Where is the prostate gland located and what are its functions?

The prostate, which is a part of the male reproductive system, is a gland located just below the bladder, in front of the rectum. It surrounds the outlet of the bladder and secretes fluid. Its main function is to produce the fluid that protects sperm and to store sperm within this fluid. Additionally, the prostate, by contracting the sphincter muscles and tightening the bladder's opening, prevents urinary incontinence. The prostate is divided into three zones surrounded by a capsule, which separates it from other parts of the body.

What is benign prostatic hyperplasia?

As men age, the prostate gland also undergoes growth. This enlargement is referred to as benign prostatic hyperplasia (BPH), and it typically occurs in the transitional zone surrounding the urethra, the passage for urine. Prostate enlargement can obstruct the bladder or the urethra, leading to a hindered urinary flow. Men may experience frequent, painful, bloody urination, or issues with ejaculation. They might also have lower back pain and discomfort. These symptoms could be a result of benign prostate enlargement or could indicate a sign of cancer.

What is prostate cancer?

Prostate cancer develops in the walnut-shaped small gland called the prostate, which is a part of a man's reproductive system. Prostate cancer arises from the uncontrolled growth of cells in the prostate gland. Cancerous cells primarily exhibit unchecked growth, spreading within the prostate. They then extend beyond the prostate's surrounding capsule, breaking through it and spreading outside the prostate. Unlike benign prostate gland enlargement, prostate cancer originates not from the center of the prostate but from the region near the capsule, away from the center. Consequently, urinary symptoms in prostate cancer tend to disturb the patient in later stages. During growth and dissemination, it can metastasize to nearby organs, the lymph system, and other parts of the body through the bloodstream. Prostate cancer can progress slowly, but the tumor can also display an aggressive nature, spreading to bones and other organs.

What are the symptoms of prostate cancer?

Symptoms of prostate cancer can emerge as the disease progresses. Therefore, it possesses a subtle nature. Especially in its early stages, there might be no apparent signs or complaints. When symptoms of prostate cancer do manifest, the patient could potentially lose some treatment opportunities, underscoring the significance of regular medical check-ups in the success of treatment.

Symptoms of prostate cancer can include:

• Difficulty urinating

• Weakened urine flow

• Blood in semen or urine

• Pain during ejaculation

• Discomfort in the groin area

• Bone pain

• Erectile dysfunction

These symptoms that signal prostate cancer can sometimes also indicate benign prostate enlargement. Similar signs and complaints can be seen in benign prostatic hyperplasia (non-cancerous prostate enlargement) that occurs due to the growth of the prostate gland. If prostate cancer has spread to other parts of the body and organs, it can also present symptoms related to those areas. For example, if it has spread to the bone, it might cause bone pain.

What are the risk factors of prostate cancer?

The exact cause of prostate cancer is not fully understood. Prostate cancer develops due to the uncontrolled growth of certain prostate cells driven by genetic abnormalities at the cellular level, which lead to the displacement of normal cells. Subsequently, it can spread to surrounding tissues and in advanced stages, even to distant organs.

Causes and risk factors of prostate cancer include:

Hereditary or Genetic Factors About 9% of prostate cancers are hereditary, and in 15% of those with prostate cancer, the disease is passed down from first-degree male relatives. Mutations in the BRCA2 gene, known to be linked with breast and ovarian cancers in women, have been observed to increase the risk of prostate cancer in men.

Non-Genetic (Environmental) Factors Environmental factors play a more significant role in prostate cancer compared to genetic factors. For instance, a Chinese individual living in China has a very low risk of prostate cancer, while the same individual living in America for an extended period starts to carry a similar risk to that of an American individual.

Age Effect The risk of prostate cancer increases with age. While prostate cancer is rare in men under 50, it becomes more common in men over 55. It's known that one in every six men will be diagnosed with prostate cancer during their lifetime.

Race Factor Race also plays a role in prostate cancer. It's most prevalent in Black men, followed by White men. It's also seen in Asian/Pacific Islander men but is rare.

