Prostate Cancer

Prostate cancer symptoms and treatment

Prostate cancer is the second most common cancer type in men worldwide. With proper care, the 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 Acıbadem Hospitals in Turkey, provided by a multidisciplinary team of experts with international recognition.

Frequently encountered prostate diseases

The prostate gland, which all men are born with, is located just below the urinary bladder. Its functions are associated with reproduction and sperm maturation. It is the size of a walnut in young men, but starts enlarging with age. Since the urinary tract goes through the prostate, enlargement of the prostate causes compression and problems with urination.

Prostate diseases can be either malign or benign. Benign conditions are much more common. The most common conditions are benign prostatic hyperplasia (BPH), prostatitis (prostate infection), and prostate cancer. These may cause urinary complaints such as frequent urination during the night and day, a burning sensation during urination, and inability to empty the urinary bladder completely. More rarely, they may 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 the 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 BPH causes difficulty in urination and other symptoms, prostate cancer is a more insidious disease. It often develops in the peripheral zone of the prostate, and frequently does not cause 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 thought that the underlying factor might be hormones—fats stimulate increased production of testosterone and other hormones, and testosterone speeds up the growth of cancer cells.

Family history is important as well. The risk of developing prostate cancer is 7 times for men with family members with this condition. In addition, men whose mothers had breast cancer have a higher risk of prostate cancer. Men with first degree relatives diagnosed with prostate cancer or breast cancer with BRCA need to start regular examinations and Prostate-specific antigen(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 urination, a feeling of incomplete bladder emptying, burning or pain during urination or ejaculation, blood in the urine or semen, erectile dysfunction, and beginning to get up at night to urinate after age 40. It is important to remember that prostate cancer may not show early signs at all. This is why routine annual checkups are essential.

Diagnosing prostate cancer

When a patient consults a doctor with symptoms that may be signs of prostate cancer, the diagnostic process usually includes some of the following procedures:

PSA test to measure the level of PSA 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 performed by hand to examine the texture, shape, and size of the prostate gland
Prostate biopsy to analyze a sample of prostate tissue in a lab if there is reason to suspect a malignant condition based on the previous tests

Acıbadem uses both established and innovative methods and techniques 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 of diagnosis from collecting samples of prostate tissue, as 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 right area. During the MRI/US fusion biopsy procedure, 3-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 the hi-tech devices that may be needed for a prostate cancer diagnosis are available at Acıbadem without waiting time, ensuring a fast and accurate diagnostic process.

Types of prostate cancer

More than 95% of all prostate cancers are of a type called adenocarcinoma, which originates from the gland cells of the prostate. Adenocarcinomas are usually slow-growing and non-aggressive cancers, though there are some variations. Ductal adenocarcinoma is generally more aggressive and spreads more quickly than acinar adenocarcinoma. 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, and 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 treatment planning and determining the patient’s prognosis. Generally, in stage 1 and stage 2, the tumor’s spread is limited to the prostate gland. In stage 3, the tumor has grown outside of the prostate, usually up to the seminal vesicles, and is called locally advanced prostate cancer. In stage 4, the disease has spread to surrounding lymph nodes or distant organs. In some cases, it can metastasize to the bone as well.

At Acıbadem, Gallium-68 PSMA PET is routinely used in the staging of prostate cancer. It provides improved 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 assessment of the tumor and evaluation of if 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—cancer that has never caused symptoms and most likely will never hurt the patient or threaten his life. They are closely monitored and if the cancer ever becomes a real threat, it is treated in a timely fashion. Nearly two thirds of patients on active surveillance will never require active treatment and can avoid the side effects of unnecessary treatment.
NanoKnife therapy. This is a safe method for focal treatment of prostate cancer, used as an alternative to surgery for 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 tissue, it can be used for tumors located near nerves or the urethra.
Surgery. This is the most effective treatment option for cancer confined to the prostate gland; it is also used for advanced prostate cancer patients in combination with other treatment options. Prostate cancer surgery usually implies the removal of the prostate gland, called radical prostatectomy. It can be performed as open or laparoscopic surgery. Nerve-sparing radical prostatectomy is frequently performed at Acıbadem for appropriate patients. This method ensures effective treatment and gives patients a better chance 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 on a console. It provides clear 3-dimensional visualization of the surgical site, which is magnified 12x on the console. Furthermore, the robotic instruments on the system’s arms, which can rotate 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 precision of the robotic system often allows the removal of the cancerous tissues while preserving the critical structures and nerves responsible for urinary continence and sexual function. Acıbadem employs some of the most experienced surgeons and care teams for robot-assisted surgery 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 Acıbadem.

Focal therapies (HIFU, cryotherapy). These are noninvasive techniques used to destroy cancer cells by heating or freezing respectively. They can be used to treat very small tumors localized to the prostate gland while leaving the surrounding prostate tissues intact.
Medication treatment. Unlike the other treatment options, which are applied locally, drugs used to manage advanced prostate cancer are intended to reach cancer cells throughout the body. This is called systematic treatment. There are various options, including hormone therapy to decrease the production of the male hormone testosterone, which stimulates the growth of prostate cancer cells; chemotherapy given by mouth or by injection; and immunotherapy or targeted therapy that can be used for certain patients. Experienced medical oncologists at Acıbadem are able to choose the best treatment option for each patient based on the patient’s 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 other options have been 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 in 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 where the disease no longer responds to hormone therapy.

Acıbadem uses a team approach for successful outcomes from prostate cancer treatment. 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 every patient. Integrated care is essential for the treatment of prostate cancer and for patient satisfaction, as all treatment options are assigned, assessed, and provided in one place.