Prostate cancer, the second most common cancer in men, is becoming more and more common nowadays. Head of Department of Minimally Invasive and Robotic Urology at Acıbadem University Maslak Hospital, who emphasized that obesity, cholesterol-rich western diet and genetic factors increase the risk, although the exact cause of prostate cancer, which increases in prevalence especially after the age of 50 and knocks on the door of 7 out of every 1 men, is not known. Dr. Ali Rıza Kural said, “Because prostate cancer progresses insidiously and initially does not cause any complaints in any patient, it appears at an advanced stage. For this reason, from the age of 40, those with a father or sibling with prostate cancer in their family, as well as those with breast cancer in their family, are at increased genetic risk; Otherwise, it is critical for early diagnosis to have serum PSA (prostate specific antigen) determination and digital rectal examination (DRM) every year for early diagnosis from the age of 50.” prof. Dr. Ali Rıza Kural answered the 15 most frequently asked questions and made important warnings and suggestions in his statement within the scope of September World Prostate Cancer Awareness Month and September 8 World Prostate Cancer Awareness Day.
QUESTION: It is said that for the diagnosis of prostate cancer, only having a PSA checked is sufficient. I don't want to have the finger examination done. What should I do?
REPLY: Of course, it is important to have a PSA checked. However, there are also a small number of aggressive cancers that do not produce much PSA. In addition, every elevated PSA does not mean that there is cancer, PSA may also increase for other reasons. Although age-specific PSA is normal, digital prostate examination (DRM) is very important for these patients. Regardless of the PSA value, the presence of stiffness in the DRM should raise the suspicion of prostate cancer and biopsy should be performed after the necessary imaging.
QUESTION: Although one of my relatives had no complaints, prostate cancer was detected in the examinations performed and it was a surprise to us. Does prostate cancer show any symptoms?
REPLY: Prostate cancer does not cause any complaints in the early period. In advanced cancers, difficult and frequent urination, blood in the semen, bone pain and weight loss may occur due to the pressure of the tumor mass on the urinary tract. Therefore, early diagnosis is important. Necessary tests and examinations should be performed every year from the age of 40 in the presence of a family history, or from the age of 50.
QUESTION: When my PSA value was high, the doctor I went to said to do a biopsy immediately. I was worried about this and the urologist I went to get a second opinion said, let's do an MRI first, let's decide according to the result. He also said he would look at other parameters. Which way should I go?
REPLY: Every PSA elevation does not mean the presence of prostate cancer. When we compare the total PSA and free PSA values, if the free/total ratio is less than 0.19, our suspicion of cancer increases. Another measurement is “PSA density”. In this measurement, the PSA value is divided by the prostate volume, and if the value found is higher than 0.15, the suspicion of prostate cancer increases. The fact that the Phi value calculated from Pro-PSA, a fraction of PSA, is higher than it should be in recent years also increases our suspicion of prostate cancer. With all these evaluations, when there is doubt, Multiparametric Prostate MRI, which can be described as a high-resolution photograph of the prostate, should be taken and biopsy should be performed if necessary.
QUESTION: As a result of the examination and biopsy, prostate cancer was detected in me. The doctor who performed the biopsy immediately recommended surgery. Another doctor I went to said that there is no need for surgery or any treatment, let's follow up? I'm confused, what should I do?
REPLY: Surgery or other treatments may not be necessary for every prostate cancer patient. If there is a Gleason Score 3+3:6, that is, non-aggressive cancer in one or two of the samples, less than half of the tissue in the biopsy, these patients should not be treated with surgery or other methods, but should be followed regularly. Studies conducted on thousands of patients over the years have shown that most of these tumors do not harm the patients during their lifetime. In such a case, using the Active Monitoring method, PSA determination every 6 months and MRI within two years and focused biopsy are sufficient. Only 5-25 percent of these patients will require treatment within 30 years. Others will require no lifelong treatment.
QUESTION: My urinary complaints don't bother me much, but I want to have prostate surgery now so that I don't get cancer in the future, do you mind?
REPLY: prof. Dr. Ali Rıza Kural: "In benign prostate enlargement, we usually remove the part of the prostate that we call the "Transitional Zone" in the surgeries we perform by entering through the urinary tract (if the gland is very large, robotic surgery). Thus, the urinary tract is opened and patients can urinate comfortably. We leave the crust of the prostate, which we call the "Peripheral Zone", in the patient. Prostate cancer often arises from this section. After all, having benign prostate surgery does not eliminate the risk of cancer. In addition, we follow the PSA levels of especially young patients who we have surgery for benign prostate enlargement in the coming years and perform DRM when necessary.
QUESTION: Prostate cancer was detected in the biopsy. My doctor suggested open surgery. “I feel better with my hand in open surgery,” she said. Another physician definitely recommended Robotic surgery. What should I do ?
REPLY: Robotic Radical Prostatectomy surgery has been performed in increasing numbers for the last 20 years. In the first years, the answer to the question of whether open surgery or robotic surgery should be applied has now been given. Although there is no significant difference between the two methods in terms of cancer control, the improvement of urinary control and sexual erection is significantly better in robotic surgeries. In addition, the rate of blood donation in robotic radical prostatectomy operations is below 1 percent, and the postoperative recovery rate is 2 times shorter. Nowadays, since we have access to all kinds of detailed anatomical information before the operation, the opinion of "I feel better with my hand" is no longer valid. Robotic surgery should be preferred if it is economically accessible.
QUESTION: Does taking vitamins prevent prostate cancer?
REPLY: The issue of using vitamins has been talked about a lot for years. Although it was recommended to use selenium and vitamin E for a while, the "Select" study showed that it was not beneficial. To avoid prostate cancer today; take these 5 simple but effective measures; It is recommended to have a low-fat diet, eat plenty of fruits and vegetables, not consume too much milk and dairy products, take plenty of fluids and exercise. No vitamins or drugs are helpful.
QUESTION: When I said that the PSA level was high, they suggested some drugs from the pharmacy. Bought but hesitant to use it; should i use it?
REPLY: prof. Dr. Ali Rıza Kural: "The drugs we call 5 alpha reductase inhibitors (Finasteride, Dutasteride) can reduce the prostate size a little bit and can reduce PSA levels by half. However, these drugs can have side effects such as decreased libido or erectile dysfunction. In addition, the decrease in PSA value with these drugs may lead to misconceptions in patients we follow up with suspicion of cancer. These types of drugs should be used under the control of a physician in order to reduce the complaints in patients with advanced age and prostate volume above 50 ml.