Prostate cancer, which is the most common type of cancer in men in developed countries, is the second most common after lung cancer in Turkey. It is the fourth leading cause of death worldwide due to cancer.
Prostate cancer is generally a low-risk type of cancer with a slow-growing tendency and relatively limited aggressiveness. The diagnosis is often delayed due to the absence of symptoms in the early period. As the disease progresses, conditions such as weakness, anemia, bone pain, paralysis (paralysis) after metastasis (splash) to the spinal cord and kidney failure due to bilateral urinary tract obstruction may occur.
For this reason, it is important for men to have prostate cancer screening at regular intervals for early diagnosis. Because the earlier the disease is diagnosed, the higher the treatment and survival rate. For screening, a biochemical parameter called PSA is checked in the blood analysis and prostate examination is performed with a method called rectal digital examination.
What is prostate cancer?
Prostate cancer is defined as malignant tumoral formations that occur as a result of abnormal and uncontrolled proliferation of prostate gland cells, which are part of the male reproductive system.
The prostate gland is a walnut-sized organ that is located in the lower abdomen just below the bladder and surrounds the urethra, called the urethra. Prostate is a Latin word meaning “protruding”. The secretion of testosterone hormone, which plays a role in regulating the functions of the reproductive system in the male body, and the production of semen, which protects the vitality and mobility of sperm cells, are among the important functions performed by the prostate gland. Among the people, the benign prostatic enlargement that occurs with the advancement of age is known as the prostate, which is the name of the organ.
60% of prostate cancer cases, which is a condition that affects thousands of men, especially middle-aged and older, are detected in people over 65 years of age.
What are the symptoms of prostate cancer?
Prostate cancer symptoms usually begin to appear in the later stages of the disease and can manifest with many symptoms. Since the disease progresses insidiously, it is possible to detect it in asymptomatic (asymptomatic) people at an early stage, but with regular screening.
Disease symptoms are uncharacteristic and can be seen in other prostate diseases. There are many common symptoms of prostate cancer:
- difficulty urinating
- frequent urination
- Presence of blood in the urine or semen
- erection problems
- Pain during ejaculation
- Involuntary weight loss
Because prostate cancer often metastasizes to the bone (it can spread), it can cause severe pain in the lower back, hips or legs.
Because the prostate gland is located just below the bladder, the most common symptoms are urinary system problems. After the enlargement of the prostate due to the tumor, pressure on the prostate gland, bladder and urinary tract may cause symptoms such as frequent urination, intermittent and slow flow of urination, and bleeding during urination, which is expressed as hematuria.
Erectile dysfunction, defined as erectile dysfunction (impotence), should also be taken into account because it can be among the symptoms that occur in people due to prostate cancer.
These symptoms can also occur in other conditions such as benign prostatic enlargement, inflammation of the prostate (prostatitis) and are not obvious signs of prostate cancer. Only one in ten people with these signs and symptoms has prostate cancer.
What is Benign Prostatic Hypertrophy?
Benign prostatic hypertrophy (BPH) is a benign prostate gland enlargement, commonly known as prostate, which is common in men with advancing age. The tissue growth here does not tend to spread or spread to other organs as in cancer and causes complaints about urination.
Differential diagnosis (differentiation of the two diseases) is important because prostate symptoms give similar symptoms to prostate cancer. The development of BPH may occur due to various risk factors and the effect of sex hormones such as testosterone on the prostate tissue. The testosterone hormone synthesized from the testicles is converted to its form called dihydrotestosterone (DHT) in the prostate gland, and this form of the hormone directly affects the proliferation of prostate gland cells. After the increase in the hormone level, there is an imbalance between the production and destruction of prostate gland cells. This results in benign enlargement of the gland.
What are the causes of prostate cancer?
The exact cause of prostate cancer is unknown. However, as a result of various studies, some risk factors for this type of cancer have been identified. Prostate cancer, in its most general form, develops as a result of abnormal changes in the DNA of a normal prostate cell. DNA is the chemical structures that make up the genes in our cells. Our genes control how our cells work, and therefore changes in DNA can affect how cells work and divide.
