TRPROF. LUTFI TUNCUROLOGY, ROBOTIC & LAPAROSCOPIC SURGERY
What is Prostate Cancer?

Prostate

Prostate

What is Prostate Cancer?

Prostate cancer is the most common cancer and second reason of death from cancer among men.It is rarely seen among young men, but the incidence increases in men above 50 years of age. Every year, 37.000 new cases are diagnosed as prostate cancer in the United Kingdom where there is a male population of 32 millions.

Prostat cancer survival is quite different than any other cancer. Inside the prostate gland, cancer can stay as a localized small tissue without any symptoms. At the age of 50, half of men may carry cancer cells inside their prostates and over the age of 80, 8 men out of 10 (80%) carry such cells. Mostly, prostate cancer progresses slowly and especially among the elderly population, it is not so problematic.

In a small population of patients, prostate cancer may progress quickly and spread to the other sides of body including bones.

What Are The Symptoms?

  • Frequency,
  • Nocturia,
  • Urgency,
  • Urge incontinence,
  • Hesitancy,
  • Strain to void,
  • Intermittent voiding,
  • Post voiding residue,
  • Inability to void.

The aforementioned symptoms are generally observed in prostate diseases, but localized prostate cancer is usually observed without any symptoms.

In the advanced stages of prostate cancer, voiding problems, blood in semen, hematuria and even distant metastasis may be seen with severe pain, anemia and weakness because of the mass effect.

Symptoms of prostate cancer? Ages of risk groups?

Prostate is a glandular organ of males with special roles in male reproductive system and is located below the bladder, anterior to the rectum. If there is an uncontrolled cell division process, prostate cancer develops. Painful and bloody ejaculation, painful voiding (disuria),frequency and intermittent voiding with postvoiding residue may develop or even do not develop in asymptomatic patients. In men with long life expectancy, prostate cancer may develop in one way or another. Mostly, prostate cancer is seen over the age of 50 and 85% of the cases are over the age of 65.

Risk Factors and Etiology

In the UK, 1 out of 9 men is diagnosed with prostate cancer. In the USA, this ratio is even higher. This may occur because of early PSA controls and early diagnosis. The serum PSA test is used for measuring protein-structured prostate specific antigen (PSA) levels in blood. Normally, it is very low in blood but it is expected to be high in prostate cancer.

In the UK and many other countries, the incidence of prostate cancer is gradually increasing during recent years. This may be the case due to the early diagnosis of prostate cancer and longer life expectancy in men.

The etiology presents many risk factors and the relevant studies are going on. Some of the risk factors are;

​Age: It is the most powerful risk factor. Men under 50 years of age have a very low risk of prostate cancer. It is thought that 80% of men over 80 years of age have prostate cancer.

Ethnicity: Some ethnic groups have higher incidence of prostate cancer. For example, Black African and Caribbean men are thought to have higher risk of prostate cancer while Asian men have lower risk to be diagnosed with prostate cancer.

Family History: Men with relatives (father, grandfather or uncle) having a history of prostate cancer have higher risk to be diagnosed with prostate cancer.

Men at Higher Risk for Prostate Cancer:​

  • A brother or father diagnosed with prostate cancer below the age of 60
  • One or more relatives with prostate cancer in the family.

If these are present, there is probably a defective gene. A specific gene related to prostate cancer is not yet described. But studies demonstrate that high-risk breast cancer susceptibility genes such as (BCRA1 and BRCA 2) may also increase the risk of prostate cancer.

So, if there is a family history of breast cancer especially below the age of 40, this may suggest the presence of a defective gene.

Hereditary prostate cancer is thought to be as low as 5-10%.

Diet

The press and televisions cover many aspects of the relation between diet and cancer. There is no‘’superdiet’’ which can protect you against cancer. But low glucose and fat levels as well as high fibers within a balanced diet may decrease the risk of some cancer types.

In the Western countries (UK and USA),the incidence of prostate cancer is higher than the Eastern countries (China and Japan). This is due to a high ratio of fat and low ratio of fruits and vegetables in the diet. Besides, people in eastern countries consume high amounts of soy and soy plants that include plant estrogens. Plant estrogens may decrease the risk of prostate cancer, but further studies are needed.

High amount of calcium intake (dairy products) may increase the risk of prostate cancer. But complete cessation of dairy products is not recommended as they protect bone health.

Tomato and tomato products such as ketchup are studied for any potential relation with prostate cancer. High amounts of lycopene in tomato products are thought to be protective against prostate cancer but further studies are needed.

Staging and Grading

Staging: Staging is a process used to detect to what extent cancer has spread within the prostate or toother parts of the body through biopsy and imaging.  The two most-commonly used systems are number staging (see below) and TNM staging.

  • Stage I: cancer is small and present only in the prostate
  • Stage II: cancer is larger and may be located in both lobes of the prostate but is still confined to the prostate
  • Stage III: cancer has spread beyond the prostate to nearby lymph nodes or seminal vesicles
  • Stage IV: cancer has spread to other organs such as bone and is referred to as metastatic cancer.

Grading: Grading is also called Gleason scoring. This score can indicate how quickly the tumor will grow and spread.

To calculate a Gleason score, tumor cells from the biopsy are investigated under a microscope. A number is assigned to them based on how abnormal they look. The scale goes from 1 (non-aggressive) to 5 (very aggressive). Numbers of the two most common patterns are added together to create a Gleason Score.

For example, in a biopsy where the most-common cell type is a 3, and the second most common cell type is a 4, then the total Gleason Score would be 7. However, a biopsy where the most common cell type is a 4 and the second most common cell type is a 3 would also be considered a Gleason Score 7. Keep in mind, though, that a 3+4 can progress very differently than a 4+3. Today almost all patients have a Gleason Score of 6 or above.

  • Gleason 6: the tumor tissue is well differentiated, less aggressive, and is likely to grow more slowly.
  • Gleason 7: the tumor tissue is moderately differentiated, moderately aggressive, and likely to grow but may not spread quickly.
  • Gleason 8-10: the tumor tissue is poorly differentiated or undifferentiated, highly-aggressive, and likely to grow faster and spread.

Prostate Cancer Investigation, When?

Men over 50 are recommended to get an annual prostate check even when they do not have any complaints. If they have any family history of prostate cancer, annual controls are recommended over the age of 45. Moreover, men with voiding and ejaculation problems should have an earlier visit to the doctor.

Differential Diagnosis?

Prostate cancer may mostly be confused with benign prostate hyperplasia (BPH). In addition, chronic prostatitis may need to be considered in differential diagnosis. Biopsy is needed for differential diagnosis. Besides, blood in ejaculate and pain may also be observed in urinary tract infections.

PROF. LUTFI TUNCPROF. LUTFI TUNCUrology, Da Vinci Robotic & Laparoscopic Surgery
0312 285 80830530 968 4994