Prostate cancer is the second most common cancer for the male gender, and a man's lifetime probability of developing prostate cancer is 15-20%. Despite this high rate, the low mortality rate due to prostate cancer can be explained by the increase in diagnostic tests and the good results of treatment options.
Cancer-related life expectancy in low-risk prostate cancer is around 98%. This is a strong indication of the importance of early diagnosis and treatment.
The most important risk factor for prostate cancer is age. The risk will increase for a man year by year. In autopsy studies, the presence of cancer in prostate tissues over 90 years of age was found to be almost 100%, even if it did not show any symptoms. Two other important risk factors are ethnicity and genetics.
For example, the probability of prostate cancer in Japanese has been calculated to be lower than that of western societies. Those with a family history of prostate cancer are also at increased risk. For example, those with prostate cancer in their fathers have a 1.8-fold increase in risk, 5.5-fold in those with a father and a sibling with prostate cancer, and 7.7-fold in those with two brothers with prostate cancer compared to other individuals. Some environmental exposures are also frequently investigated as risk factors. Cadmium element has been shown to be a risk factor for the development of prostate cancer.
Since cadmium is used in battery and battery production, it can be mentioned that employees in this type of industry are at risk. It has also been shown that cigarettes contain cadmium, and it can be said that smoking is a risk factor for prostate cancer. Excessive alcohol intake has also been shown to increase the risk of prostate cancer and cancer-related deaths.
Contrary to our previous knowledge, current information has unfortunately shown that the intake of substances such as vitamin E, vitamin D, selenium and omega 3 does not have a significant benefit in preventing the development of prostate cancer. It has been understood that the substance called lycopene, which was popular for a while and found in tomatoes, was not useful in recent randomized controlled studies.
Although it has been suggested that drugs with dutasteride used for benign prostate enlargement and metformin used for diabetes (diabetes) may also be protective, recent studies have shown that they cannot be used for protection purposes.
Since it is known that high alcohol intake and smoking are risk factors, the best method of protection we can recommend to our patients is to avoid smoking and alcohol. In addition, as it is known that the survival rate after treatment in low-stage prostate cancer caught with early diagnosis is close to 100%, another important advice we would recommend to our patients is regular and timely application to a urology physician for early diagnosis. The first of this visit should be 45 years old for patients whose fathers and siblings with prostate cancer, and 50 years old men without family history.
Low-stage prostate cancer often has no symptoms. The fact that it does not cause any symptoms shows the importance of timely application for early diagnosis. The most common complaints in symptomatic patients are; burning during urination, difficult urination, bleeding during urination, bleeding in the semen, frequent urination.
Since these symptoms can also be a symptom of benign prostate enlargement or other diseases in the bladder, the diagnostic tests and examination of a urologist will determine the differantiation of these diseases. Fatigue, weight loss, and widespread body aches can be seen in advanced cancers.
At the first application, your doctor will ask you for the PSA (prostate specific antigen) test, which is a prostate specific test. Although this test is increased in the case of prostate cancer, it can sometimes be elevated in benign enlargement of the prostate and in prostate inflammation.
All elevation of PSA should not worry our patients. At the same time, prostate cancer can also be detected in patients with normal PSA levels, even with a low probability. This shows us how important the digital prostate examination is. Since the prostate is located just in front of the rectum, which is the part of the large intestine close to the exit, its examination can be easily done from the anus with a finger. However, it is obvious that this situation also causes concerns in patients, especially in some societies.
I would like to state that the worries and fears in the prostate examination are mostly unfounded. This examination can be done painlessly within seconds. Moreover, considering that it is very valuable for the early diagnosis of cancer, it should be known that it is very beneficial for our patients. It is a fact that we urology physicians frequently encounter the existence of patients who have symptoms but do not apply to the doctor just because of the fear of finger examination.
I recommend our patients who have concerns about this examination and do not want to have it done in any way, to apply to their urologist. Do not forget that your doctor will not perform any tests or examinations that you do not want. Even without this examination, your doctor will try to diagnose and treat you with other tests.
Although not yet in routine use, new and valuable diagnostic tests have been developed for patients suspected by PSA and examination. PCA3 and SelectMDX are also tests applied in a limited number of laboratories and are used in the diagnosis of prostate cancer.
Multiparametric MRI, which is popular today and gives valuable information for us radiologically, is applied to patients whose diagnosis is in doubt both before biopsy and in terms of the location of the lesion in the biopsy, and contribution is expected by applying it before and during the biopsy.
After performing auxiliary diagnostic tests in prostate cancer, prostate biopsy is performed in patients with a high probability, and the final decision is made after pathological examination of the tissues (For more information visit; https://www.drarifdemirbas.com/en/mr-fusion-biopsy)
If cancer is diagnosed, there are various scores and rates that predict the course of this cancer. If necessary, additional radiological imaging methods (MR, Tomography, Bone Scintigraphy, PSMA-PET CT) are applied to determine whether there is metastasis to nearby tissues and distant organs, and the treatment method is decided.
Prostate cancer treatment methods; radical prostatectomy (surgery),radiotherapy, active monitoring, focal treatments (HIFU and Brachytherapy),hormone suppression therapy and chemotherapy. Although the choice of these methods is decided according to the stage of the disease, some patients may need to apply several methods.
Unlike benign prostate surgery, this surgery involves removing the entire prostate, semen ducts and sacs. Depending on the stage of the disease, lymph node dissection may also be required. In this surgery, since the prostate is completely removed, there may be a possibility of damage to the adjacent vascular-nerve bundle and thus erection and urinary incontinence problems can be occured.
Despite these possibilities, this method constitutes the main framework in the treatment of prostate cancer due to the high oncological results in patients who have had this surgery. The average 10-year survival rate after radical prostatectomy is 90-95%, which is an indication of its success.
Radical prostatectomy can be performed openly, laparoscopically and robotically. In the guideline of the European Urology Association (EAU) published in 2020, it was stated that these three methods are not superior to each other in terms of both functional (incontinence and sexual activity) and oncological (cancer-free survival) results.
Laparoscopic and robot-assisted radical prostatectomy have shorter hospital stay than open radical prostatectomy.
Laparoscopic radical prostatectomy costs vary 6000-7500 USD in Turkey.
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It is one of the most preferred methods in prostate-limited cancer stage. Oncological results are almost as good as surgery. An average of 8 weeks of treatment is required. The length of the process can be seen as a disadvantage.
For prostate cancer, the focused beam can damage the cells of other surrounding organs, and as a result, prolonged burning in the urine, bleeding, difficulties in making stool and bleeding may occur. Rarely, it has been reported to cause a secondary cancer of the bladder and rectum. In the radiotherapy method, cancer-free survival rates can be increased by adding hormone therapy according to the stage of the disease.
Hormonotherapy can sometimes be added to surgery and radiotherapy in low-stage prostate cancers. Another prostate cancer condition in which hormonal therapy is frequently used is the advanced stages of the disease. Testosterone hormone causes the proliferation of cells in prostate cancer. With this hormone suppression therapy, it is aimed to suppress prostate cancer cells that have spread to the prostate or other organs.
In metastatic prostate cancer, chemotherapy drugs in addition to or alone have been shown to have a survival benefit. It significantly increases the quality of life and survival, especially in patients with low metastasis. In advanced prostate cancer, urology and oncology physicians should evaluate the patient in coordination. For this reason, your urologist will direct you to the oncology department when needed.
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Note: Page contents are for informational purposes only and a doctor's application is required for your diagnosis and treatment.