Prostate cancer is one of the most common types of cancer in men and it is 28 per hundred thousand in the world in terms of frequency. According to the American Cancer Society, the risk of men experiencing lifelong prostate cancer is reported to be 16.7% and the risk of loss of life is 2.5%. Every 5-6 man is at risk of developing prostate cancer throughout his or her life. While prostate cancer is diagnosed every 3 minutes in the world, prostate cancer related life losses occur every 14 minutes .
Prostate cancer is one of the cancer types that have a high success rate when caught in the early stage. Generally, since the age of 40, every man should have annual prostate examination and blood tests since he is a symptom-free cancer in the initial stage. With robotic surgery, it is possible to maintain urinary retention and better protection of the nerves that maintain sex life.
Where is the prostate gland located and what functions?
The prostate, a part of the male reproductive system, is a gland that covers the outlet of the bladder, just below the bladder, on the front of the intestines. Its main task is to produce sperm and seminal fluid which protects healthy way to store this liquid in the prostate, also squeezes the mouth of the bladder sphincter muscle, urine prevents missed. The prostate capsule divided into three regions surrounded by capsules separates the prostate from other parts of the body.
What is Benign Prostatic Growth?
Prostate gland also shows growth as men grow older . This growth is called benign prostatic hyperplasia (benign growth of the prostate) and is generally seen in the transition region surrounding the urethra of the prostate. Prostate enlargement can prevent the urinary flow by blocking the bladder or urethra. Men may experience frequent, painful, bloody urine or sperm problems, and may experience laxation and pain. These symptoms may be the result of benign growth of the prostate or may occur as a sign of cancer.
What is Prostate Cancer?
Prostate cancer arises from uncontrolled growth of cells in the prostate gland. Cancer cells firstly spread uncontrolled growth into the prostate. It then extends into the capsule surrounding the prostate, penetrating the capsule and spreading out of the prostate. Prostate cancer, unlike benign prostate gland growth, is not from the center of the prostate, but from the central, near-capsule region. Therefore, urinary complaints in prostate cancer disturb the patient later. During the growth and expansion period, it can spread to close organs, lymphatic system and other parts of the body through blood circulation. As the prostate cancer has a slow course, the tumor can leap to the bones and other organs by showing a rather aggressive character.
Prostate Cancer Symptoms
Symptoms of prostate cancer may occur due to disease progression. In this respect, it is an insidious disease. Especially in the early stages, no symptoms or complaints may occur. PE symptoms of cancer rostat arose, some patients may lose their chance of successful treatment, the importance of regular medical checks for the treatment success is great.
Symptoms of prostate cancer can be listed as follows;
- Difficulty in urinating
- Force reduction in urine flow
- Blood in the urine or urine
- Pain during ejaculation
- Discomfort in the groin area
- Bone pains
- Hardening disorder
These symptoms of prostate cancer may sometimes be an indicator of benign prostate growth. Similar symptoms and complaints may be seen in benign prostatic hyperplasia (benign growth of the prostate) due to the growth of the prostate gland. If prostate cancer has spread to other parts of the body and organs, it may give symptoms related to that area. For example; like bone pain if it spread to the bone.
Prostate Cancer Risk Factors
The cause of prostate cancer is unknown. Prostate cancer occurs when some prostate cells due to genetic defects at the cell level are out of control and replace normal cells. Then it can spread to surrounding tissues and to advanced organs in distant organs.
The causes and risk factors of prostate cancer can be listed as follows;
- Hereditary or Genetic Factors
9% of prostate cancers are hereditary and in 15% of patients with prostate cancer the disease passes through first-degree male relatives. The mutation in the BRCA2 gene, which is known to be associated with breast and ovarian cancers in women, has also been shown to increase the risk of prostate cancer in men.
- Non-Genetic (Environmental) Factors
Environmental factors in prostate cancer are more effective than genetic factors. For example, a Chinese man living in China has a very low risk of developing prostate cancer, compared to an American, while the same Chinese individual begins to have a similar American prostate cancer when he or she lives in the United States for a long time.
- The Effect of Age The
Risk of prostate cancer increases with age. Prostate cancer is rarely seen in men under 50 years of age and is more common in men over 55 years of age. It is known that 1 out of 6 men will be diagnosed with prostate cancer throughout their lives.
- Race Factor
Race factor is also important in prostate cancer. Prostate cancer, mostly seen in black men, is seen in white men. It is rarely seen in men living in the islands of Asia / Pacific.
The direct effect of feeding on prostate cancer has not been established. Previous studies have shown that selenium and vitamin E can reduce the risk of prostate cancer, but the more clear results from later research have shown that both do not. Nevertheless, eating healthy foods can increase the risk of prostate cancer directly because healthy diet reduces the risk of cancer.
Diagnosis of Prostate Cancer
If there is a possibility of prostate cancer based on the patient’s PSA blood test and / or an out-of-line examination, the suspicion must be confirmed by biopsy. Prostate cancer is diagnosed by one or more biopsies of the prostate gland.
