What is Prostate Cancer?

What is Prostate and Prostate Cancer?

What is Prostate: The prostate is a chestnut-sized gland in the male reproductive system and is located between the bladder and the urethra (the tubular structure that carries urine from the bladder to the outside of the body).

What is Prostate Cancer? The prostate is largely composed of muscle fibers and glands, and its main function is to produce fluid to the sperm to deliver sperm. Prostate cancer is a malignant tumor originating from the outer part of this gland, and as it grows, it spreads to the inner parts of the prostate. Cancer that is located only in the prostate and does not extend beyond the capsule is called “Localized Prostate Cancer”. Like other cancers, prostate cancer can spread (metastasize) and primarily spread locally to the tissues around the prostate or to the seminal vesicle (semen storage sac behind the prostate). Locally spreading tumors spread to other parts of the body, such as lymph nodes and bones, over time.

What are the Causes of Prostate Cancer?

The exact causes of prostate cancer are not known. Having a family history of prostate cancer and high cigarette consumption increase the risk of its occurrence. Other risk factors are advancing age, irregular and unbalanced nutrition, especially high-temperature cooked foods, a nutrition rich in animal fat and red meat, overweight, inactive lifestyle, age, black race, family history of prostate or breast cancer, high male hormone levels. and sedentary lifestyle.

What are the Symptoms of Prostate Cancer?

Prostate cancer progresses insidiously, the symptoms usually appear in the later stages of the disease. For this reason, it is of great importance to have regular check-ups, especially after the age of 40, for early diagnosis. Although not characteristic, the most common symptoms:

• Difficulty urinating and/or inability to urinate frequent urination
• Continuation of urine flow drop by drop at the end of urination
• Difficulty during defecation blood in urine and/or semen
• Erection problems pain during ejaculation

However, these symptoms may also be a precursor to other conditions such as prostate enlargement and inflammation of the prostate. Because prostate cancer can often spread to the bone, it can cause severe pain in the lower back, hips or legs. For this reason, it is of great importance to consult a specialist physician in case of possible symptoms, and more importantly, not to neglect regular check-ups.

Which Test are Required fort he Diagnosis of Prostate Cancer and After the Diagnosis?

Many tests can be done to detect and then stage (detect the extent of spread) prostate cancer, but not all of them are necessary in every man.

Rectal Examination with Fingers

It is a simple form of examination and is useful both in the diagnosis of cancer and in determining whether the cancer is localized in the prostate or has local spread to the tissues around the prostate.
Since the prostate is an internal organ, direct visual inspection is not possible. Since it is located in the anterior part of the rectum (last bowel), it can be examined with a finger inserted through the anus into the rectum.

Prostate Specific Antigen (PSA) Test

It is a blood test that can provide indirect information about the presence of prostate cancer and, if cancer is present, information about its size and extent. The PSA test can sometimes be difficult to interpret because PSA is produced by both tumor cells and normal cells. However, PSA made by the normal prostate passes less into the blood, while PSA made of tumor tissue passes into the blood in greater amounts.

PSA 3 Letters can save your Life: PSA

This simple blood test detects the amount of prostate-specific antigen (PSA), a chemical that escapes from prostate tissue in small amounts into the blood stream.

High levels of PSA indicate a prostate problem, such as an enlarged prostate, infection, or cancer. If your PSA level is high, you should definitely see a urologist for further examinations.

The American Cancer Society recommends regular annual PSA testing for people who:

• From the age of 40 for African American men.
• White men from age 40 if a father or brother has prostate cancer
• From age 50 to white men with no family history of prostate cancer. you are in one of the above groups, make an appointment with a urologist immediately for a PSA test and a digital rectal examination of the prostate.

Transrectal Ultrasonography (TRUS)

It is the ultrasonography of the prostate directly from the rectum using a special ultrasonography probe.
It is an easy and safe way to view the prostate. With this examination, both the size of the prostate is evaluated more clearly and the nodules that are more likely to be cancer are better visualized. Most importantly, when a biopsy is required from the prostate, this procedure is much easier under the guidance of transrectal U.S. and biopsy is taken from suspicious nodules more easily and effectively.

