Prostate cancer

WHAT YOU NEED TO KNOW ABOUT PROSTATE CANCER

SYMPTOMS

Prostate cancer usually does not cause any complaints in the early stages of the disease. Complaints that can be seen frequently in patients in this period:

• The need to urinate frequently, especially at night
• Delay in starting urination and continuation of urine flowing drop by drop at the end of urination
• Inability to urinate at all
• Weak, thin or intermittent urination
• Burning or pain when urinating
• Painful ejaculation (ejaculation) mentioned above during sexual intercourse
• Blood in the urine or semen

  Back, hip and/or leg pains may be the primary complaints in late stage prostate cancer patients. Any of the above-mentioned complaints may develop due to cancer or another non-serious health problem. In a different sense, the presence of any of these complaints does not necessarily mean that the individual has prostate cancer.

DIAGNOSIS

Prostate biopsy: If the test results indicate that the patient may have prostate cancer, tissue sampling (biopsy) should be performed. A biopsy is the only way to confirm the diagnosis of prostate cancer. After the painkillers to be applied around the anus, biopsy samples are taken with the help of a thin needle under the guidance of transrectal ultrasonography.

The ‘Gleason Scoring’ system is widely used in the grading of prostate cancer. Prostate cancer gets a score between 2 and 10 with this system. Low-scoring tumors have slower growth and spread than high-scoring tumors.

PROSTATE CANCER TREATMENT OPTIONS ACTIVE SURVEILLENCE

Prostate cancer progresses very slowly in most patients. Therefore, despite the diagnosis, some patients do not need to be treated. Treatment for prostate cancer may not be recommended for patients whose cancer has not spread to other parts of the body and who have other serious health problems, especially in elderly patients. In this case, the patient is followed at regular intervals and with examinations without treatment; If necessary, treatment is initiated according to the findings during follow-up.

SURGICAL TREATMENT

It is a frequently used treatment method in the early stages of prostate cancer. Surgery to remove the entire prostate gland is called ‘Radical Prostatectomy’. It is a viable treatment method especially in stage t1 and t2 tumors, which are thought to be limited to the prostate, if the patient’s life expectancy is over 10 years.

Radical prostatectomy is performed with open or laparoscopic surgical techniques. The main side effects are temporary or permanent urinary incontinence, not enough erection for sexual intercourse in the penis after surgery (erectile dysfunction) and stenosis in the urinary canal in the urethra.

RADIOTHERAPY (BEAM RADIATION) TREATMENT

It is a treatment method that can be applied to different stages of prostate cancer for different purposes. In radiation (ray) treatment, it is aimed to destroy cancer cells with high-energy rays and prevent their growth. In early-stage prostate cancer, radiation therapy can be applied instead of surgery or to destroy any cancer cells that may have remained in that area following surgery. When prostate cancer spreads to other organs, radiotherapy can be applied in these areas and may play a role in relieving the discomfort caused by the cancer. Radiation can be directed into the body with an external machine (external radiation) or a radioactive core can be placed in the prostate (internal radiation brachytherapy) and delivered directly to the cancerous tissue. For some patients, these two radiation treatments can be used together.

HORMONE THERAPY

Prostate cancer cells need male hormones to grow and multiply. For this reason, reducing the level of male hormone in the blood or preventing the effect of the hormone on the cells has an important place in the treatment of prostate cancer. The drop in hormone levels affects all cancer cells, even if they have spread to other parts of the body. Hormone therapy is a systemic therapy.

LHRH – agonist drugs administered monthly or quarterly as injections (injections) are another form of hormone therapy. LHRH- agonists prevent the testicles from producing male hormone (testosterone). Antiandrogen drugs in tablet form can be used to prevent the effect of this small amount of hormone production.

CANCER TREATMENT WITH CHEMOTHERAPY

proliferation of prostate cancer cells that have spread to other parts of the body can usually be controlled for a while with hormone therapy. This period can often last for years. However, over time, prostate cancer cells become able to grow in an environment where there is no male hormone. In this case, as hormone therapy will be insufficient, additional treatments may be started by using different drugs. In this period, the physician may also recommend treatment practices that are still in the research phase to the patient.

ROBOTIC SURGERY IN PROSTATE CANCER (RADICAL PROSTATECTOMY-LYMPHADENECTOMY)

Robotic Surgery

(Robot-Assisted Laparoscopic Radical Prostatectomy

Minimally Invasive Surgery):

The camera, which transmits the 3D HD real image of the instruments and the operation area to the surgeon console, is sent to the patient’s operating area through small incisions. By controlling these instruments, which can rotate 540 degrees from the console in the operating room, the surgeon performs the operation in very narrow spaces with maneuvers that human hands cannot do.