Certain genes that help cells grow, divide, and survive are called oncogenes. Genes that normally keep cell growth under control, repair errors in DNA or make cells die at the right time are called tumor suppressor genes. Mutations in some oncogenes and tumor suppressor genes are risk factors for prostate cancer.
Other risk factors for prostate cancer can be listed as advanced age, black race, family history of prostate or breast cancer, high male hormone levels, excessive consumption of foods rich in animal protein and fat content, obesity and sedentary life.
Prostate cancer may require an earlier screening study in the presence of certain conditions that may indicate a genetic predisposition. Individuals with a first-degree relative with prostate cancer have a 2-fold increased risk of developing this disease. Especially in the history of prostate cancer in siblings, the increase in risk is more pronounced.
There is an increase in risk between diet and prostate cancer, especially in people who eat a western style. Excessive consumption of milk and dairy products, diet rich in saturated fat foods, high calcium intake, low vitamin D levels, excessive consumption of red meat and processed meat products are among the dietary characteristics considered effective in the development of prostate cancer.
Advanced age is another risk factor for prostate cancer. Care should be taken as this disease occurs more frequently especially after the age of 50.
Obese individuals may have a predisposition to prostate cancer. A healthy body weight is considered among the important conditions for prostate cancer, as the disease may follow a more aggressive course and relapses may occur after treatment.
How is prostate cancer diagnosed?
Prostate cancer is a disease that does not cause obvious symptoms in the early stages. With the enlargement of the prostate gland, symptoms such as increased frequency of urination, getting up at night, difficulty in starting to urinate and maintaining the flow, blood in the urine and painful urination may occur. In addition to symptoms related to urination, sexual function and performance may be adversely affected over time.
In prostate cancer patients, pain felt in bones such as the spine, hips and ribs may indicate that the disease has begun to spread outside the gland.
In people who apply to health institutions with these symptoms, the physician first evaluates the patient’s medical history and physical examination for the diagnosis of prostate cancer. Among the physical examination applications, rectal digital rectal examination is at the forefront for the diagnosis of prostate cancer. Thanks to the digital rectal examination, abnormalities, asymmetries and suspicious nodular structures in the patient’s prostate gland can be detected.
Prostate cancer is detected in approximately 1 in 5 patients with abnormality in digital rectal examination. During this examination, the physician wears examination gloves and proceeds through the rectum of the person and examines the surface of the prostate with his index finger.
Prostate specific antigen (PSA) is an important biochemical parameter of diagnostic importance for prostate cancer. The level of this substance in the bloodstream of the person is detected as high in approximately 80% of prostate cancer patients. PSA is a protein substance produced by the prostate gland.
Transition to the biopsy procedure, which is the next stage of diagnosis, is decided by considering the patient’s physical examination findings, PSA value and other values related to this marker. If the total PSA value is found to be between 4-10 nanograms per milliliter as a result of the analysis, the free PSA value is checked. A percentage of free PSA greater than 25% indicates that the risk of cancer is less than 10%, while if this value falls below 10%, there is a risk of prostate cancer of up to 50%.
Ultrasonography and magnetic resonance imaging (MRI) are among the important radiological examinations for the detection and diagnosis of prostate cancer. Transrectal ultrasonography (TRUS) allows the detection of suspicious areas in the prostate tissue and the determination of the biopsy site. MRI, another radiological examination, has the power to detect up to 90% of the suspicious area.
If prostate cancer is suspected after the examinations, a biopsy can be performed. Prostate biopsy is performed with ultrasound guidance and samples are taken equally from each region. The biopsy procedure, which is performed by taking two samples from the base, middle and upper part of the prostate, is called 12 core biopsy. Thus, it can be ensured that the developing tumor tissue is not missed and its spread can be detected accurately.
As in other types of cancer, staging of prostate cancer examines the extent and size of the tumor, whether there is involvement in the lymph nodes, and whether the cancer has metastasized to other parts of the body. Stages for prostate cancer are expressed in numbers 1-4. The most advanced stage of cancer is stage 4 prostate cancer.
