What is the structure and function of the prostate
The prostate is a gland that is only present in men and helps to produce semen. Its approximate size and structure are similar to that of chestnut. Patients have trouble understanding where the prostate is in the body. In men, the urinary bladder arises from the penis via a urinary canal. About one-third of this canal remains in the body, while the other two-thirds continues in the lower part of the penis as a tube. The prostate, a gland that surrounds this canal like a ball and connects it to the bladder, is located at the junction of this canal and the bladder. Since the prostate surrounds the urinary canal, prostate diseases often manifest themselves with urinary complaints. The patient, for example, is having trouble urinating because the development of this gland is placing pressure on the urinary canal. The prostate, which reaches its normal size (20-30 gr) in adolescence, starts to grow after the age of 40-50 in about half of the people.
What is Prostate Cancer?
The prostate can have many diseases, such as prostate inflammation, benign prostatic hyperplasia, cancer development. Prostate cancer, like other cancers of the body, is caused by an abnormal cell increase in the prostate. The issue that should not be confused here is that prostate cancer is not always associated with prostate enlargement, cancer may develop without enlargement of the prostate, as well as may develop in an enlarging prostate. It can be thought of as getting wormy and rotting of an apple. Prostate cancer is one of the most common cancers in men, but it has a high treatment success rate if identified early (can provide a life without cancer and without additional treatment).
What are the symptoms of prostate cancer?
While early diagnosis is critical in prostate cancer, the disease does not always manifest itself in the form of complaints and symptoms in the patient. Hence, any man over the age of 40 should have a check-up and analysis in this area at least 2 years, and after the age of 50, at least once a year. Men with a family history of prostate cancer, on the other hand, should be monitored more closely since they are at a higher risk of developing prostate cancer.
Patients with prostate cancer can experience trouble urinating, a drop in urine rate, repeated urination, blood in urine or semen, pain during ejaculation, waist-hip-bone pain, and erection problems. However, the presence of one or more of them in a patient does not always indicate the presence of prostate cancer, so it is best to consult a urologist in this situation.
Methods to diagnose Prostate cancer
The first step in making a diagnosis is taking a comprehensive medical history and doing a thorough physical examination on the patient. There are two indispensable procedures in the diagnosis of prostate cancer. The first is the prostate examination made from the anus with a finger, the second is the PSA level, which is measured by blood analysis. If the finger test reveals an irregular condition, or if the PSA level is above normal, or if both, a piece of the prostate must be removed and examined (prostate biopsy).
PSA values under 2.5 are considered normal in patients under 60 years old, under 3 in those 60-70 years old, and under 4 in those over 70 years old. However, it should not be forgotten that PSA is not a cancer indicator that gives 100% results. Cancer may also occur in a patient with a PSA value of 1 (rarely). That’s why a finger examination is a must. Therefore, patients with normal PSA values and abnormal findings on examination should also be biopsied. Another important thing to note about PSA is that a high level does not necessarily signify the existence of cancer, as other factors may cause this value to rise. For example; urinary canal infection, prostate infection, benign prostatic hyperplasia, catheter insertion, etc.
Prostate biopsy is a procedure that can be performed under ultrasound-guided local or general anesthesia today. Patients with abnormal examination findings or high PSA are candidates for biopsy. The pathology doctor examines the light small tissue samples taken during the biopsy to determine if there is cancer in the prostate and, if so, which part of the prostate it is in and if it is aggressive cancer.
Prostate Cancer Treatment Methods
There are many types of prostate cancer, with Adenocarcinoma being the most common. This type, on the other hand, has a variety of forms with varying degrees of aggression. Its aggressive nature and the spread of prostate cancer are not the same things. A very small newly started prostate cancer can be aggressive, while a larger cancer can be slower and harmful. Therefore, the aggressiveness of cancer and its spread (ie the stage) are different things. In addition to these, many other factors are taken into consideration when evaluating treatment options;
– Stage of cancer (spread status)
– Cancer grade (aggressiveness status)
⁃ Age of the patient
⁃ Additional diseases in the patient
⁃ Medications used by the patient
⁃ PSA level
– Presence of metastasis etc.