Diet The direct impact of diet on prostate cancer hasn't been definitively proven. Previous studies indicated that selenium and vitamin E might reduce the risk of prostate cancer, but subsequent research provided clearer results showing that neither had a beneficial effect. Nonetheless, a healthy diet can lower cancer risk, so consuming unhealthy foods could directly increase the risk of prostate cancer.

How is prostate cancer diagnosed?

If there is a possibility of prostate cancer based on the results of a patient's PSA blood test and/or digital rectal examination, the suspicion must be confirmed through a biopsy. Prostate cancer is diagnosed through one or more biopsies taken from the prostate gland. Biopsy identifies whether there is benign prostatic hyperplasia, cancer, or other medical issues. During a biopsy, small samples of prostate tissue are taken through a needle inserted into the rectum. These tissue samples are examined under a microscope to detect the presence of cancer cells.

The following screenings are used to diagnose prostate cancer:

PSA Blood Test: The PSA level in the blood of a patient diagnosed with prostate cancer is proportional to the amount of cancer present in the body. PSA (Prostate Specific Antigen) is a protein produced by cells in the prostate, and the higher its level in the blood, the more advanced the prostate cancer. Additionally, PSA levels are extremely useful in monitoring the success of treatment or detecting recurrence after surgery.

Digital Rectal Examination (DRE): This is one of the most common prostate cancer screening tests. A doctor examines the prostate by touching it through the rectum, looking for abnormalities based on size and characteristics.

Transrectal Ultrasound: During transrectal ultrasound, a small probe is inserted into the rectum. The probe emits high-frequency sound waves that produce echoes when they hit the prostate. A computer uses these echoes to create an image called a sonogram that can show abnormal areas. Research on transrectal ultrasound's ability to reduce the vital risk of prostate cancer is ongoing.

Advanced PSA Test: Efforts are ongoing to improve the PSA test for clearer results regarding prostate cancer. The clearer the PSA results, the less anxious the patient becomes, and the less need there is for other tests.

Insulin-Like Growth Factor: Insulin-like growth factor (IGF) is an important growth and anti-apoptotic (cell death-preventing) factor for cancer cells in many types of cancer. Insulin-like growth factor binding protein-3 (IGFBP-3), independent of IGF-1, promotes apoptosis (cell death) and inhibits growth. Recent research indicates that high IGF-I levels, low IGFBP-3 levels, or an increase in the ratio of both are associated with an increased risk of prostate cancer.

Early detection in prostate cancer

Just like in other cancers, early detection can reduce mortality rates in prostate cancer. Another benefit of early detection is minimizing the side effects associated with prostate cancer treatment. To diagnose prostate cancer early, methods such as the Prostate Specific Antigen (PSA) blood test, digital rectal examination, and/or transrectal (through the rectum) ultrasound are used. However, prostate cancer screening remains a complex and debated topic, and sufficient evidence regarding its reduction of vital risk factors has not been established yet. Moreover, all screening tests come with certain risks. It's important to discuss the potential benefits, uncertainties, and harms with a specialized doctor before undergoing prostate cancer screening. After discussing the potential benefits, uncertainties, and risks of screening tests, the decision to proceed or not should be based on the patient's personal preferences.

What are the stages of prostate cancer?

Prostate cancer is staged based on the extent of its spread. The most important criteria for staging are whether the prostate tumor has spread to surrounding tissues such as the bladder or rectum, and whether it has affected lymph nodes and bones. The Gleason score, which indicates the grade of the tumor, and the PSA (Prostate-Specific Antigen) level are also essential for determining the stages of prostate cancer.

Stage 1: In stage 1, the tumor is confined to the prostate gland itself. Sometimes, it can be so small that it cannot be felt during a rectal examination. The Gleason score is 6 or lower, and the PSA level is below 10.

