What is Prostate Cancer?
Prostate cancer, the most common type of cancer in men, ranks second among cancer-related deaths. The prostate organ is an organ found in men. The prostate is about the size of a walnut and is located at the bottom of the bladder. The function of the prostate is to secrete various secretions to enable men to reproduce.
Prostate cancer is defined as the abnormal proliferation of the cells that make up the prostate to form a tumor. These tumors can be seen in only one part of the prostate or in many different parts.
Prostate cancer is more common in men over the age of 65. If left untreated, prostate cancers, which usually progress without any symptoms in their early stages, grow over time and begin to put pressure on the urinary ducts. For this reason, prostate cancer usually occurs when patients experience problems with urination.
Symptoms of Prostate Cancer
If prostate cancer is limited to the prostate, some patients have no symptoms at all. On the other hand, the symptoms seen in many patients are as follows:
- Patients experience a burning sensation when urinating,
- Bleeding in semen,
- Difficulty urinating,
- Urinary incontinence
- In advanced stages, bone metastases are observed. Because of these metastases, patients experience fractures and bone pain.
Symptoms of Prostate Cancer Spreading to Bones
Since prostate cancer is one of the insidious types of cancer that does not give any symptoms, its progression is extremely common. Metastasis of prostate cancer is primarily seen in the bones. Symptoms of prostate cancer that spreads to the bones are as follows:
- Bone pain
- Bone pain that increases in intensity over time,
- Pain with movement if it spreads to long bones such as arms and legs,
- If it has spread to the spine, severe pain at night while sleeping,
- Back pain
- Do not have difficulty walking,
- Numbness of the legs,
- Power loss
- Urinary incontinence
- Fecal incontinence
- Numbness in the abdominal area,
- Anemia,
- Fatigue
- Shortness of breath
- Dizziness,
- Fire,
- Do not cough,
- Tremors
- Susceptibility to infection,
- Abnormal bleeding
Causes of Prostate Cancer
The biggest risk factors that increase the risk of prostate cancer are family history and age.
Age is the most influential cause of prostate cancer. Because 50% of men over the age of 70 and almost all men over the age of 90 have microscopic prostate cancer. On the other hand, men under the age of 50 are extremely less likely to develop prostate cancer.
Another important cause of prostate cancer is family history. In 15% of patients with prostate cancer, there is a family history of prostate cancer. Gene groups that cause prostate cancer have also been identified.
Finally, smoking and obesity also play an important role in the increase in prostate cancer.
How is Prostate Cancer Diagnosed?
There is no early diagnosis method for prostate cancer. In other words, the risk of a healthy man is not known beforehand. However, since the factors that cause prostate cancer are known, it is extremely important for men at risk to undergo regular screening for early diagnosis. While every man without a family history of prostate cancer should have regular prostate check-ups after the age of 50, men with a family history of prostate cancer should start these check-ups at an earlier age. Methods used for screening include PSA blood test and physical examination.
PSA Blood Test
PSA stands for Prostate Specific Antigen. These particular antigens can be detected in the blood. With this test, not only prostate cancer is diagnosed, but also benign prostatic hyperplasia, prostatitis (inflammation of the prostate) and BPH (enlarged prostate).
On the other hand, catheterization, sexual intercourse and urinary tract surgery are also causes of high PSA levels. Since there are many different reasons for its elevation, PSA tests alone are not a definitive diagnosis. For this reason, the PSA blood test should be supported by a rectal examination.
Breech Examination
A rectal examination is a physical examination. In addition to being used for cancer identification, it is also used for cancer localization. A rectal examination is important because the prostate is an invisible organ. Since the prostate is located just in front of the rectum, a rectal finger examination can be easily performed.
Transrectal Ultrasonography
Transrectal ultrasonography, also known as TRUS, is an easy and safe way to visualize the prostate using a special ultrasound head. With this imaging, the size of the prostate can be clearly evaluated. It also provides a better evaluation of nodules that are likely to be cancerous.
Transrectal ultrasonography, which is especially used when a prostate biopsy is required, allows better sampling of suspicious nodules.
Insulin-Like Growth Factor
The insulin-like growth factor (IGF-1) test is an indirect measure of the growth hormone produced by the body. It is a blood test that measures a small protein involved in the growth of bones and tissues.
Multiparametric MR
Multiparametric MRI is a diagnostic method that allows three different MRI scans to be performed at once and is considered a new horizon for prostate cancer. It is the diagnostic method that offers the most detailed anatomical imaging of the prostate organ. The most resolution-enhanced imaging modality is parametric MRI. In a scoring system called PI-RADS scoring, patients who score 4 or 5 are diagnosed with cancer.
MR-Ultrasound Fusion Biopsy
It is a type of biopsy performed with various computer software as well as high-tech devices. This highly sensitive method is targeted. This method prevents erroneous diagnoses.
Cases that cannot be detected in conventional biopsy procedures can be easily detected with this system. It is also more accurate in terms of results than conventional biopsy. It is a method used especially in cases where it cannot be determined whether there are cancerous tissues or not. This method significantly reduces the chance of a repeat biopsy.
In this system, both MRI and transrectal ultrasound methods are used together. The images obtained with both systems ensure that the biopsy is taken from the right place. With this system, early diagnosis is provided more clearly. In addition, the accuracy rate is between 70% and 75%.
