PROSTATE CANCER | ASSOCIATE PROF. CENK ACAR
PROSTATE CANCER




What is prostate cancer?
Prostate is an organ about a walnut size in male urinary tract located after the bladder and continuing with the outer urinary tract (urethra). It is a secretory gland that contributes to the formation of ejaculate (semen). Growth of the prostate depends on the male hormone, testosterone. The sources of testosterone sources in our body include the testes and adrenal glands. Prostate cancer is the malignant tumor of the prostate. Prostate cancer is rather frequent. Based on the data of the World Health Organization, prostate cancer is the most frequently diagnosed male cancer in the world and is reported as the 2nd most frequent cause of death. Regarding the data in Turkey, incidence is 43/100.000, and frequency of diagnosis is similar of the averages in Europe.

What are the signs of prostate cancer?
Prostate cancer is seen frequently in males older than 50 years of age. The incidence increases with the increasing age. Prostate cancer is not a homogeneous disease, and while cause no problems in some patients for a lifetime, it has a rapid course in some other and can cause death. Generally it causes no complaints in patients, while the most frequent reason of application of patients include findings similar to those in benign prostate hyperplasia (difficulties in urination, urinate at night, and urinary frequency, etc.). It is possible that the cancer can be spread to outside the prostate to lymph nodes and to bones through the blood at presentation. In case of bone involvement, they can present with hip and low back pain.

What are the risks and causes of prostate cancer?
There are 3 definite risk factors for the prostate cancer. These are the advanced age (60 years of age or older), familial inheritance and ethnicity. The mean age of the prostate cancer diagnosis in the world is 68. Familial inheritance is rather important. Prostate cancer in one of the first-degree relatives (father or brother) increases the cancer risk 2.5 times. At the same time, it has been shown that individuals with prostate cancer in their families develop this disease at earlier ages. It is now clearly seen that individuals with close relatives with prostate cancer are under the risk of developing prostate cancer at earlier ages and at higher rates.

How prostate cancer is diagnosed?
Since the prostate cancer prevalence increases within years, it is recommended that men should be examined by urologists after 45 years of age. Follow-up of individuals with relatives having prostate cancer starting from 40 years of age is very important for early diagnosis and treatment. Urinalysis, Prostate-Specific Antigen (PSA), rectal digital prostate examination comprises the first to be carried out among the prostate cancer diagnostic tests. Since PSA test is the indicator of the prostate and not the cancer. It can also increase in prostate infections and benign hyperplasia of the prostate as well as the prostate cancer. In addition, normal values change with age and prostate size. Therefore, interpretation of PSA test singly will not suffice. Prostate examination and rectal ultrasound will provide important information for diagnosis. If there are any doubtful conditions as a result of these tests, collection of a tissue sample (biopsy) from the prostate must be made.

What are the treatment modalities in prostate cancer?
Patients are treated according to the spread of the cancer and aggressiveness in the prostate biopsy.

Active surveillnace: Prostate cancer can have a more benign course in some patients and no cancer deaths are seen although they receive no treatment. With this reason, treatment is not deemed necessary in some patients despite the diagnosis made. “Active surveillance” can be applied particularly for patients in advanced ages with multiple co-morbid diseases with the opinion that side effects of the treatment will outweigh the benefits. In this case, patients can be checked with certain intervals and treated based on the findings.

Surgery: Although there are many treatment options in cancers limited with the prostate, surgical removal of the prostate (radical prostatectomy) is accepted as the golden standard of the treatment methods. Although this method is applied as an open procedure, it can also be applied as a laparoscopic procedure with the assistance of a robot with the technological developments of the last 10 years. Studies have shown that robot provides cancer control comparable to open surgery in the hands of experienced surgeons.

In this procedure, the prostate gland is surgically removed completely from its location between the bladder and the outer urinary tract (urethra), and the bladder is connected to urethra with sutures. At the same time, the lymph nodes in the lower abdomen are removed in patients with a potential of spread of cancer to lymph nodes both for staging purposes and also four treatment purposes, although not definite.

Both urinary continence and sexual functions can be preserved after the radical prostatectomy. However, preservation of urinary continence and sexual functions depend on the patient’s age, preoperative functions and the techniques in the operation. Preservation of nerves in suitable patients with all the three radical prostatectomy methods (open, laparoscopic and robot-assisted) can be possible to maintain the sexual function and continence in the postoperative period. In this regard, robot-assisted procedures give somehow better results as compared to open and laparoscopic procedures. Additionally, robotic surgery has the advantages including going back to work early and cosmetic. However, it must be kept in mind that experience is important for better outcome. Don’t forget that the technology does not treat the patient, surgeon do it by himself by using technology. Therefore, the important thing when deciding the surgical method is to prefer which method the surgeon can be done successfully.