Bone Scintigraphy

It is used to show whether the cancer has spread to the bones because the most common metastasis site of prostate cancer is the bones. It does not need to be done in all patients, especially in small cancers and patients with low PSA levels.
However, if a radical surgical treatment is considered, it should be ensured that there is no metastasis in the bones before such surgery.

Computed Tomography (CT)

It helps detect enlarged lymph nodes due to cancer rather than cancer in the mail. Usually CT cancer is done with diffuse, high grade or high PSA.

Pathological Examination

The definitive diagnosis of prostate cancer can only be made by examining the biopsy samples taken from the rectum with a needle under a microscope by pathologists.

Patients who required Biopsy

• Those with high PSA.
• Stiffness and nodules detected in digital rectal examination.
• Patients with combination of 1 and 2 substances.

The extent and grade of the tumor in the biopsy taken and the PSA level of the patient play a role in deciding the treatment to be made.

How is Prostate Cancer Treated?

• Watchfull – waiting = Wait – see = Tracking protocol
  It is the follow-up of the patient without any treatment. Although untreated prostate cancer continues to grow, this growth is often quite slow. Indeed, prostate cancer growth can be slow enough and may not cause problems at any stage of human life, even if left untreated. In older men, follow-up is a reasonable option, especially if the cancer is small and low grade on microscopic examination. Studies have shown that if the cancer is high-grade, it becomes a significant threat to health and life within 10 years.
• Active Follow-up
  Active follow-up is a process in which curative treatment is delayed until predefined signs of disease progression are detected by following the patient with close follow-up in order not to overtreat patients with clinically insignificant prostate cancer and to protect them from the increased risk of morbidity brought by the treatment rather than the disease. PSA, rectal examination, as well as recurrent prostate biopsies are performed at regular intervals, and if the disease becomes clinically important, a curative treatment such as radical prostatectomy or radiotherapy is started.
• Radical Prostatectomy (RP)
  It is a radical surgical intervention for the treatment of localized prostate cancer (limited within the prostate capsule). The prostate is removed with its entire capsule and the seminal vesicle behind it, and the bladder neck is re-anchored into the urethra (the urinary tract). If the cancer is completely confined to the prostate capsule in the pathological examination of the excised part, it means that RP has completely cured the prostate cancer. Since the entire prostate is removed, PSA should decrease to values that cannot be measured (close to zero) after the operation. If there is a tumor outside the prostate capsule in the pathological examination, PSA is an excellent test in the follow-up of even very small-volume cancers.  On the other hand, the success of the surgery is not as good as the localized ones in larger and extracapsular tumors. Important complications of this radical surgery can be bleeding during the operation, heart attack and pulmonary embolism in the early postoperative period, urinary incontinence and loss of erection (hardening) in the late period. This surgical procedure can be performed open, laparoscopically, or robot-assisted laparoscopically.
• Radiotherapy (Radiation Therapy)
  It is an alternative treatment to radical prostatectomy. 10-year results in prostate cancer localized to the prostate are close to surgical treatment. However, later results are in favor of a little more surgical treatment, although they are not conclusive. Radiation therapy is especially suitable for cases where the capsule has protruded beyond the capsule but is still thought to be limited to the tissues around the cancer. Among the side effects of radiotherapy, difficulty in urination, frequent urination, sudden urge to urinate and diarrhea are seen in the early stages, while erection problems (frequently), reduction in bladder capacity, and strictures in the urinary tract may occur in the late stages.
• Hormonal Therapy
  Hormonal therapy may be beneficial, as many prostate cancer cells proliferate dependent on male hormones, particularly testosterone. Hormone therapy is not a curative treatment, but aims to temporarily slow down the proliferation of prostate cancer cells. Hormone therapy is generally not used unless there is evidence that the cancer has spread beyond the prostate. In other words, it is mostly used in cases with systemic spread (spread to lymph nodes or bones). The aim of this treatment is to eliminate or suppress the testosterone hormone in the body, which can be achieved either by surgical removal of the testicles (orchiectomy) or medically (with LHRH analogues performed every 3 months and anti-androgens taken by mouth every day). While hormone therapy causes hot flashes in half of the patients, it causes loss of erection and sexual reluctance in all.