Is prostate cancer one of the most common types of cancer?

According to the data from the Ministry of Health, prostate cancer is the second most common cancer in men after lung cancer. In our country, approximately 36 out of every 100,000 men are diagnosed with prostate cancer each year. About 1 in 8 men have a lifetime risk of developing prostate cancer.

At what age is prostate cancer typically seen?

More than half of patients diagnosed with prostate cancer are over the age of 65. However, it can occur at earlier ages in individuals with a family history of prostate cancer.

Is prostate cancer a fatal disease?

As with all cancers, the stage at the time of diagnosis affects the survival rate in prostate cancer. If the disease is confined to the prostate, death due to prostate cancer is unlikely within 5 years. In Western countries, prostate cancer accounts for 2.5% of deaths in men who die within one year.

How is a prostate exam performed, and what information does it provide to the doctor?

The prostate exam is performed via the rectum. Since the prostate is located just in front of the last part of the large intestine, it can be examined through the rectum using a digital rectal exam (DRE). Even small irregularities on the surface of the prostate can easily be detected during this examination. Particularly, the feeling of hard areas through the finger may suggest the possibility of cancer. Since prostate cancer typically develops on the surface of the organ, the digital rectal exam method can provide insights into prostate enlargement without causing significant pain.

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What is PSA?

PSA stands for Prostate-Specific Antigen. It is an enzyme secreted by the prostate. Its function is to liquefy semen, turning it from a gel-like consistency into a fluid.

PSA is not specific to prostate cancer. Therefore, a low PSA does not necessarily mean that a person does not have prostate cancer, just as a high PSA does not necessarily indicate the presence of prostate cancer. PSA levels can rise not only in cancer but also in benign prostate enlargement. Additionally, PSA levels can increase in cases of prostate inflammation or after the insertion of a catheter into the urinary tract.

PSA, along with a digital rectal exam, is an important test to indicate the likelihood of prostate cancer.

How is PSA used in the diagnosis of prostate cancer?

When there is benign enlargement, inflammation, or cancer in the prostate, the amount of PSA in the blood can increase. Therefore, an increase in PSA does not necessarily indicate the presence of cancer. As men age, the prostate enlarges, and PSA levels can rise even without cancer.

After a PSA test, a biopsy decision should not be based on a single test. Since PSA can sometimes increase due to factors such as prostate infection, recent sexual activity, or prostate examination, it is recommended to repeat the PSA test after one month.

To distinguish which PSA elevation indicates cancer and which one is due to benign enlargement, certain calculations are performed. One of the most commonly used is the PSA density. PSA density is calculated by dividing the PSA value by the prostate volume, which is measured via ultrasound or MRI. If the result is greater than 0.15, the likelihood of prostate cancer increases. Values lower than 0.15 generally indicate benign enlargement. [Click here for calculation.]

The second calculation is the free/total PSA ratio. A portion of PSA in the blood circulates freely, while another portion is bound to proteins. The level of free PSA can also be measured. The ratio of free PSA to total PSA in the blood can be calculated, and if the result is greater than 0.2, it suggests benign prostate enlargement. This calculation is done for total PSA values between 4-10 ng/ml. [Click here for calculation.]

How is prostate cancer diagnosed?

There are no specific symptoms for prostate cancer. Most patients with prostate cancer are either those visiting for routine check-ups or those suffering from symptoms of benign prostatic hyperplasia (BPH). In the evaluation of these patients, if there is an elevated PSA level and/or hardness detected in the prostate during a digital rectal exam, a prostate biopsy is performed. A prostate biopsy is an essential evaluation for diagnosing the disease. The diagnosis of prostate cancer can only be confirmed after the pathologist evaluates the prostate biopsy. Therefore, prostate cancer cannot be diagnosed through examination, blood tests, or imaging methods alone.

Can screening be done for prostate cancer, similar to breast and cervical cancer in women?

As prostate cancer is common, it is recommended that all men visit a urology clinic annually for prostate cancer screenings after the age of 50, and especially after the age of 45 for those with a family history of prostate cancer.

What is the role of MRI in the diagnosis of prostate cancer?

If PSA and prostate examination alone are insufficient to make a biopsy decision or if we need assistance in determining which part of the prostate to biopsy, we use an imaging method called multiparametric MRI. Multiparametric MRI can map out potential areas of cancer within the prostate, helping guide the biopsy process. (For detailed information, refer to the prostate biopsy section.)

How does the grade of prostate cancer affect treatment?

Prostate cancer has various grades. The grade of prostate cancer is determined based on pathological evaluation and PSA levels. The pathological grading portion of this evaluation is called the Gleason score. The score ranges from 2 to 10, with prostate cancers scoring 6 or lower being considered low grade.

Low-grade prostate cancer has a very low risk of causing death. However, prostate cancer treatment, although rare, can have significant effects on the patient's life. Therefore, for individuals with low-grade prostate cancer, where the likelihood of severe impact on life is very low, a more appropriate approach may be to closely monitor the disease rather than applying treatment.

How is prostate cancer treated?

If prostate cancer is detected after a biopsy, there are three treatment options available: surgery, radiation therapy (radiation treatment), and medication.

The choice of treatment depends on the severity and stage of the disease, as well as the patient's overall condition and preferences.

Each of these three treatment options can be applied in different ways. Surgery can be performed openly, laparoscopically, or robot-assisted laparoscopically. The outcomes of all types of surgery in terms of controlling the cancer are similar.

Radiation therapy also has various methods of application. Radiation can be delivered from outside the body, or radioactive needles can be inserted into the prostate to deliver the radiation from within the body.

What is the medication treatment for prostate cancer?

In medication treatment, initial hormonal therapies are used, followed by or sometimes alongside chemotherapy. Medication treatment is primarily used in cases of prostate cancer that have spread throughout the body or as a supportive treatment alongside radiation therapy.

What is the likelihood of recurrence after prostate cancer treatment?

The likelihood of recurrence after prostate cancer surgery can be calculated based on the pre-surgery PSA level, prostate biopsy pathology, and surgical pathology results.