Prostate Cancer

Prostate Cancer Symptoms and Treatment

Prostate cancer is the second most common cancer type encountered in men worldwide. With proper care, the overall prognosis for prostate cancer patients is generally positive, thanks to advanced diagnosis methods and successful treatment techniques. A full range of diagnostic and treatment options are available at Acibadem Hospitals in Turkiye, provided by a multidisciplinary team of experts with international recognition.

Frequently Encountered Prostate Diseases

The prostate gland, which is present in every man from birth, is located just below the urinary bladder. Its functions are associated with reproduction and sperm maturation. Normally, it is the size of a walnut in young men but starts enlarging as men get older. Since the urinary tract goes through the prostate, enlargement of this organ causes compression and problems with urination. 

Prostate diseases can be either malign or benign, and benign conditions are much more common. The most frequently encountered of them are BPH (benign prostatic hyperplasia), prostatitis (prostate infection) and prostate cancer. All of them may cause urinary complaints such as frequent urination during the night and day, burning sensation during urination and inability to empty the urinary bladder completely. Though rarely, they might also cause ejaculation problems and bleeding. While BPH and prostate cancer are usually encountered in men over 40, prostatitis is often found in younger men.

What is Prostate Cancer? 

Prostate cancer begins with abnormal growth of cells in the prostate gland. The cancer cells grow and divide at a rapid pace, forming a tumor. Over time, the cancer cells may spread to close and distant tissues and organs (metastasize).

While benign prostatic hyperplasia (BPH) causes difficulty in urination and other complaints, prostate cancer is a more insidious disease since it often develops in the peripheral zone of the prostate. Very often, it may not show any symptoms before reaching an advanced stage. Therefore, annual medical checkups are crucial for early diagnosis and successful treatment.

What Causes Prostate Cancer? 

The exact causes of prostate cancer are not yet fully known. Older age is considered the number one risk factor, as most cases are detected after 50. Genetic inheritance and obesity are also associated with a higher risk. According to some studies, men who consume large amounts of fats, particularly from red meat cooked at high heat, may be more likely to develop advanced prostate cancer. It is considered that the underlying factor might be hormones: fats stimulate the increased production of testosterone and other hormones, and testosterone speeds up the growth of cancer cells. 

The family history is important as well. The risk of developing prostate cancer increases by 7 times for people who have family members with this condition. In addition, if a man’s mother had breast cancer, then he has a higher risk of prostate cancer. This occurs in carriers of BRCA mutations, but other risk factors are also involved. People who have family members of first grade diagnosed with prostate cancer or breast cancer with BRCA need to start regular examinations and PSA tests at the age of 40, while those without a family history may start at 45.

Signs and Symptoms of Prostate Cancer

The disease may not manifest any symptoms at an early stage, or if it does, they can easily be confused with benign conditions. Prostate cancer symptoms may include frequent urination, including at night; difficulty in urination; split-stream and a feeling of incomplete bladder emptying; burning or pain during urination or ejaculation; blood in the urine or semen; erectile dysfunction. Starting to get up at night to urinate after age 40 is also among the symptoms. It should be remembered that prostate cancer may not show early signs at all. This is why annual routine checkups are essential.

Diagnosing Prostate Cancer

When a patient consults a doctor with complaints that could be caused by prostate cancer, the diagnostic process usually includes some of the following procedures:

• PSA (Prostate-Specific Antigen) test to measure the level of the PSA substance produced by the prostate;
• Uroflowmetry tests to evaluate the urine flow;
• Ultrasound examination to check the size and anatomy of the prostate;
• Digital rectal exam (DRE) performed by hand to examine the texture, shape and size of the prostate gland;
• Prostate biopsy to analyze in a lab a sample of prostate tissue if any suspicion of malignant condition arises during the previous tests.

At Acibadem, all established and some innovative methods and techniques are being used for accurate diagnosis. The Esomed system for early prostate cancer diagnosis makes it possible for patients to be screened with their clothes on, eliminating the need for rectal examination by hand in many cases. The MRI/Ultrasound fusion biopsy significantly improvesthe accuracy and reliability when samples of prostate tissue are collected, since the suspicious areas are detected with high precision via multi-parametric MRI. In the past, some patients could not be diagnosed in time because the biopsy needle failed to access the exact area. During the MRI/US fusion biopsy procedure, three-dimensional images from the rectal ultrasound scan are combined (fused) with those from the MRI scan, ensuring sampling from the right spot with millimetric precision. 

If the pathology results confirm the presence of prostate cancer, further tests and examinations may be recommended to determine whether cancer has spread to other parts of the body. These might include an MRI scan, CT scan, PET scan or bone scan. All hi-tech devices that may be needed for prostate cancer diagnosis are available at Acibadem without waiting time, ensuring a fast and correct diagnostic process.

Types of Prostate Cancer

More than 95% of all prostate cancers are of a type called adenocarcinoma. It originates from the gland cells of the prostate. Adenocarcinomas are usually slow-growing and non-aggressive cancers, though they have some variations. Ductal adenocarcinoma is generally more aggressive and spreads more quickly than acinar adenocarcinoma cases. There are also some rare types of prostate cancer originating from different cells of the gland, such as small-cell carcinoma, squamous cell carcinoma, transitional cell or urothelial cancer, neuroendocrine tumors, soft tissue sarcoma. The type of prostate cancer, along with its stage and grade, determine the treatment strategy.

