Prostate cancer treatment is possible!

Although the incidence of prostate cancer varies according to geographical regions, it is the 5th most common cancer in the world. The incidence increases with increasing age. It is the most common type of cancer in men over the age of 70. Familial, genetic and environmental factors are held responsible for the development of prostate cancer. The risk is relatively increased in people with a first-degree relative with prostate cancer. It has been shown that genes such as Retinoblastoma1, C-myc, c-ERBB and Bcl-2 play a role in prostate cancer. It is thought that treatments for these genes will guide the course of the disease in the future. Smoking, fatty diet and obesity are environmental factors associated with prostate cancer. Although there are some studies showing that foods containing vitamin E, selenium, lycopene (tomatoes and red-colored fruits), and supplements containing saw palmetto have a reducing effect on the risk of prostate cancer, there is no conclusive evidence.

There are no typical symptoms specific to prostate cancer patients. The disease often does not show any symptoms. Sometimes, there may be complaints similar to benign prostate enlargement (BPH), such as difficulty urinating, interrupted urination, and frequent urination. In advanced disease, complaints such as widespread bone pain and fatigue can be seen as the first findings. Rectal Touch (finger prostate examination) and blood PSA test are cheap and easy methods used in prostate cancer screening. PSA screening test is recommended after the age of 45 in people with a family history and after the age of 50 in people who do not. Prostate biopsy should be recommended in the presence of elevated PSA (>2.5-4 ngmdl) and/or a firm lesion that is palpable on rectal examination. Definitive diagnosis is made by prostate biopsy. Today, prostate biopsy can be performed from 10-12 cores under the guidance of transrectal ultrasonography or MR. After the diagnosis of prostate cancer is made, staging should be done with MRI, Computed Tomography, Bone Scintigraphy and PSMA PET. Correct staging is required for correct treatment. Prostate cancer mainly; It is evaluated in 3 stages as local (limited to the prostate), locally advanced (exceeding the prostate and/or reaching the lymph nodes), metastatic (spread to other organs) stages. In local stage disease, treatment is surgery (Radical Prostatectomy; open or robot-assisted) or radiotherapy (IMRT, IGRT).

Although the success and side effects of both methods are similar, it would be more appropriate to decide on the treatment method together after discussing it with the patient. The most common side effects are; urinary incontinence and decrease or loss of erection in the penis. In recent years, the incidence of these side effects has decreased with nerve-sparing surgeries in suitable patients. Active surveillance is also an option in a limited group of patients who meet certain criteria. In locally advanced disease, treatment should be multimodal, including both surgery, radiotherapy and hormonal therapy. In metastatic disease, however, the place of surgery and radiotherapy is limited; Removal of testicles by surgery, hormonal therapy, chemotherapy and immunotherapy are the types of treatment that should be considered more at this stage. Prostate cancer patients should be treated and followed up by a urologist, radiation oncologist and medical oncologist in a multidisciplinary manner.

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