prostate

If you’ve been diagnosed recently with prostate cancer, you might be confused searching about prostate cancer and possible treatment options. Every treatment has its benefits and risks and no single treatment is right for every man with prostate cancer. This article tries to explain prostate cancer and the latest treatment modalities in 12 questions:

QUESTION: What is prostate cancer?

ANSWER: Prostate cancer occurs in the prostatic capsule or, as the scientific definition goes, the peripheral zone of the prostate tissue as one’s age advances. This is one of the most frequently encountered types of cancer, second only to skin cancers. Prostate cancer can be diagnosed early through the PSA (Prostate-Specific Antigen) test, which enables the disease to be fully treated. Those with prostate cancer in the family should have their PSA measured and go through a prostate examination once a year after the age of 40, while those without should take these measures after the ages of 45 to 50. Otherwise, undiagnosed prostate cancer that is especially aggressive may spread to lymph nodes, bones, the liver and in some rare cases, lungs.

QUESTION: Is prostate cancer a frequently encountered disease?

ANSWER: It is calculated that prostate cancer is found in 50% of men over 70 and almost all of men over 90 on a microscopic level. For a healthy man, the risk of coming down with prostate cancer is approximately 17% throughout his life. In other words, one of around 6 or 7 men develops cancer. The invention and clinical use of the PSA test in the 1980s has reduced the prostate cancer mortality rate.

QUESTION: What causes prostate cancer?

ANSWER: The reasons for the development of prostate cancer are not exactly known. As in other types of cancer, it is thought for genetic predisposition, as well as adverse environmental conditions, to have a role in the occurrence of this disease. Advanced age, presence of prostate cancer in the family, lipid-rich nutrition, hormones and vitamins A and D are considered as having the possibility of contributing to the development of prostate cancer.

QUESTION: Is it possible for me to prevent development of prostate cancer by eating healthy?

prostate-foodANSWER: Since the causes of prostate cancer are unknown, preventing the development of the disease is currently not possible in many cases. However, recent studies show that the risk of developing cancer can be reduced by making changes in one’s diet and lifestyle. For example, research indicates that consumption of tomatoes, which have plenty of lycopene in them, reduces the risk of cancer by 26%. There are also studies that show soy beans, which contain the vegetable substance of phytoestrogen that is similar to the estrogen in our body, decrease PSA levels. It is known for omega-3 fatty acids which are found the most in cold water fish such as salmon and tuna fish to have protective effects against cardiac diseases and cancer. The mineral selenium is also claimed to reduce the risk of prostate cancer. Mushrooms contain plenty of this substance that prevents tumor growth and reduce PSA levels. A nutrition rich in vegetables and fruits reduces the risk of developing prostate cancer as well. Fruits increase the production of vitamin D in the body, which is also known to decrease the risk of prostate cancer. Broccoli and Brussels sprouts are other foods that decrease this risk.Green tea is known to decrease the development rate of cancer cells by means of the polyphenols it contains. Additionally, it is also claimed that green tea reduces the amount of the substance polyamine which increases the aggressiveness of cancer cells.

QUESTION: I exercise regularly. Does this practice reduce the risk of developing prostate cancer?

ANSWER: Certainly. Exercising regularly ensures weight loss and decreases the risk of prostate cancer. Research conducted indicates that exercise reduces the testosterone and PSA levels in the body.

QUESTION: My father passed away due to prostate cancer. Is there any risk of me developing this disease as well?

ANSWER: The most significant risk factors in prostate cancer are age and family history. It is estimated that 10% of all prostate cancer cases develop due to genetic inheritance from father to son. The risk of developing prostate cancer is 2 to 9 times higher for the male children or brothers of patients with prostate cancer. Therefore, while it is generally recommended for individuals to get examined for prostate cancer during normal check-ups after the age of 50, the examinations for people with prostate cancer in the family are started after the age of 40.

QUESTION: Are there any conditions I need to avoid to prevent prostate cancer?

ANSWER: There are some important points to be taken into account for prevention of prostate cancer. For example, prostate cancer is encountered at a higher rate in individuals who eat foods with high fat rates and red meat. Intake of excessive calcium also reduces the synthesis of vitamin D in the body, which has protective effects against prostate cancer. Being overweight is also a risk factor for prostate cancer. Prostate cancer progresses more aggressively in men whose body mass index is 32.5 and higher. This is due to the fact that proteins such as leptin and hormones such as insulin-like growth factors are stored within the mass of fat in the body. Research conducted shows that there is a correlation between high cholesterol levels and prostate cancer. High cholesterol levels cause levels of bad cholesterol or, as the medical definition goes, LDL (Low-Density Lipoprotein) to increase and prostate cancer to progress faster and more aggressively. In addition, accumulation of cholesterol in cells, especially in prostate cells, may generate signals that cause cancer cells to advance. Apart from these, smoking is also known to increase the growth of prostate cancer cells.

QUESTION: What symptoms are developed due to prostate cancer?