Prostate Cancer Stages 

Once the diagnosis has been confirmed, staging is used to determine the extent of the disease, meaning how far it has progressed. Prostate cancer staging is crucial for the treatment planning and patient’s prognosis. Generally, in stage 1 and stage 2, the tumor spread is limited to the prostate gland. Stage 3 is when the tumor has grown outside of the prostate, usually up to the seminal vesicles, which is called locally advanced prostate cancer. Stage 4 prostate cancer means that the disease has spread to surrounding lymph nodes or distant organs. In some cases, it can metastasize to the bone as well. 

At Acibadem, Gallium-68 PSMA PET is routinely used in the staging of prostate cancer. It provides superior accuracy in identifying metastases or recurrences compared to conventional imaging with computerized tomography (CT) and scintigraphy. The radiopharmaceutical Gallium-68 PSMA binds especially to the membrane of tumor cells in the prostate. It allows to assess the tumor, but also to evaluate whether it has spread to lymph nodes or bones.

Prostate Cancer Treatment

The treatment for prostate cancer is planned individually, according to the type, size, and aggressiveness of the tumor, as well as the patient’s age, preferences, and overall health condition. The treatment process may include one or more of the following options:

• Active surveillance. For a large group of prostate cancer patients, treatment will never be needed. These are men with low-grade, slowly progressing tumors or ‘clinically insignificant disease’; it means cancer that has never caused symptoms and most probably will never hurt the patient or threaten his life. They are closely monitored and if the disease ever becomes a real threat, then it is treated in a timely fashion. Nearly 2/3 of patients on active surveillance will never require active treatment and thus, they will avoid the side effects of unnecessary treatment.
• NanoKnife therapy. This is a safe method for focal treatment of prostate cancer, applied as an alternative to surgery in selected patients. The NanoKnife procedure uses short, low-energy electrical pulses to destroy cancer cells. Since this method does not cause heating and temperature changes in tissues, it can be considered for tumors located close to nerves and the urethra.
• Surgery. It is the most effective treatment option for cancer confined to the prostate gland; it is also used in advanced prostate cancer patients combined with other treatment options. Prostate cancer surgery usually implies the removal of the prostate gland, called radical prostatectomy. It can be performed either as open or laparoscopic surgery. Nerve-sparing radical prostatectomy is frequently performed at Acibadem for appropriate patients. In selected cases, this method ensures effective treatment and provides the patients with better chances of preserving their urinary and sexual functions after recovery. 
• Robotic prostate surgery. Robot-assisted surgery is the next level of laparoscopy. In this case, a robotic device called Da Vinci is managed by a surgeon sitting on a console. It provides clear 3-dimensional visualization of the surgical site, which is magnified by 12 times on the console. Furthermore, the robotic instruments at the arms of the system, which can rotate at an angle of 540 degrees, are able to reach areas that cannot be accessed manually. The benefits for the patients are smaller incisions, less pain, minimal blood loss, and faster recovery. Moreover, the ultimate precision of the robotic system often allows removing the cancer tissues while preserving the critical structures and nerves responsible for urinary continence and sexual functions. Acibadem employs some of the most experienced surgeons and care teams for robot-assisted surgery in Turkiye and worldwide.
• Radiation treatment. It is used either as a curative treatment for localized prostate cancer or as a debulking (reducing the tumor load) or palliative therapy for patients with locally advanced or metastatic cancer. Both external beam radiation with the latest radiotherapy devices and brachytherapy (radioactive seeds placed locally inside the body) are performed at Acibadem. 

• Focal therapies (HIFU, Cryotherapy). These are noninvasive techniques used to destroy cancer cells respectively by heating or freezing. They can be applied for the treatment of very small tumors localized to the prostate gland while the surrounding prostate tissues remain intact.
• Medication treatment. Unlike the other treatment options that are applied locally, the drugs used to manage advanced prostate cancer are intended to reach the cancer cells throughout the body. Therefore, this is called systematic treatment. There are various options, including hormone therapy aiming to decrease the production of the male hormone testosterone, which stimulates the growth of prostate cancer cells; chemotherapy given by mouth or by injection; immunotherapy or targeted therapy that can be applied for certain patients. Experienced medical oncologists at Acibadem are able to choose the best treatment option for each individual patient based on his medical history and their vast expertise.
• Lutetium-177 PSMA therapy. This is an innovative treatment option in the field of nuclear medicine. It is appropriate for patients with advanced prostate cancer, also known as metastatic prostate cancer, when the other options are exhausted. The prostate-specific membrane antigen (PSMA) is a specific marker found on the surface of prostate cancer cells, including metastases throughout the body. The radioactive isotope Lutetium-177 is administered by injection into the patient’s bloodstream. It is combined with a molecule able to localize and bind to the PSMA receptors on the cancer cells, wherever they are within the body. Hence, the cancer cells are selectively targeted and destroyed by radiation. Lu-177 PSMA therapy contributes to prolonged survival and improved quality of life even in patients with metastatic castration-resistant prostate cancer, a condition when the disease no longer responds to hormone therapy.

For successful outcomes of prostate cancer treatment, Acibadem applies a team approach. Highly skilled specialists in various medical disciplines, including but not limited to urology, lab pathology, radiology, nuclear medicine, surgery, medical oncology, and radiation oncology, join their efforts to achieve the best outcome for each and every patient. Integrated care is essential for the treatment of prostate cancer and patient satisfaction, as all treatment options are assigned, assessed and provided in one place.