Prostate cancer is a cancer that occurs in the prostate gland. While it is among the common types of cancer, it can be mild or severe. Cancer develops as a result of an uncontrolled increase in some cells that make up the prostate gland. There may not be any symptoms in the early stages of this disease, which occurs mostly in men over the age of 65. Symptoms such as blood in urine and semen, difficulty and burning during urination can be seen. Treatment depends on the stage of the cancer.
The prostate gland is a gland about the size of a walnut in men, located just below the bladder and supplies some of the fluid that makes up semen for reproductive activities. Cancers can develop in only one part of the prostate or in more than one part. If left untreated, it grows and presses on the urinary canal. It can cause many problems with urination. In cases where treatment is delayed, cancerous cells can also spread to surrounding tissues outside the prostate.
Why does prostate cancer occur and what are the risk factors?
Although the causes of prostate cancer are not fully known, there are some conditions that may be effective in the development of this condition. It can cause cancer as a result of an uncontrolled increase in some cells that make up the prostate gland. This may also be due to genetic factors. In addition, the causes and risk factors of cancer can be listed as follows:
Age
About 50 percent of men over 65 and 70 and almost all men over 90 have this type of cancer at microscopic levels. In people under 50 and younger, it is not very common. Experts emphasize the importance of early diagnosis and recommend cancer screening from an early age.
Genetic and Hereditary Factors
According to research, about 15 percent of cases have a history of cancer in family members. Some gene groups that cause cancer to develop have been identified.
In addition, tobacco use and obesity are also risk factors in the development of cancer.
What are the Symptoms of Prostate Cancer?
Symptoms of prostate cancer vary depending on the stage of the disease. In some cases, it may progress without showing any symptoms. It is a type of cancer that progresses insidiously. Complaints may not be experienced in the early stages. Symptoms and signs are as follows:
- Difficulty and difficulty urinating
- Decreased urine flow force
- Blood in semen or urine
- Experiencing pain during ejaculation
- Discomfort in the groin
- Experiencing pain in the bones
- Erectile dysfunction
In some cases, the above symptoms and signs may also indicate benign prostate enlargement. Failure to go for screening tests or regular check-ups despite a diagnosis may result in treatment being too late. In such cases, the disease progresses and spreads to surrounding tissues. However, if it has spread to different regions and tissues, complaints about those regions may also be experienced.
Prostate Cancer Stages
Prostate cancer stages are examined under 4 different headings. Treatment planning can be done depending on the level and stage of the cancer.
Tumor Grade
If cancer is detected after a prostate biopsy, the cancerous cell is examined and evaluated by the pathologist. The commonly preferred Gleason Scoring System is used. The findings and results provide information about the rate of tumor progression and differentiation from healthy cells.
When the grade of the tumor is similar to normal tissues and there is not much differentiation, it means that the possibility of spreading is low and low. On the other hand, when there is excessive differentiation from healthy and normal tissues, it is seen as a high risk that it can grow rapidly and spread to different tissues.
Stages of Prostate Cancer
Prostate cancer stages are classified depending on how far the tumor has progressed in and around the prostate gland where it has developed. Stages are determined by the size of the tumor, its spread in the region or surrounding tissues, its spread to the lymph nodes and its spread to different parts of the body. The stages can be listed as follows:
Stage 1
In the early stages, the tumor is located only in the prostate. The tumor is too small and of low grade to be detected by rectal examination. There is no spread to lymph nodes or other parts of the body.
Stage 2
In the second stage, the tumor has progressed into the prostate, but has not spread around it. The tumor can be detected by rectal examination or imaging methods such as Multiparametric Prostate MRI. There is no spread to other parts of the body or lymph nodes.
Stage 3
In stage 3, the tumor has spread to the tissue capsule surrounding the prostate. This spread can be to tissues such as the sperm sac.
Stage 4
In stage 4, the cancer has spread to different tissues and cells around the prostate. In this case, metastasis can often occur in the lymph nodes, bones, liver or lungs. It is important to determine the degree of cancer, to provide the necessary treatment and to monitor the progression of the disease.
