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Prostate cancer is a malignant tumor of the prostate gland. There are several stages of prostate cancer. Your treatment depends on the characteristics of the tumor and the experience of your doctor.

What is Prostate?
Figure 1: Healthy prostate and lower urinary tract.
Today, prostate cancer is the most common cancer in men over 50 years of age. It is also the second most common cause of cancer-related deaths after lung cancer. Prostate cancer is the fifth most diagnosed cancer in the world. There has been a large increase in the incidence of prostate cancer in the last 25 years.
Prostate cancer is the second most common malignant tumor in the world in men and 679 thousand new cases are diagnosed each year.
The incidence of prostate cancer, which is 25.3 per 100 thousand worldwide, varies widely among countries, but is the second most common cancers in men
Prostate cancer usually develops slowly and does not cause significant symptoms. Rapidly progressing prostate cancer is rare. The risk of developing prostate cancer increases with age. The average age at which prostate cancer is diagnosed is 69.
Advances in diagnostic tools and increased life expectancy increase the number of diagnosed prostate cancer. Prostate cancer is the most common cancer among elderly men in Europe. The life expectancy in patients with prostate cancer is relatively long and continues to increase.

Prostate cancer risk factors
Prostate cancer is a disease that can develop at different stages. It is called localized prostate cancer if the tumor is limited in the prostate and there is no spread. In locally advanced prostate cancer, which is an advanced circuit, tumor tissue spreads to tissues such as seminal vesicles, bladder neck or surrounding lymph nodes, which are a gland adhered to the prostate. The last stage is defined as metastatic cancer if there is tumor spread to distant lymph nodes or other organs.

Stage of the disease
There are several known risk factors, the most important of which is age. Prostate cancer is very rare, especially under 40 years of age, and it usually develops in men over 65 years of age. Family history is also very important for risk increase.
More meat and dairy products are said to increase the risk of cancer, but more research is needed.
The tumor develops when cells start to grow faster than normal. The growth of prostate cancer cells is due to male hormones known as androgens. The most important androgen is testosterone and is synthesized to a large extent in the testis.

Prostate cancer is usually insidious, insidious, meaning there are no symptoms specific to prostate cancer. Most prostate cancers are usually detected following blood testing to check the level of prostate-specific antigen (PSA) in the blood. If the blood PSA level is high, the urologist will recommend further testing to understand the cause of the PSA increase. The PSA test can never be used alone in the diagnosis of prostate cancer.
PSA and digital rectal examination (PRM) are the most common diagnostic tools for the evaluation of your prostate. Your doctor will recommend these tests if you have problems with urination. These problems include the need to urinate more frequently than usual, a sudden urination sensation that is very difficult to delay, or involuntary instillation of the underwear. These symptoms usually indicate other conditions, usually benign prostate enlargement (BPH), and sometimes metabolic diseases (Diabetes, etc.). It may also be a sign of advanced prostate cancer. This is why the doctor performs various tests before making a diagnosis. Based on the results of these tests, your doctor may recommend prostate biopsy. Prostate biopsy is the only test to confirm the diagnosis of prostate cancer.
Since prostate cancer usually does not cause any complaints, your doctor may recommend that you regularly check your blood PSA level. Whether your doctor recommends this depends on many factors, including the health policies of your hospital or country. The most important factors are always your age and family history.
If a prostate cancer is diagnosed, the urologist should determine the tumor stage. The pathologist determines the tumor characteristics and whether the tumor is aggressive by examining the tumor tissue obtained during the surgical procedure or biopsy. The grading of the tumor and the staging of the tumor together determine the classification.
The classification of the tumor in the prostate is used to predict the course of your disease. Your doctor will consider the best treatment for you based on the individual course of your illness.

Prostate cancer is usually asymptomatic and most of the symptoms are caused by benign prostatic enlargement (BPH) and / or infection. If prostate cancer causes symptoms, this is usually a symptom of advanced disease. It is therefore important to consult a doctor to see what causes these symptoms.