ANSWER: Prostate cancer develops without any symptoms during the early stages. In other words, prostate cancer occurs asymptomatically in the early phase. Before the invention of the PSA test, prostate cancer could only be diagnosed if a nodule large enough to be detected with a finger during rectal examination had developed or after the pathological examination of the tissue taken from patients who had undergone surgery for benign prostate enlargement. Advanced stage prostate cancer can cause bone pain, especially when it is metastatic to the bone. Since blood production will be disrupted when there is pervasive bone stiffness, the stiffness might lead to fatigue and weakness. During the phase called “local advance stage”, the organ might be enlarged severely and prevent urine flow by blocking the urinary canal. Such a case can even lead to swelling of kidneys, which is call hydronephrosis, and impairment in functions. In this stage, surgery (TURP) might be necessary in order to relieve urinary blockage symptoms.

QUESTION: How is prostate cancer diagnosed?

ANSWER: Prostate cancer is generally identified via detection of high levels in the PSA blood test that is performed during normal check-ups. Symptoms develop only rarely during the early stages. Complaints such as difficulty in urination, decrease in urinary flow rate and frequent urination are often due to benign enlargement of prostate volume which occurs as individuals age. Similar blockages and difficulty in urination develops due to prostate cancer only in the advanced stages. High PSA levels due to age and any roughness that is detected during rectal examination requires biopsy without a doubt. Prostate biopsy is a process that is carried out as an outpatient procedure with local anesthesia. It can also be performed under general anesthesia in patients with low pain threshold or patients from whom a larger amount of tissue is required to be taken (saturation biopsy). The rectal ultrasonography-guided procedure is carried out by taking thin strips of tissue from various areas of the prostate with a special needle, after which the tissue samples are submitted to pathological examination.

QUESTION: What is prostate specific antigen (PSA)?

ANSWER: PSA is a protein that is released by the glands around the prostate and the urethra. Its function is to assist in liquefaction of semen before discharge. PSA has two forms in blood, protein-bound and free. Free PSA measurement is a method that has been in usage during recent years and is intended to facilitate diagnosis of prostate cancer. While the normal values for PSA used to be considered as being between 0 and 4, the acceptable levels were pulled down due to identification of many cancer patients whose PSA levels were within this range, especially in young patients. While rates of young people developing cancer increased with age-dependent PSA usage, the possibility of performing unnecessary biopsies in old individuals decreased. An increase over 30 to 40% in the PSA level of an individual even though his age-dependent PSA value is normal gives rises to the suspicion of prostate cancer and such patients are required to be monitored closely.

QUESTION: From time to time, I read news on robotic surgery. Is this technique utilized for prostate cancer as well? How is robotic surgery carried out?

prostate-3ANSWER: The disease for which robotic surgery is most used is prostate cancer. Kidney cancers and cervical cancers are among other diseases where robotic surgery is utilized. With robotic surgery, even the most difficult operations can be performed via 5 or 6 puncture holes. In standard laparoscopic surgery that was carried out as an alternative to open surgery, the visuals were provided through a single camera and the operation was performed with two-dimensional display, which resembles the visuals without depth seen in televisions at homes. The da Vinci Robotic Surgery System however, carries high-resolution images via double optics to the surgeon’s console after scaling them up by 10 to 12 times. These optic cameras are placed in the area of surgery via a robotic arm. Thus, the surgeon is able to see the surgery area and the anatomy more clearly and in more detail through the three-dimensional, enlarged and high resolution images. Surgery instruments are tools that provide 7 degrees of movement freedom. The tips of these instruments can rotate for 540 degrees around their own axis and mimic the wrist movements of a human hand. Since these instruments have much smaller dimensions than a hand, they can reach areas a human hand is not able to reach during surgeries. The surgeon sits at his console and performs the operation via using the 4 arms inserted into the body by means of the 2 hand controllers and the pedals right under her feet. She can also carry out even the most time-consuming operations without getting tired since she is able to sit at the console.

QUESTION: I have developed prostate cancer and the tumor is required to be removed via surgery. My friend recommended the robotic surgery method. What kind of advantages does this method have over others?

ANSWER: There are various alternatives for the treatment of prostate cancer. The main ones are hormonal treatment, radiotherapy and radical prostatectomy. Radical prostatectomy, which is the most frequently utilized method, involves a large incision. This causes the patient to take a longer time to recover, stay in the hospital for an extended period, become more subject to wound infection risks and be left with a large scar.

  •  However, in robotic prostatectomy surgeries carried out with the da Vinci System, bleeding areas are seen more clearly by means of the cameras that provide three-dimensional, high resolution images with the ability to scale up the image of the surgery area. Thus, blood loss is much less since any bleeding can be stopped much earlier.
  •  Additionally, since the operation involves only 3 or 4 millimetric incisions, the skin is not left with a scar that is aesthetically disturbing and the patient experiences much less postoperative pain.
  •  Since the urinary tract, which is called “urethra”, and the bladder can be stitched hermetically by means of the robot’s needle holders which can move in any direction, the catheter placed at the end of the urinary tract can be removed much earlier.
  •  Owing to the small surgical incision and loss of less blood, patients can recover from even the most serious operations and be discharged from the hospital in 1 or 2 days. Moreover, their urinary catheters can be removed in 5 or 6 days and thus, they can swiftly return to their business and social lives.
  •  Other advantages of this method are that the risk of urinary incontinence, which patients fear greatly, is very little and there is a chance for sexual functions to recover more quickly since the nerves can be better protected.