Finally, there are studies showing that eating animal foods and high-fat diets increases the likelihood of developing prostate cancer. Prostate cancer is the 2nd most frequently diagnosed cancer type in our country.

Can prostate cancer be prevented?

There is no method yet to prevent the development of prostate cancer. However, engaging in regular physical activity and eating a balanced and healthy diet can reduce this possibility. Apart from this, recognizing prostate cancer early is the most important tool in preventing deaths from prostate cancer. Investigation for prostate cancer should begin at age 45 in men with a family history and at age 50 in men without a family history.

What are the symptoms of prostate cancer?

Prostate cancer has no specific symptoms. However, difficulty urinating, frequent and/or sudden need to urinate, and burning sensation while urinating may still occur due to enlarged prostate. There may be blood in the semen. In advanced disease, pain may occur in the spine and hip bones.

How is the presence of prostate cancer investigated in men?

After taking the patient’s history, a digital prostate examination is performed. An experienced physician can detect almost half of prostate cancers during this examination. Afterwards, the serum PSA value, which is an important screening test for prostate cancer, is checked. At this stage, transrectal prostate biopsy can be performed on patients with differences in digital examination and the diagnosis of prostate cancer can be investigated. Patients with no difference detected in digital rectal examination but with high serum PSA value (3.0 ng/ml) are evaluated with multiparametric prostate MRI. In this evaluation, if a lesion or lesions suspicious for prostate cancer are detected, a prostate fusion biopsy is performed for the target (lesion). Tissue samples obtained by biopsy are evaluated by experienced pathologists.

How is the treatment process guided after prostate cancer is detected?

Not all prostate cancers are the same, and the pathology of prostate cancer shapes the basis of treatment. Roughly speaking, prostate cancer is pathologically classified in a system called ISUP grading from I to S (1 being the most innocent, 5 being the worst).

In addition to this pathological classification; As a result of clinical examination with serum PSA level and digital examination (or multiparametric MRI), patients are evaluated in 3 categories as low, medium and high risk. The risk statement here refers to the increase in serum PSA value after any treatment, that is, the return (recurrence) of prostate cancer. In addition, in some of the medium-risk patients and all high-risk patients, additional examinations such as Ga68 PSMA PET-CT are performed before treatment to determine whether the disease has spread to another place.

What treatment options are available?

There is no single treatment option for prostate cancer that can be applied to everyone. The treatment process is decided based on which risk group the patient is in and whether the disease has spread to any part of the body, especially the bones. Accordingly, there are active surveillance, prostate surgery (radical prostatectomy), radical radiotherapy (radiation therapy), medical castration therapy (blocking the synthesis or effect of testosterone hormone and its derivatives), chemotherapy, immuno-oncological treatment and radionuclide treatment options in the treatment of prostate cancer. UROPARK doctors will give detailed information about which of these treatments is suitable.

With which technique is radical prostatectomy performed?

Radical prostatectomy is performed with both robotic (Da Vinci system) and open surgical techniques. The main difference between both techniques is that the time taken to fully retain urine is shorter in the robotic technique. In addition, regional lymph nodes located in the pelvis must be removed depending on the risk group of the patients.

What is the da Vinci robotic surgery system?

In this technique, the surgeon performs the surgery he has planned through arms previously placed on the patient, using a system called a console that mimics the wrist. This technique is a minimally invasive technique and, just like in gallbladder surgery, the operation is performed through several holes opened in the patient’s abdomen.