These symptoms may include the following:

  • Urinary tract symptoms (frequent urination, weak urine flow, etc.)
  • Blood in urine (Hematuria)
  • Urinary incontinence
  • Pain in the hip, back, chest or legs (due to metastasis in advanced stage)
  • Weakness in the legs (neural damage)

Bone pain may be a sign that cancer has spread to the body. This is known as metastatic disease.
One of the most commonly used methods to diagnose DProstate diseases is prostate-specific antigen (PSA) and digital rectal examination. PSA is a blood test. If the PSA level is too high, this suggests that the cells in the prostate behave unusually. This may be tumor-induced, as well as infection, or benign growth of the prostate. Your doctor will perform a digital rectal examination to assess the size, shape, and stiffness of your prostate. This test is known as a digital rectal examination (PRM)
Usually your doctor may recommend lower urinary tract imaging. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) and bone scintigraphy are available. None of these methods can tell you exactly whether you have prostate cancer.
The urologist will evaluate your test results with your age and family history to estimate your risk of prostate cancer. If the risk is high, you may need a prostate biopsy. This test is usually performed with ultrasound-guided (TRUS) to confirm whether you have a tumor. During biopsy, between 6-12 prostate tissue samples, if there is a suspicious or negative results in biopsies performed consecutively with the name of the biopsy of 20 or more known cases may be taken to take parts. If you are taking medication to prevent blood clotting, your doctor may recommend discontinuation of this medication, as well as antibiotics prior to biopsy. The doctor who will perform the procedure enters the prostate with a needle through the rectal area following local anesthesia. Samples are taken from different parts of the prostate gland. Tissue samples are examined by the pathologist to help determine future treatment.
After prostate biopsy, you may see blood in the urine and semen. If you have a fever, you should contact your doctor immediately.
Although biopsy is a reliable diagnostic tool, there is a possibility that it cannot detect / overlook the tumor in the prostate.

Figure 1: Finger breech examination to evaluate prostate size, shape and structure.
Localized prostate cancer; describes a tumor that is confined to the prostate and does not spread to any other part of the body. In the diagnosis of organ-limited cancer, your doctor may recommend radical prostatectomy, radiotherapy, or conservative treatment. Each treatment has its own advantages and disadvantages. The choice of treatment depends on your individual situation.

Tedavi seçenekleri
Which treatment option is best for you depends on:

  • Tumor characteristics
  • Your medical history
  • Your age
  • Technical conditions in the hospital to be operated
  • Personal preferences

In the conservative method, the doctor monitors the tumor and growth and recommends additional treatment if necessary. This treatment is usually appropriate when the aggressive criterion of the tumor, called the Gleason score, is low.
Radical prostatectomy is a surgical treatment in which the entire prostate and seminal vesicles are removed.
Your doctor may also recommend radiotherapy. This treatment damages and kills cancer cells. External beam radiation and brachytherapy are radiotherapy types.

Figure 1: T1 (Stage 1) prostate tumor too small to feel on the digital rectal examination.
Figure 2: Prostate-limited T2 (Stage 2) prostate tumor.

Radical prostatectomy can be performed with open, laparoscopic or robotic surgery. In open surgery, the tissues are excised and the tumor prostate and surrounding surgeons are removed from the marginal sacs on the boundary line, a portion of the bladder neck, and the nerves are protected.
In laparoscopic surgery, the prostate gland is removed under the supervision of optical systems by preserving the surgical integrity as much as possible by entering the urologist with special equipment in the abdominal cavity.
Laparoscopic surgery can also be performed with the help of robotic surgery system.
Removal of localized prostate cancer by open or laparoscopic radical prostatectomy appears to be equally effective.
Figure 1a: Removal of prostate and seminal vesicles during radical prostatectomy (prostate surgery).
Figure 1b: Postoperative bladder position. What are the side effects of surgery?

After surgery, you can usually leave the hospital for 3-7 days. You may experience slight pain in the lower abdomen until a few weeks after open radical prostatectomy. You may have complaints of urinary incontinence and erectile dysfunction. You may need treatment for these conditions.

  • Having fever
  • Severe blood loss
  • Severe pain sensation
  • If you have problems with urination, you may need to go to your doctor or hospital immediately.

Radical prostatectomy; is the most common method for the treatment of localized prostate cancer.
Urinary incontinence may occur postoperatively, most of which recover rarely within weeks.
Another common risk of radical prostatectomy is erectile dysfunction. During surgery, the surgeon must perform surgery near the nerve and vessels of the penis. The surgeon tries not to damage the penis nerves. This success depends on the location of the tumor and the aggressiveness of the cancer.
If necessary, your doctor may recommend treatment for urinary incontinence or erectile dysfunction. Do not hesitate to discuss your concerns with your doctor. Together you can decide whether other treatment options are more suitable for you.
Remember that the main purpose of radical prostatectomy is to remove the tumor and treat you.

How do you follow up?
Following radical prostatectomy in prostate cancer, your doctor will schedule regular checks with you. Routine follow-up is at least 5 years. During your checks, your doctor will check your blood PSA level. In some cases, a digital rectal examination may be necessary. Follow-up is important for monitoring postoperative recovery, checking general health status and detecting possible cancer recurrence.
If you have been diagnosed with locally-advanced prostate cancer, your doctor will treat you with cancer; wait, can recommend radical prostatectomy or combination of radiotherapy and hormone therapy. Each treatment has its own advantages and disadvantages. The choice depends on your individual situation.
This section describes the different treatment options you should decide with your doctor. These are general information and are not customized to your individual needs. Please note that individual recommendations depend on your country and health system.

