Along with lung and colorectal cancer, prostate cancer is one of the most common types of cancers among men. The exact causes of prostate cancer are not fully known, but the risk factors include smoking, genetic inheritance and fat excess. The risk of developing prostate cancer increases with age, so specialists recommend that the PSA test (prostate-specific antigen-dosing), along with the rectal check, for an indication of a prostate cancer. These should be done after 40 years, if there are family members of first grade prostate cancer or breast cancer in the family with the presence of BRCA mutations. These situations represent an additional risk factor for prostate cancer. When there is a suspicion of prostate cancer, the urologist will decide the next steps of the investigations. Here’s what Prof. Dr. Saadettin Eskicorapci, one of the best uro-oncology experts at ACIBADEM clinics, says about the protocol for diagnosis, treatment and monitoring of prostate cancer.
“In prostate cancers, we need to understand the philosophy behind cancer. If you want to find cancer, you’ll find it, especially in the case of prostate and thyroid. There are what are called clinically insignificant cases. The most important thing is to carefully select cases that need biopsy. If we do a whole biopsy, we’ll find many cancers. But not all should be investigated and biopsied. If a cancer is clinically insignificant, the patient can live with the tumor. So, today we are looking to detect significant cases. We do not make biopsy just like that, we select the cases. This happens in prostate and thyroid cancers. If there is a cancer that I assess as clinically insignificant, then I do not make a biopsy from the beginning. But if they already have the biopsy done, I actively monitor them. This happens to one third of my patients”, says Prof. Dr. Saadettin Eskicorapci, a uro-oncologist surgeon at ACIBADEM Atakent University Hospital.
Thus, in active monitoring programs, patients are evaluated periodically, and physicians decide at the appropriate time when they need to intervene through surgery or other treatments. Prof. Dr. Saadettin Eskicorapci says that in half of his patients surgery can be avoided.
“In prostate cancer cases, some are not really benign tumors. For example, if I see almost 10,000 patients with prostate tumors, out of these, only one or two cases are benign. But I see a lot of clinically insignificant tumors, which does not mean benign tumors. Prostate hyperplasia is not a tumor, is a common occurrence in most men after 50 years. Now I’m writing a book about men’s health. For prostate affections, you need to look at the illness itself and consider what this means for patients. We can be excellent surgeons, we can do robotic interventions, we can apply the best treatment, but there are situations when patients are not happy and excited. You have to understand the patient, to respect what he wants. It’s like breast cancer in women, we need to understand the patient’s psychology diagnosed with testicular and prostate tumors. There are tumors that appear in men, and men do not talk about cancer. That’s why we need to talk to the patient. Men are afraid to speak, unlike women. Women can lie about their sexual life and satisfaction, but men can not. An experienced physician or surgeon will understand these aspects. Thus, we can have a friendly discussion with patients, and they can tell us about what they feel”, says the top ACIBADEM expert, emphasizing the masculine aspects of prostate cancer.
Detailed discussions with patients, the elimination of prostate cancer biases, and the application of modern methods of treatment, such as robotic surgery, represent essential conditions for long-term healing of patients.
“Obviously, there is a risk of erectile dysfunction, but it can be managed. If you openly discuss with patients and explain them everything, they will understand. In addition, there are solutions that we analyze with patients. The friendly discussion about the risks, about the Da Vinci robotic surgery that reduces the risks, about my urologist surgeon’s experience: everything helps. We need to re-connect with patients and talk about risks”, Prof. Dr. Saadettin Eskicorapci underlines.
In early stages, prostate cancer can be treated successfully. Important is having the case management debated in oncology committees, a correct diagnosis, talking with the patient, carefully selecting cases requiring surgery, and application of last generation therapies such as Da Vinci robotic surgery and observance of follow-up programs. Robotic surgery reduces the risk of impaired erectile potential, but not that of fertile potential.
“Usually, prostate cancer patients do not want kids anymore. But there are patients who still want children after surgery, and the solution is preserving sperm before surgery. The most important thing is that patients believe in the doctor. I am a happy doctor because my patients have a very high life expectancy and live long after the interventions. The hospitalization and surgery last 3 days, and recovery just a few weeks. After this period, I also do counseling, I am a coach, I have several roles. If they trust the doctor, they will call her to ask for advice if they have a problem”, concludes the ACIBADEM expert in uro-oncology.