Stage 2: In stage 2, the tumor is still within the prostate gland but may have a more aggressive structure. It can be felt distinctly during a digital rectal examination, or the tumor grade may be high.

Stage 3: In stage 3, prostate cancer has spread beyond the prostate gland but is typically confined to the seminal vesicles. However, it has not spread to the bones or lymph nodes.

Stage 4: At this stage, prostate cancer has spread to the bladder, rectum, or nearby tissues (except the seminal vesicles). It can also involve nearby lymph nodes and bones.

What are the treatment methods of prostate cancer?

In the treatment of prostate cancer, the choice of therapy can depend on factors such as the cancer's growth rate, the extent of its spread, the patient's overall health, and the effectiveness of the intended treatment, as well as the potential side effects. If prostate cancer is in its early stage, active surveillance may be recommended instead of immediate treatment. Surgical removal is one of the most common and effective treatment methods for prostate cancer. Various surgical approaches, including robotic, laparoscopic, and open surgery, are available, and the choice of surgical method should be tailored to the patient's needs. The goal of surgery is to remove the entire prostate gland. In suitable cases, the nerves surrounding the prostate that contribute to erectile function can be preserved.

In the early stages of prostate cancer, laparoscopic surgery is often the preferred option. Additionally, in early-stage prostate cancer, radiation therapy (radiotherapy) is another significant treatment option for suitable patients. Laparoscopic surgery provides a comfortable surgical experience for the patient and has high success rates in terms of cancer control. This type of surgery, performed through 4-5 small incisions, results in less postoperative pain, and patients can return to their daily activities relatively quickly. Since there are no large incisions, these surgeries also offer a high level of patient satisfaction from a cosmetic perspective. Significant advancements in the diagnosis and treatment of prostate cancer have transformed it from a feared disease into a manageable condition.

Treatment for prostate cancer varies depending on the stage of the cancer

Stage 1 and 2: In these early stages, prostate cancer can be treated with surgery or radiotherapy. Hormonal therapy may follow or treatment decisions may be tailored to the patient's condition.

Stage 3: Treatment options for stage 3 prostate cancer typically involve surgery or radiotherapy. Research has shown that adding chemotherapy for about 5 months after surgery or radiotherapy can extend the survival of prostate cancer patients. In cases where the PSA level is above 40, there is lymph node involvement, or the Gleason score is above 7, chemotherapy may be considered in addition to surgery or radiotherapy and hormonal therapy.

Stage 4: For advanced stage 4 prostate cancer, hormonal therapy is the primary treatment. Hormonal therapy can involve surgical removal of the testicles or the use of injections to block male hormones every 1-3 months. Since 2010, there have been significant advancements in the treatment of stage 4 prostate cancer. Some drugs have been shown to markedly extend survival in stage 4 prostate cancer when used in combination with chemotherapy. Additionally, new agents have been developed for cases where traditional hormone-blocking drugs are ineffective. Prostate cancer vaccines have been explored but have not shown significant efficacy. The use of radiotherapeutic agents has been proven effective for patients with bone metastases. In addition to these treatments, in some countries, therapies combining radioactive Lutetium with PSMA (Prostate-Specific Membrane Antigen) are also possible for prostate cancer treatment.

The choice of treatment should be made in consultation with a healthcare provider and tailored to the individual patient's condition and preferences.

Da Vinci Robotic Surgery

Robotic surgery using the Da Vinci Surgical System has become particularly important in prostate cancer surgeries, with the goal of minimizing the risk of postoperative sexual dysfunction. This advanced system provides experienced laparoscopic surgeons with a three-dimensional, high-definition view that is 10-20 times magnified. The da Vinci robot's arms have a 540° range of motion, allowing precise movements even in challenging areas, such as around nerves and blood vessels, ensuring the preservation of these critical structures while removing the cancerous prostate. This approach provides a radical and effective treatment for prostate cancer while aiming to maintain sexual function post-surgery.

FREQUENTLY ASKED QUESTIONS ABOUT PROSTATE CANCER