Stage 1 prostate cancer refers to the period when the disease is in one half of the prostate and no spread to the surrounding tissues is detected. During this period, the PSA values of the errors are usually below 10.
Stage 2 prostate cancer is divided into 2 substages, A and B. In stage 2A, the cancer is still limited to one half of the prostate, but a person’s PSA ranges from 10 to 20. If the tumor is detected in both halves of the prostate, stage 2b prostate cancer can be mentioned.
The condition may progress over time and become stage 3 and stage 4 prostate cancer. In these stages, there is an involvement in the capsule of the prostate and in the surrounding tissues. In patients with stage 4 prostate cancer, there is also bone involvement.
What are the prostate cancer treatment methods?
Prostate cancer treatment options vary according to the growth rate and spread of the cancer, and the patient’s general health. It also depends on other factors, such as the potential benefits and side effects of treatment.
Treatment options include surgery, chemotherapy, radiotherapy, hormonal therapy or different combinations of these. If the disease is diagnosed at an early stage, follow-up may be recommended for a while without any treatment. The most common and effective treatment option is surgery and usually involves complete removal of the prostate (prostatectomy).
Prostatectomy refers to the process of removing prostate tissue affected by cancer. Radical prostatectomy is the surgical removal of the entire gland. This surgical procedure can be performed as open or closed surgery.
In open surgical procedures, it is aimed to reach the prostate gland by making a large incision in the lower abdomen by the operator physician. The perineum region between the rectum and the scrotum (testicle) is another region that can be preferred in open surgical procedures for the treatment of prostate cancer.
Closed prostate surgery is performed laparoscopically. In this procedure, the prostate gland is removed piece by piece by means of cameras and surgical instruments inserted into the body through small incisions.
Laparoscopic interventions are less invasive than open surgical procedures (degree of intervention) and the incisions are smaller in this surgery. In both open and laparoscopic surgery, the physician performing the surgery examines whether there are traces of the disease in the lymph nodes and other tissues around the prostate.
After the removal of the prostate, the amount of semen produced decreases. This may cause a complaint called “dry orgasm” in post-operative patients.
What is good for the prostate?
Consuming foods that are good for the prostate may reduce the risk of prostate cancer. Especially foods containing vitamin E, zinc and selenium are good for the prostate. In addition to nutrition, factors such as regular physical activity and having a healthy body weight may also benefit the prevention of prostate cancer.
Among the foods that are beneficial for prostate health;
- Garlic, eggs, and seafood containing selenium
- Zinc-rich nuts, milk, and legumes
- Fruits and vegetables containing lycopene, such as tomatoes, watermelon, and rose hips
- Including whole grains, fruits, and vegetables.
Selenium and zinc are among the minerals considered important for prostate health. Regular intake of the mineral selenium has been associated with a reduction in the risk of prostate cancer, especially in tobacco users. Zinc mineral is considered important because of its effects on DNA repair and therefore on the cell cycle. Zinc is also a mineral found at high levels in prostate tissue.
Lycopene is a substance with antioxidant properties and can slow down cell division by inhibiting cell damage.
Broccoli is a food that can reduce the risk of cancer development with the help of complex substances in its content. Sulforaphane in broccoli is a nutrient that can have a protective effect against this ailment by eliminating those that tend to become cancerous in prostate cells.
Green tea is a product that has been consumed by people for thousands of years due to its many properties that positively affect normal body functions. Various chemicals in green tea can provide protective properties by showing effects on many issues such as growth, cell death and hormone interaction in the development of prostate cancer.
Beans, lentils and other legumes are plant foods with chemical content called phytoestrogens. Legumes, which are thought to have a protective effect against prostate cancer with their regular consumption, are important because of their hormonal regulation and antioxidant effects.
Fish rich in polyunsaturated fatty acid chains should be an indispensable part of nutrition programs, especially since they are rich in essential fatty acids such as omega3 and omega6. Because these fatty acids cannot be produced by the body and must be taken from the outside. While a Western-style diet contains high levels of omega 6 fatty acids, it is considered insufficient in terms of omega 3 levels. In order to maintain a balance between these two fatty acid levels, the consumption of fish grown in cold waters is recommended.