Patients are offered the most appropriate treatment options by taking into consideration all of these factors. After all the treatment options suitable for the patient are explained to the patient with their advantages and disadvantages, it is most appropriate for the patient and the doctor to decide together which one to choose. Treatment options are as follows.
1- Radical Prostatectomy (Surgical removal of the entire prostate)
It is a cancer-saving surgery that can be performed on patients diagnosed at an early stage. Besides, it is necessary to check the age of the patient and whether there is any additional disease. Generally, it is not recommended for patients over 75 years of age or with other serious diseases (heart, brain, etc.). Today, it can be performed open, laparoscopically, and robotically. It is essential to make a separate decision for each patient when selecting these.
Its biggest advantage is that it can save the patient from cancer. The disadvantages are postoperative complications (side effects and problems). The most common complication is the erection problem in the patient. Other problems are urinary incontinence and some of the cancer tissue remaining in the body. The intended success of the surgery is assessed depending on these three criteria.
2- Hormone (drug) therapy:
It is a recommended method for patients who are unable to be operated on. The drugs given here are not chemotherapy drugs, but hormonal drugs that suppress the male hormone testosterone. Therefore, it is a treatment that does not have chemotherapy side effects such as hair loss in the patient and does not affect the health of the patient except for the sexual functions. However, it may not always be enough on its own. It can sometimes be used in conjunction with radiotherapy or chemotherapy. Sometimes it may need to be used after radical prostatectomy surgery.
Since the aim of hormone therapy is to suppress testosterone, the testicles will shrink over time. Besides, the removal of the patient’s testicles is a faster and more effective method and has a similar effect.
It is a radiation therapy to kill cancer cells in the prostate. While it can be used as an alternative to radical prostatectomy in early-stage cancers, it can also be used when late-stage cancer begins to spread beyond the prostate. It can also be done to prevent the progression of cancer in late-stage patients where cancer has spread to the bones. The most important advantage is that the patient would not need major surgery. Therefore, it can be considered as the first option in patients who cannot be operated on due to advanced age or additional diseases. However, the disadvantage is that it is more difficult to comprehend that cancer has been completely eradicated. Apart from this, long-lasting urinary burning complaints and intestinal problems may occur due to radiation therapy. Radiotherapy is usually done for 5-6 weeks, 5 days a week, in sessions of about 15 minutes each day. Radiotherapy is now available in a variety of forms. As a general area can be irradiated, there are also special 3-dimensional methods that focus only on the prostate gland.
It is a method used in patients with advanced prostate cancer. Sometimes the hormone therapy used no longer affects the patient, and this method is used in such patients as well. The drugs used here are similar to chemotherapy drugs used in other cancers and have more severe effects for patients than hormone therapy. In some patients, it is used in combination with radiation therapy, and in others, it may be required to be used in conjunction with radiation therapy, hormone therapy, and chemotherapy.
5- Active Follow-up (Close follow-up without treatment)
It is a method that can be preferred in very early stage prostate cancer. We mentioned above about the aggressiveness and spread of cancer. It is based on waiting without any treatment in patients with low aggressiveness (grade) and low PSA level. Because prostate cancers with low grades sometimes do not progress even without any treatment and do no harm to the patient. To prevent the side effects of major surgeries or radiation therapies, these patients are followed up on at regular intervals instead. As soon as cancer starts to become aggressive during the follow-up, other therapeutic methods are started. However, in some patients, this may not be necessary at all. Rectal exams, PSA measurements, and prostate biopsy are used to follow up on these patients periodically. Patients diagnosed with prostate cancer in our country and many other parts of the world, however, do not prefer this choice, even if the disease is in its early stages, and instead seek out ways to fully eradicate the disease.