What is Prostate Cancer?

What is Prostate and Prostate Cancer?

What is Prostate?

The prostate is a gland about the size of a chestnut, situated in the male reproductive system between the bladder and the urethra—the tube that expels urine from the bladder to the exterior.

What is Prostate Cancer?

Composed mainly of muscle fibers and glands, the prostate's key role is to produce seminal fluid to transport sperm. Prostate cancer begins as a malignant growth in the gland's outer portion, gradually infiltrating deeper into the prostate. Cancer confined solely within the prostate, not breaching its capsule, is termed "Localized Prostate Cancer." This disease, like other forms of cancer, has the potential to metastasize, first affecting nearby tissues or the seminal vesicle and eventually spreading to distant sites such as lymph nodes and bones.

What are the Causes of Prostate Cancer?

The precise origins of prostate cancer remain unclear. However, a family history of the disease and significant tobacco use are known to elevate risk. Other factors include aging, consumption of foods cooked at high temperatures, diets high in animal fats and red meats, obesity, a sedentary lifestyle, being of African descent, having relatives with prostate or breast cancer, and elevated levels of male hormones.

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 essential to have regular check-ups, especially after age 40, for early diagnosis. Although not characteristic, the most common symptoms:

• Difficulty urinating and inability to urinate frequent urination
• Continuation of urine flow drop by drop at the end of urination
• Difficulty during defecation blood in urine and semen
• Erection problems and 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 essential to consult a specialist physician in case of possible symptoms and, more importantly, not to neglect regular check-ups.

Which Tests are Required for the Diagnosis of Prostate Cancer and After the Diagnosis?

Many tests can be done to detect and then stage (see the extent of spread) prostate cancer, but not all of them are necessary for 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 tumor is localized in the prostate or has locally spread to the tissues around the prostate.
Since the prostate is an internal organ, direct visual inspection is impossible. 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 challenging to interpret because PSA is produced by both tumor cells and normal cells. However, PSA made by the normal prostate passes into the bloodless, while PSA made by tumor tissue passes into the blood in more significant 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 into the bloodstream in small amounts.

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

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. If 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, 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 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 were detected in digital rectal examination.
• Patients with a combination of 1 and 2 substances.

The extent and grade of the tumor in the biopsy and the patient's PSA level play a role in deciding the treatment.

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 relatively 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 tumor is high-grade, it becomes a significant threat to health and life within ten 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. If the disease becomes clinically essential, 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 entirely confined to the prostate capsule in the pathological examination of the excised part, it means that RP has wholly 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 that of localized ones in larger and extracapsular tumors. Significant 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 favor a little more surgical treatment, although inconclusive. 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. At the same time, 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 slow down the proliferation of prostate cancer cells temporarily. Hormone therapy is generally not used unless there is evidence that the cancer has spread beyond the prostate. In other words, it is mainly used in cases with systemic spread (spread to lymph nodes or bones). This treatment aims 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 analogs performed every three 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.