Prostate Cancer Diagnosis Methods
There is no method for early diagnosis. Advancing age or genetic factors are risk factors for the development of cancer. Tests for these factors can be performed for early diagnosis of prostate cancer .
Cancer screening is recommended for men with no family history of this type of cancer at the age of 50 or later, and for men with a family history of cancer at an earlier age. Screening methods include a rectal examination by a doctor and a check of the prostate gland. It is also done by measuring the PSA level with a blood test.
PSA Test and Prostate Examination
It contributes to early diagnosis. It is done by taking a blood sample. This test is called the prostate specific antigen (PSA) test. In cases diagnosed early, the cure rate and treatment opportunities are high. PSA levels may be elevated in cases such as prostate enlargement, prostate inflammation, after sexual intercourse and urinary tract infections.
Its low level is not a direct factor in ruling out cancer. Therefore, it should be supported by a prostate examination. After the tests are performed, additional tests may be required.
Multiparametric Prostate MRI
It is an imaging technique used to support the diagnosis in cases of suspected cancer. In cells and tissues with cancerous growth, there is an increase in cells and blood supply. They also have a different appearance from healthy cells and tissues. Therefore, it can be visualized with Multiparametric Prostate MRI.
This imaging method can also be used as a guide when performing a prostate biopsy.
Prostate Biopsy
It is done by taking a piece from different parts of the body to evaluate, examine and perform different tests in laboratory settings. It can be done by taking samples from different parts of the prostate. The parts are usually taken with a special device used by specialist doctors under local anesthesia. Pathological examinations determine whether there are cancerous cells.
MR-Ultrasound Fusion Biopsy
With this method, the previous imaging is transmitted to the ultrasound device to determine where and in which part of the body the cancerous cells and tumor are located. It can be applied in two different methods. The first one is the transperineal method, which is applied by entering through the skin in the perneal part.
Local anesthesia or general anesthesia can be applied. Another application is the transrectal method, which is accessed through the rectum. This method can be performed with local anesthesia.
Prostate Cancer Treatment Methods
Prostate cancer treatment is planned depending on the stage and progression of the cancer and tumor, the age of the patients, their general health and possible side effects. In the early stages, follow-up and observation may be used instead of treatment. In this way, complications and side effects that may be caused by treatments are avoided. However, treatment is inevitable in advanced stages.
Surgical methods are the most commonly used and effective methods in the treatment of this type of cancer. Surgical methods include robotic surgery, laparoscopic (closed) and open surgery. These methods are preferred depending on the suitability of the case. The goal of surgical approaches is to remove the prostate completely. However, in suitable patients, the nerves around the prostate that help the penis to harden can be preserved.
In the early stages, the first goal is to completely remove the cancer from the body or to destroy the cancer cells. However, if the cancer is in advanced stages, the cancer cells may have increased excessively and this method cannot be applied. In such cases, treatment methods aimed at slowing or stopping the progression of cancer are planned.
The surgical approach in the early stages is laparoscopy. Radiotherapy is also known to be a useful treatment option for suitable patients in the early stages. Laparoscopic surgery provides a comfortable operation process for cases and has a high success rate in terms of cancer control.
In advanced stages, there may not be any signs or symptoms. The aim of the treatment is to prevent further progression of the disease. Hormonal treatment method is applied.
Partial Hormonal Treatment
Most of the male hormone is produced in the testicles. This treatment stops the production of male hormone in the testicles. The methods that can be used for this application are as follows:
Estrogen: It is a female hormone that should be used in some cases during the treatment process. By lowering male hormone levels, the progression of cancer is prevented.
Orchiectomy: Surgical removal of the testicles. Since male hormone causes the tumor to grow, these operations slow down the progression of the cancer.
Chemical Castration: Apart from surgical methods, these are drugs applied to stop the production of male hormone. It is applied by injection.