The prostate is usually the size and shape of a walnut and grows with age. It sits under the bladder and surrounds the urethra, tube males urinate and discharge.
Prostate Cancer is a common type of cancer in men today, only men have a prostate gland.
What Is the Prostate and What does it Do?
The prostate is a chestnut-shaped, walnut-sized gland weighing about 17-20 grams in front of the last part of the large intestine, which we call the rectum.
Its most important task is that the semen, ie semen, constitutes approximately 30% of its volume and secretes some substances such as prostatic acid phosphatase (PAP), prostate specific antigen (PSA), zinc (zn) that enable the semen to liquefy.
The prostate fluid in the semen is alkaline and when it reaches the vagina after sexual intercourse, it neutralizes the acidic environment of the semen and causes the semen to be liquefied and the sperm to stay alive in the vagina for a longer time.
As a result, it has a critical role in the formation of pregnancy. It also covers the part of the urinary tract after the bladder and contributes to urinary retention.
How and Why does Prostate Cancer Occur?
Prostate cancer tumor occurs as a result of uncontrolled atypical cell proliferation in an organ.
This happens in two ways. The first is a benign or non-malignant type and reproduction occurs only in the organ it originates from and does not metastasize to distant organs through blood.
It can only affect its environment and neighboring organs. The second is the malignant species, that is, the female among the people, and it causes dysfunction by invading both the organ from which it originates and distant organs through blood, lymph and neighborhood.
If not treated, it will result in death. Prostate cancer arises from the outer part of the prostate (peripheral zone).
Cancer cells first proliferate uncontrolled in the prostate and cause some structural changes.
It then spreads primarily to regional lymph nodes, bone and then distant organs through the blood.
As with all cancers, the causes of prostate cancer are not known precisely. However, some factors are held responsible.
Basically, there are 3 factors. The first of these is age and prostate cancer is more likely to occur as the age increases. The second is genetic factors.
Those with cancer in a first-degree relative should be closely monitored and are at risk. Those who have prostate cancer in their father, uncle or uncle should be closely monitored over the age of 40.
The third is race and it is more likely to be seen in black race. In addition, many factors such as smoking, environmental factors, viral infections are thought to be the reasons
What are the Symptoms of Prostate Cancer?
Prostate cancer symptoms may not be obvious at first. The vast majority of the disease occurs as a result of the biopsy performed as a result of the examination suspicion or the height of the (PSA) test during routine checks or checkup.
In cases where cancer progresses, non-specific symptoms such as intermittent urination, difficulty in urinating, frequent urination during the day and night, burning in the urine, continuous urine sensation may occur due to the growth of the cancer in the prostate.
There may be bone pain due to the further progression of the disease and some complaints related to the organ it holds.
Sometimes severe symptoms such as kidney failure due to upper urinary tract involvement, bone fractures due to advanced involvement of bones can be seen.
In rare cases, prostate cancer can be diagnosed in elderly patients with only bone pain.
Prostate Cancer Diagnosis and Diagnosis
Prostate cancer is the most common cancer in men in the world, especially in the USA. Most of these cancers are diagnosed during routine controls.
Those over the age of 50 should be evaluated in normal men, and those over the age of 40 in those with a family history. PSA test and rectal examination are very important in evaluation.
If there is an abnormality in either or both, a biopsy from the prostate is required. If cancer is detected as a result of the biopsy, treatment alternatives are discussed according to the stage and grade.
When Is Multiparametric MRI (MPMRI) Necessary in the Diagnosis of Prostate Cancer?
If there is still a suspicious situation in patients who have previously undergone biopsy but cannot detect cancer, that is, if the PSA is high or there is a problem in the examination, the patient should be given Multiparametric Prostate MRI (MPMRI). Based on the MPMRI result, it can be decided whether to perform a re-biopsy or not.
What Is Fusion Biopsy and When Should It Be Done?
Prostate fusion biopsy is the process of overlapping the MPMRI images with ultrasound images, locating the suspicious lesions in MPMRI and taking biopsy only from the suspected cancer area.
In normal biopsy, cancer can be skipped while randomly removing 12 parts of the prostate and repeated biopsies are required.
In fusion biopsy, since biopsy can be taken directly from the suspicious lesion, cancer detection rate is higher.
Therefore, fusion biopsy has recently become more current.
Normal prostate biopsy is performed by entering the prostate from the anus or perineal (between the bags and the anus).
We perform prostate fusion biopsy from the perineal area.
The most important advantage of this is that it does not enter a dirty area such as the rectum, it is entered through the skin under more sterile conditions and the possibility of infection is lower. Rectal biopsies can also cause serious infections.
When Is PSMA Scintigraphy Necessary When Diagnosing Prostate Cancer?
PSMA scintigraphy is more sensitive in the correct staging rather than in the diagnosis of prostate cancer. Biopsy is sufficient to diagnose prostate cancer. However, pelvic MRI / CT and whole-body bone scintigraphy are required for staging.
If there are suspicious lesions that cannot be clarified in bone scintigraphy and MRI and this will change the treatment of the patient, PSMA scintigraphy may clarify the situation.
When and How Is Prostate Cancer Treated?
After prostate cancer is diagnosed and staged, risk classification is made as low, medium high. It can also be evaluated as local, locally advanced and metastatic.
Risk assessment is made according to the patient’s PSA results, the degree of pathological evaluation (Gleason scoring), tumor stage, and whether there is bone or distant organ spread.
In addition, the life expectancy of the patient after that and the presence of additional diseases affect the treatment options. Patients are basically offered 4 options.
- Active monitoring
- Surgery (open, robotic, laparoscopic)
- Hormone therapy
If the patient is at low risk (PSA below 10 ng / dL, pathological classification (Gleason) 6-7, presence of tumor in 2 or less foci, no involvement in bone scintigraphy, MRI / CT is normal), we can recommend active surveillance to the patient in the first place.
The intention of active surveillance is to follow the patient closely. PSA follow-up every 3 months and a re-biopsy at the end of 1 year. If there is a change in the stage or risk, the patient is classified as risk in terms of re-treatment and the treatment is determined accordingly.
This group of patients sometimes do not want to follow the activity. In this case, surgical treatment or radiotherapy alternatives are discussed with the patient. Low-risk patients are not recommended hormonotherapy.
If the patients are at intermediate risk (PSA 10-20, pathological score 7-8, more than 3 tumor foci, bone scintigraphy negative, MRI / CT normal) Surgical treatment or alternative radiation therapy (radiotherapy) according to the patient’s condition, brachytherapy (localized beam) cryotherapy may be recommended.
If the patients are at high risk (PSA above 20, pathological score 9-10, bone involvement +/-, MRI / CT +/-), if the patient is locally advanced, surgical treatment, irradiation and other treatments may be recommended as an alternative. However, the patient’s age, life expectancy and the patient’s own decision are very important in determining treatment alternatives.
If the patient is metastatic, hormonotherapy or if there is metastasis in distant organs, chemotherapy may be considered. When resistance to the hormone develops, chemotherapy alternatives are available.
Prostate Cancer Treatment Types
What Are The Advantages And Disadvantages Of Prostate Cancer Surgical Treatments?
According to scientific studies, the results of all three methods are similar in terms of oncological outcomes such as overall survival and recurrence rate. However, robotic and laparoscopic surgery is superior in terms of urinary incontinence and loss of sexual function.
In addition, patients return to work more quickly in robotic and laparoscopic surgery while prostate cancer treatment is performed.