According to 2020 data, prostate cancer is the second most common cancer after lung cancer. In addition, it is also in the 5th place in the list of the most deadly cancers. Early diagnosis is very important in prostate cancer, which is one of the cancer types that can be completely treated today. For this reason, it is recommended that patients over the age of 45 should be screened for prostate cancer in the urology outpatient clinic once a year. A number of procedures must be performed to determine whether the patient has a risk of prostate cancer. These;
Digital Rectal Examination
Digital rectal examination is a physical examination method for prostate cancer screening. In this method, your doctor directly examines the prostate gland by entering through the rectum with your index finger. In this method, the prostate gland is evaluated in terms of stiffness and asymmetry. It also gives information about the spread of prostate cancer outside the organ. If there are abnormal findings in the rectal examination, prostate biopsy can be planned without looking at the prostate specific antigen (PSA) level.
Prostate Specific Antigen
Prostate specific antigen is a protein secreted from cells in the prostate gland. Its main function is to liquefy semen. For this reason, while it is predominantly found in semen, a small amount can be measured in the blood. A PSA level above 4 ng/ml in the blood is considered suspicious for prostate cancer. However, PSA is a prostate-specific protein, not prostate cancer-specific! For this reason, inflammations arising from the prostate gland, ejaculation, etc. In some cases, the PSA may increase. For this reason, your doctor will also ask you for the free form of PSA in the blood at the same time. If the free and total PSA ratio is below 20%, the suspicion of prostate cancer becomes stronger.
Multiparametric MR (MpMR)
It is widely used in patients with suspected prostate cancer after rectal examination and PSA tests. With MpMR, foci that are suspicious for cancer in the prostate gland can be detected with high accuracy. In addition, with this imaging method, cancerous areas in the prostate can be detected by blood clots, inflammation, etc. more clearly distinguishable from pathologies. Thus, the necessity of prostate biopsy with MpMR is determined more precisely and unnecessary biopsies are avoided.
As a result of screening tests, prostate biopsy If you suspect cancer, your doctor will recommend a prostate biopsy. Tissue sampling from the prostate gland can be done in 2 ways. The first is transrectal ultrasound-guided prostate biopsy. In this standard biopsy method, 6-12 pieces are systematically taken from the prostate gland and sent for pathological examination. However, with this method, clinically significant cancer can be missed in approximately 30% of patients. For this reason, if clinical suspicion persists in patients without cancer, it may be necessary to perform a biopsy again. For this reason, today, there are smart biopsy methods that provide highly sensitive tissue sampling by superimposing real-time ultrasound images of suspicious areas for prostate cancer seen in MpMR imaging by using special computer software. This smart biopsy method, also known as targeted biopsy or MR-TRUS fusion biopsy, has been successfully applied in our institution since 2016. With this method, sampling is performed with zero error from suspicious areas detected in prostate MRI. In this way, prostate cancer is diagnosed at the earliest possible stage and appropriate treatment is started without losing time.
How is MR-TRUS Fusion Biopsy Performed?
- MpMR images of the patient are examined and targeted determined.
- The determined target is loaded into the software in the smart biopsy robot and three-dimensional mapping of the prostate is performed.
- Target-directed biopsy can be performed under local or general anesthesia.
- Target-oriented biopsy Thanks to the robotic arm used by the system, tissue sampling is performed with zero error from the target determined in MpMR.
- Sampled areas in biopsy are recorded in accordance with their coordinates to facilitate treatment.
What are the Advantages of MR-TRUS Fusion Biopsy?
- Identifies and diagnoses cancers that cannot be diagnosed by standard biopsy.
Multidisciplinary Approach in the Treatment of Prostate Cancer
Those who applied to us for prostate cancer The medical condition of each patient is discussed in multidisciplinary meetings attended by radiation and medical oncology units. Thus, the most appropriate and up-to-date treatment method is planned for the patient. Radical prostatectomy is the most appropriate treatment approach in organ-confined prostate cancer. In our clinic, this surgery is performed with robotic surgery. With Robotic Surgery, which broke new ground in medicine with the developing technology and started to be used in our institution for the first time in Turkey, the treatment of especially kidney and prostate cancers is performed with high success and Florence Urology continues to be a regional and international leading institution in this regard. Robotic surgery systems to the surgeon; It provides many advantages such as 3D and 10 magnification images and easy access to all directions where the wrist cannot normally be rotated. In the postoperative period, in addition to standard imaging methods, state-of-the-art imaging methods (Gallium-68 PSMA PET/CT, PET/MR, PET/CT etc.) are planned in coordination with the radiology clinic.
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