Biopsy identifies the patient’s existing benign prostatic hyperplasia, cancer or other medical problems. During the biopsy, several small pieces of prostate tissue are taken from the rectum through the help of a needle. These tissue samples are examined under a microscope to determine if they have cancer cells.
The following scans are performed to diagnose prostate cancer;
PSA Blood Test: The PSA level in the blood of the patient diagnosed with prostate cancer is equal to the amount of cancer in his body. PSA (Prostate Specific Antigen) is a protein produced by the cells found in the prostate, and the higher the amount in the blood, the better the prostate cancer. At the same time, the PSA level is extremely helpful in monitoring the success of the given therapy or in determining the postoperative recovery.
Rectal Finger Inspection: One of the most widely used prostate cancer screening tests. By touching the prostate of the patient, abnormalities are examined according to the size and characteristics of the patient.
Transrectal Ultrasonography: During transrectal ultrasound, a small catheter is inserted into the rectum. The probe emits high frequency sound waves that produce echo and return to the prostate. The computer creates a picture with the sonogram, which can display abnormal regions using these echoes. Research is continuing that transrectal ultrasonography reduces the vital risk in prostate cancer.
Advanced PSA Test: For the more pronounced results of prostate cancer and pancreatic cancer, studies are underway to develop the PSA test. The clearer the PSA results, the less concerned the patient and the less need for other tests.
Insulin-Similar Growth Factor: Insulin-like growth factor (IGF) is an important growth and anti apoptotic factor for cancer cells in many cancer types.
Insulin-like growth factor binding protein-3 (IGFBP-3) induces apoptosis independent of IGF-1 (cell death) and inhibits growth. Recent research suggests that increased rates of high IGF-I and low GFBP-3 levels, or both, are associated with increased risk of prostate cancer.
Early Diagnosis of Prostate Cancer
As with other cancers in prostate cancer, early diagnosis can reduce life loss rates. Another benefit of early diagnosis is that the side effects associated with prostate cancer treatment remain minimal. In order to diagnose prostate cancer early, blood test, digital-rectal examination and / or transrectal ultrasound methods which are known as Prostate Specific Antigen (PSA) are used.
However, screening for prostate cancer is a complex and controversial issue and there is not enough evidence that it has reduced the risk of life. Moreover, all screening tests carry some risks.
It is important to discuss the uncertainties and potential damages associated with its benefits with a specialist doctor before prostate cancer screening tests. The potential benefits of screening tests,
Prostate Cancer Treatment
In the treatment of prostate cancer, different treatments may be preferred depending on the growth rate of the cancer, its spread, the general health of the patient and the effectiveness of the treatment to be applied, as well as possible side effects. If prostate cancer is in an early stage, it may be recommended to follow the treatment immediately.
The surgical option is one of the most common and effective treatment methods in prostate cancer. Robotic, laparoscopic and open surgical methods are available and each surgical method should be preferred according to the patient. The aim of the surgical approach is to remove the entire prostate. In appropriate cases, the nerves around the prostate and which help harden the penis can be preserved.
The preferred operation in early stage prostate cancer is laparoscopy. In early stage, prostate irradiation (radiotherapy) is an important treatment option in appropriate patients.
Laparoscopic surgery provides the patient with a comfortable operation and has high success rates for cancer control. After these operations performed by 4-5 small holes, the patient experiences less pain and can return to his daily activity in a short time.
Since there is no surgical incision, these surgeries provide a great deal of patient satisfaction. The major advances in the diagnosis and treatment of prostate cancer have led to this disease being a feared disease.
Treatment by Prostate Cancer Stage
Prostate cancer can be treated by surgery or radiotherapy in the 1st and 2nd stage. Then, hormonal therapy can be started or the patient can be acted upon. In the treatment of prostate cancer, the third stage plan should be either surgery or radiotherapy. According to research, 5 months of chemotherapy after surgery and radiotherapy in prostate cancer prolonged In patients with a PSA of more than 40, who have a lymph node involvement or a Gleason score above 7, chemotherapy should be considered in addition to hormonal therapy after surgery or radiotherapy.
The primary treatment of prostate cancer in stage 4 should be hormonal therapy. With hormonal treatment, the patient’s ovaries can be surgically removed or the male hormone can be blocked by injections every 1-3 months.
There have been many innovations in the treatment of prostate cancer in the 4th stage after 2010. Some drugs used and the duration of chemotherapy in phase 4 has been shown to significantly increase.
In addition, some agents have been developed when conventional hormone blocker drugs do not work. Although the prostate cancer vaccine has been tried, it has not been able to show the expected effect. The efficacy of radio therapeutic agents has been shown only for patients with bone metastases. In addition, treatments with PSMA combined with radioactive Lutetium in prostate cancer are also possible.