Local-advanced prostate cancer is called a tumor spread outside the prostate. It means that the tumor has already reached the prostate, seminal vesicles, bladder neck, urinary sphincter, rectum or pelvic region.
Treatment options
The most common treatment options for locally-advanced prostate cancer are; radical prostatectomy, radiation therapy, hormonal therapy, or a combination of these and conservative therapy (when the general condition of the patient is unsuitable for other options). Which treatment is suitable for you:

  • Tumor characteristics
  • Your medical history
  • your age
  • Depends on your personal preferences and values

This may be related to your age or the presence of a medical condition that may make these treatments dangerous to you.
If you have locally-advanced prostate cancer, you may often need additional treatment after surgery. This may be radiotherapy, hormonal therapy, or a combination thereof.
As an alternative to surgery, your doctor may recommend radiotherapy to treat your cancer. This treatment damages and kills cancer cells. It is a common treatment option for locally-advanced prostate cancer. In locally-advanced prostate cancer, radiation therapy is always combined with hormonal therapy.
Hormonal therapy affects testosterone production in the body. The aim is to stop the growth of the tumor. Hormonal therapy is also called androgen-suppressive therapy (ADT).

Figure 1: T3 (Stage 3) prostate tumor spread to seminal vesicles.
Figure 2: Spread to the bladder neck, urinary sphincter, and rectum. T4 (Stage 4) prostate tumor.

Terms your doctor may use:

Prostate cancer can spread to other organs or lymph nodes outside the pelvic region. This is called metastatic disease. Tumors in other organs or lymph nodes are called metastases. Your doctor may recommend that the metastatic disease be treated with hormonal therapy.
It is important to know that metastatic disease cannot be cured completely. Instead, your doctor will work to slow down the growth of the tumor and metastasis. This gives you a chance to live longer and show fewer symptoms.
This section includes the different types of hormonal treatments you should discuss with your doctor.
This information is public, not customized for your personal needs. Personal needs may vary depending on your country and health care system.

What is metastatic prostate cancer?
If prostate cancer has metastasized, it usually spreads to the bones or spine. In later stages, prostate cancer may also metastasize to the lung, liver, distant lymph nodes, or brain [Fig. one]. Many metastases cause an increase in the level of prostate-specific antigen (PSA) in the blood.
Metastases in the spine can cause severe back pain, spontaneous fractures or nerve or spinal cord compression. It may also be asymptomatic. In rare cases, lung metastasis can also cause persistent cough.
Imaging methods can be used for the detection of metastases. Bone metastases can be seen in bone scan. CT imaging can be used to obtain more detailed data on bone metastases or to detect liver, lung and brain metastases.

Treatment options
d hormonal treatment. This is part of the palliative care approach. This treatment will slow down the growth of the primary tumor and metastasis and will alleviate the symptoms.
Another name for hormonal therapy is androgen suppression therapy (ADT). This can be done surgically or with medication. In surgical treatment, both testes are removed by a procedure called bilateral orchiectomy. Drug treatment that stops the production of androgens is called LHRH antagonist or LHRH agonist. These drugs are administered subcutaneously or intramuscularly in the form of depot injections. Antiandrogens are drugs that block the effect of androgens. They are in pill form. All of these treatments cause castration.
Castration has physical or emotional consequences. The most common ones are hot flashes, sexual reluctance and erectile dysfunction. The effects of castration are permanent. In chemical castration some of the effects may return after cessation of treatment. Do not hesitate to discuss anything with your doctor.
If you have bone metastases that cause symptoms when taking medication, radiation therapy can alleviate them and prevent fractures.
LHRH agonists are the most commonly recommended treatment for metastatic prostate cancer. However, treatment options should always be tailored to your personal circumstances. Listed below are the points your doctor will consider when planning your treatment.

  • Your age
  • Your medical history
  • Where cancer spreads
  • your symptoms
  • Treatment methods available in your hospital
  • Your personal preferences and values
  • Support network available to you

Figure 1: Bone, spinal cord, lung and brain metastatic prostate cancer.
Terms that your doctor may use:

  • Benign tumor → Non-cancerous growth that does not spread to other organs
  • Malignant tumor → Cancer-causing growth, continuous or in the form of attacks. Malignant tumors can metastasize, meaning spread to the body
  • Metastatic disease → If the tumor has spread to other organs or distant lymph nodes