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 Turkey, provided by a multidisciplinary team of experts with international recognition.
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.
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.
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.
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.
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:
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.
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.
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.
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:
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.