Prostate is a pear- or chestnut-shaped organ that surrounds the first part of the urinary tract at the bottom of the urinary bladder. Prostate is a congenital organ in men.
Prostate cancer shows symptoms in advanced stages. Initially, symptoms are observed due to prostate enlargement. Since prostate enlargement usually occurs over the age of 50, patients apply to us with symptoms caused by prostate enlargement.
The main symptoms of these symptoms are:
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difficulty urinating,
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waiting,
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thin urine,
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intermittent urination.
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Frequent urination at night
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burning in urination
What is done to a patient who comes with complaints of prostate enlargement?
When evaluating patients' prostate enlargement complaints, in order not to miss the possibility of cancer, PSA should be checked in the blood test and the patient's anus = rectal finger examination. needs to be examined. However, diagnosis and treatment may be delayed, especially in our patients who are reluctant to undergo this examination and therefore cannot come to the examination. For this reason, we care about our patients' privacy and can diagnose them with other medical tests without having them examined at their own request.
PSA analysis is a test that can be performed in any laboratory and does not require the patient to be fasting.
p>PSA, Fingertip Examination and Prostate Cancer Diagnosis
In the diagnosis of prostate cancer, a biopsy is performed if the patient's PSA level is high in the blood or if there is a suspicious finding in the examination.
How is prostate cancer diagnosed? is placed? What is Fusion Biopsy?
Treatment is successful when prostate cancer is detected at an early stage. The primary goal is to detect the cancer in the prostate, that is, at a stage that has not spread beyond the prostate.
Today, there are 2 ways to detect the disease early:
Total PSA. Total PSA analysis shows suspicion of prostate cancer. And further examinations are performed.
Prostate examination is performed by rectal touch. r. And prostate cancer can be diagnosed at an early stage. The sensitivity of prostate examination combined with total PSA analysis is 35%.
PROSTATE TISSUE BIOPSY IS ABSOLUTELY REQUIRED IN DIAGNOSIS.
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Prostate biopsy is performed by observing the prostate with rectal USG and taking a total of 8-25 tissue samples with biopsy needles. Contrary to popular belief, biopsy is not a painful or painful procedure. It can be performed in as little as 15 minutes under local anesthesia or under general anesthesia depending on the patient's preference.
What has been done recently? What has changed?
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In recent years, new MRI techniques have been developed in parallel with technological developments and 'MULTIPARAMETRIC PROSTATE MRI' has come into use. Cancerous tissue within the prostate can now be seen with 85% sensitivity. Thanks to MULTIPARAMETRIC PROSTATE MRIunnecessary prostate biopsies can be prevented.
Causes that increase PSA other than cancer?
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Urinary tract infections, interventions made by entering the urinary bladder through the penis (such as endoscopy, lithotripsy, catheterization), prostate biopsy and sometimes the presence of a large-volume prostate also increase PSA.
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Some The use of drugs reduces PSA in the blood below its real value (drugs used for prostate enlargement and some drugs used for hair loss reduce PSA in the blood when used for a certain period of time).
What to know when cancer comes as a result of biopsy What is required
Prostate cancer is expressed as "Adenocarcinoma"in the prostate biopsy pathology report results.
As seen in the biopsy result example below, how many of the samples taken have cancer? The size and percentage of the cancerous part in mm gives an idea about the biological behavior of the cancer, that is, its aggressiveness.
The most important of these is the Gleason Score, which is expressed as the sum of two numbers, and what it does to the patients. It is the parameter that guides the type of treatment to be planned. The closer the sum of two numbers is to 10, the more aggressive the cancer is, generally 7 and above are much more dangerous.
For example;3+3=6, 4+3=7. , 4 Expressions such as +5=9 are encountered; The first number written is also of particular importance, as a matter of fact, a type of cancer with a diagnosis of 4+3=7 is more aggressive and dangerous than a cancer with a diagnosis of 3+4=7.
Treatment of Prostate Cancer
Treatment is closely related to the stage at which we diagnose the cancer. When we diagnose prostate cancer, the disease may be in one of the following 3 stages and the treatment is planned according to the stage. has not spread to distant organs (Localized prostate cancer): Most cases of prostate cancer are detected at an early stage thanks to the use of a blood test called PSA and the greater awareness of patients. The ideal treatment for these patients is the surgery known as "Radical Prostatectomy".
It has gone a little beyond the prostate, but there is no spread to distant organs: In this patient group, if the patient's age is under 70, that is, if he/she is in the young group, surgery (Radical Prostatectomy) is the ideal treatment, but this surgery alone is usually not sufficient in this patient group and additionally Radiotherapyand sometimes Hormone Therapymay also be required.
Metastasized (spread to distant organs) group: Prostate cancers are distant As organs, they spread especially to bones and lymph tissues around the large intra-abdominal vessels. The main treatment for the group with metastasis is Hormone Therapy. Hormone treatment is provided with medications or by surgically removing both testicles (Bilateral Orchiectomy). Both methods, that is, medication or testicular surgery, give the same result.
Robotic Surgery, Laparoscopic Surgery or Classical Surgery in the surgical treatment of prostate cancer?
Which type of surgery? It depends on the experience of the urologist you choose, there is no significant difference between them in terms of surgical success. However, the recovery period of patients is shorter in laparoscopic and robotic surgery. In particular, there is no difference between laparoscopic and robotic surgery.
Before and after Radical Prostatectomy Surgery
This surgery is today the best globally accepted treatment for prostate cancer caught early. This surgery is a special surgery and is performed by a team with experience in this field. With Radical Prostatectomy Surgery, the prostate, seminal vesicles, and sometimes, when necessary, the lymph tissues around the vessels are removed and the urinary tract in the penis and the bladder are reconnected.
In cases of early detected cancer, this surgery is performed. What is desired to be achieved:
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To be completely free from cancer (No tumor within the surgical margins)
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To be able to hold urine after surgery
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It is the continuation of the erection (penis hardening).
The picture below shows a scale, as can be seen from this scale, the contents of the two pans of the scale are balanced. It is necessary to be able to obtain; In other words, it is necessary to be able to urinateand maintain erection at the same time while being cured of cancer.
Urinary Incontinence after surgery
Patients after this surgery The problem they fear most is urinary incontinence.
During this surgery, the nerves that provide erection can be protected and thus the problem of impotence is less common. Although temporary urinary incontinence may occur after the surgery, it is generally short-lived and disappears in as little as 1 month.
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