Prostate Cancer Stages
Correctly determining the stage of prostate cancer is extremely important for planning the right treatment.
Phase 1
In first stage prostate cancer, cancerous tissues are limited to the prostate. In this stage, which is limited to a certain part of the prostate gland, the PSA value and Gleason score are extremely low. In addition, first stage prostate cancers may not be detected by rectal examination or imaging methods.
Prostate cancer 1. stage symptoms
Since stage 1 prostate cancer affects only the prostate, the symptoms are also seen in the prostate. However, in patients in the first stage, cancer cannot be detected by physical examination and the symptoms are not very prominent. Patients at this stage generally do not cause physical changes.
Phase 2
When prostate cancer reaches the second stage, the tumors have spread over a larger area. At this stage, the tumor can usually spread to both lobes. However, at this stage, cancerous tissues have not spread outside the prostate.
On the other hand, prostate cancers at this stage may not show symptoms in imaging methods and physical examination. However, Gleason scores are higher.
Prostate cancer 2. stage symptoms
In patients with stage 2 prostate cancer, symptoms usually affect the urinary tract and sexual function. 2. Patients diagnosed with stage prostate can have all symptoms or only a few of them. 2. Symptoms seen in stage prostate cancer are as follows.
- Frequent urination
- Blood in the urine
- Pain during urination
- Poor urine flow
- Urination problems
- Burning sensation during urination
- Painful ejaculation
- Blood in seminal fluid
- Impotence
Phase 3
Prostate cancer 3. When it reaches this stage, it usually spreads outside the prostate. Lymph nodes are found especially close to the sperm sac.
Prostate cancer 3. stage symptoms
In stage 3 prostate cancer, a significant part of the symptoms are related to the prostate and surrounding structures. Because cancer cells are usually not found in other tissues at this stage. 3. The problems seen at this stage are related to urinary and sexual functions.
- Blood in seminal fluid
- Pain during ejaculation
- Erectile dysfunction
- Blood in the urine
- Pain and burning during urination
- Interrupted urine flow
- Frequent urination
- Increased prostate size
- Frequent urination at night
- Poor urine output
- Inflammation of the prostate gland
- Urination problems
Phase 4
Stage 4, the last stage of prostate cancer. stage cancer metastasizes. It spreads especially to bones and nearby or distant lymph nodes. It can also spread to organs such as the liver.
Prostate cancer 4. stage symptoms
In stage 4 prostate cancer, there are signs and symptoms such as painful urination, decreased urine flow strength, blood in the urine, bone pain, swelling in the legs and fatigue. 4. In stage prostate cancer, the cancer spreads from the prostate to the lymph nodes or other parts of the body. The spread of cells from the prostate to the lymph nodes is called prostate cancer metastasis. Cancer cells that spread usually spread to the bones and liver. As the cancer metastasizes, symptoms may also appear in other organs. Symptoms at this stage vary depending on the metastasizing organ.
When prostate cancer metastasizes to bone tissue, symptoms such as easy fracture of bones, bone pain and increased calcium levels in the blood are observed.
Prostate Cancer Treatment Methods
Especially in the early stages of prostate cancer, a wait-and-see technique is usually used. Because prostate cancer progresses very slowly. In the vast majority of patients, prostate cancer does not cause any problems even if it is not treated throughout their lives.
Non-Surgical Treatment
There are many methods used in the treatment of prostate cancer. The probability of success of these methods is also extremely high. However, since these methods negatively affect the daily lives of patients, treatment methods other than these methods have started to be developed. Non-surgical treatment methods are also called Focal treatment.
- Freezing (Cryoablation),
- High Frequency Focused Ultrasound (HIFU),
- Photodynamic Therapy,
- Radiofrequency Ablation (RITA)
- Irreversible electroporation Nanoknife
In these methods, the prostate glands of the patients are not removed. The aim is to eliminate the cancer without this procedure. In the first four treatment options, cancerous tissues are burned. However, the vessels passing near the tissues can also be damaged during this procedure. Some cancerous cells may also remain in the blood vessels. In addition, damage to the nerves and canals causes additional problems. For this reason, the most preferred method is the treatment option with irreversible electric current.
Nanoknife Treatment
The most important point in the application of nanoknife treatment is to determine exactly where the cancerous tissue is located. Advanced imaging methods are used for this.
Nanoknife treatment is a procedure performed under general anesthesia and patients need to be hospitalized for 1 day. The operation takes approximately minutes.
Radiotherapy
Radiotherapy, which has almost the same success rate as surgery in the treatment of prostate cancer, is a treatment method used especially in patients whose cancerous tissues have grown outside the prostate.
Radiotherapy Side Effects
It is preferred for prostate cancer that has not metastasized to other areas although radiotherapy has extended beyond the prostate. However, this treatment has some side effects. These side effects include difficulty urinating, diarrhea, frequent urination and sudden urge to urinate.
In addition to these side effects seen in the early stages, it also has some side effects in the late stages. These side effects are frequently experienced erection problems. Patients may also experience reduced bladder capacity and stenosis of the urinary tract.
Robotic Surgery
It is a treatment method applied in cases where the cancerous tissue is limited to the inside of the prostate. With this surgery, the entire prostate capsule is removed. The vesicular seminalis at the back of the capsule is also removed.