The biggest advantage of robotic surgery to prostate cancer surgery is that instruments can be moved freely in very narrow spaces. The prostate is found only in men, and the pelvic area of ​​men is much narrower than that of women. During the operation, the prostate is separated from the bladder and urethra, and the bladder is brought closer to the urethra and joined together. Thus, the urinary tract is restored. This method, which helps to protect the nerves, minimizes the risks of urinary incontinence and sexual insufficiency after surgery. In addition, the small incisions made during the surgery allow the patient to return to his daily life faster after the surgery.

IS THERE A NON-SURGICAL SOLUTION FOR PROSTATE CANCER?

Among the treatments for prostate cancer, surgery is the most successful in terms of cancer control. However, there is a risk of urinary incontinence of up to 5% in good centers. Impairment of sexual functions is seen between 30-50% despite the protection of the nerves. Although radiation therapy has similar results to surgery in terms of cancer control, sexual function and urinary problems can still be seen. In recent years, instead of removing or irradiating the entire prostate, only the treatment of the tumor area (focal treatment) is on the agenda. Especially High intensity focused ultrasound (HIFU) method is also applied in our country. It is based on the principle of destroying cancer cells by focusing ultrasound waves into the prostate. Although there is no follow-up as long as surgery yet, it is a promising form of treatment in suitable patients and in experienced centers. It is reported that there may be an advantage in terms of urinary incontinence and sexual functions.

As a result; There are successful non-surgical treatment alternatives in prostate cancer. The most important point is that a PATIENT SPECIFIC treatment is performed in an experienced center and with an experienced physician.

Focal therapy with HIFU in prostate cancer

FOCAL TREATMENT

Prostate cancer is diagnosed at an earlier age, often in the late 50s and early 60s. Giving them the same treatment options as 20 years ago dramatically jeopardizes their biggest concern, their quality of life. Focal therapy with HIFU is a modern, truly non-invasive, focal therapy aimed at preserving patients’ quality of life and leaves open all treatment options, including recurrence of HIFU, in case of local recurrence of the disease. It is a localized treatment for localized prostate cancer, as it is applied only to the prostate area affected by cancer, as a remedy to reduce side effects such as erectile dysfunction and urinary incontinence. HIFU is designed in such a way that each patient can apply a special treatment depending on the prostate anatomy.

FOR HIFU, FOCAL TREATMENT PROTOCOLS:

• Half Prostate ablation: Treatment of half of the prostate affected by cancer
• Nerve sparing: Treatment aimed at preserving erectile function by treating the entire prostate excluding the neurovascular nerves on both sides of the prostate
• Regional treatment: The “most cancer-targeted” approach applied only to the cancer-affected area.

HIFU NON-SURGERY TREATMENT IN PROSTATE CANCER

It is a non-invasive surgical ablation method aimed at the treatment of prostate cancer using high-intensity focused ultrasound energy, accompanied by live ultrasound image guidance.

It is aimed to destroy the cancerous area by transmitting high-intensity ultrasound energy to the cancer foci determined by MRI in the prostate through the rectal wall.

High-intensity ultrasound sound waves rapidly increase the temperature of the targeted prostate tissue, destroying cancerous lesions, and providing treatment without damaging the surrounding tissues.

Erectile nerves are not touched (on one or both sides) to avoid erection problems. Urine retention structure is preserved.

Basic patient selection criteria:

patients over 50 years old

• T1c – T2a localized prostate cancer
• PSA value less than 10 ng/ml
• Cancer confined to a single lobe
• Gleason score less than 6

Advantages:

– Noninvasive, bloodless procedure

– Customizable, customizable energy pulses

– Minimum hospital stay

– Non-radiation therapy

– Low side effects

FOCAL TREATMENT (HIFU), SURGERY-RADICAL PROSTATECTOMY CAN IT BE AN ALTERNATIVE?

In a study led by Professor Hashim Ahmed, who is the world’s leading authority on prostate cancer at the “Imperial College, Department of Surgery and Cancer” in London, it was aimed to compare the effectiveness of focal therapy (FT) with radical prostatectomy (RP) patients.

This comparison showed that HIFU therapy is equivalent to radical prostatectomy in the treatment of prostate cancer. The fact that HIFU patients only stay in the hospital for a few hours and that very few personnel are needed in the operating room for this procedure made it a treatment alternative, especially during this Covid pandemic.

Hashim continued, adding that focal therapy has shown that with appropriate error selection, cancer control has been achieved more than 8 years after treatment, similar to that in radical prostatectomy patients. He explained that although focal treatment is not suitable for every patient, thousands of eligible patients should be told about Focal treatment and its advantages.

After the HIFU treatment performed under anesthesia in the operating room, the patient can stay in the hospital for one night and go home the next day.