Overview
Prostate cancer is cancer that begins in the prostate gland. It is the 2nd most common cancer in men in our country; about 16,000 new cases per year. It usually grows slowly and has an excellent prognosis when treated at an early stage.
The prostate is a walnut-sized gland surrounding the urethra that produces semen fluid. As the cancer grows, it can affect urinary and sexual functions.
Symptoms
There may be no symptoms in the early stage. As it progresses:
Urinary complaints:
- Difficulty starting urination
- Weak, intermittent urine stream
- Frequent urination (especially at night)
- Urgent need to urinate
- Pain, burning during urination
- Blood in urine (hematuria)
- Feeling of incomplete emptying
Sexual:
- Erectile dysfunction
- Pain during ejaculation
- Blood in semen
Advanced cancer:
- Pelvic pain
- Back, hip, thigh pain (bone metastasis)
- Leg weakness, numbness
- Unexplained weight loss
- Extreme fatigue
- Swelling
Risk Factors
- Age: Most important factor, over 50
- Family history: Prostate cancer in father/brother
- Genetic: BRCA1, BRCA2 mutations, Lynch syndrome
- Ethnicity: More common in men of African origin
- Obesity
- Diet: Excess red meat, high calcium
- Occupational exposure: Some chemicals (cadmium)
- Smoking, alcohol
Screening
PSA (Prostate Specific Antigen) test:
- Controversial starting at age 50 (40-45 in high-risk men)
- Should start earlier in those with family history
- Benefits and harms should be discussed with the doctor
Digital rectal examination:
- Performed with PSA
Diagnosis and Treatment
Diagnosis:
- PSA test
- Digital rectal examination
- MRI (multiparametric): Lesion identification
- Transrectal ultrasound-guided biopsy
- MRI-fusion biopsy
- Bone scintigraphy
- PSMA-PET (new, very sensitive)
- Gleason score (1-5, higher = worse)
- TNM staging
Treatment (according to stage and patient age):
1. Active surveillance:
- In low-risk, slow-growing cancers
- Follow-up with PSA, MRI, biopsy
- In older patients
2. Surgery:
- Radical prostatectomy (removal of the prostate)
- Robotic (da Vinci), laparoscopic, open
- Curative in localized disease
- Side effects: urinary incontinence, erectile dysfunction
3. Radiotherapy:
- External beam radiotherapy (IMRT, IGRT)
- Brachytherapy (internal, radioactive seeds)
- Stereotactic (SBRT)
4. Hormone therapy (androgen suppression):
- LHRH agonists (leuprolide, goserelin)
- LHRH antagonists (degarelix, relugolix)
- Anti-androgens (bicalutamide, enzalutamide)
- New generation: abiraterone, enzalutamide, apalutamide
- In advanced or high-risk cases
5. Chemotherapy:
- Docetaxel, cabazitaxel
- In metastatic cases
6. Immunotherapy and targeted:
- Sipuleucel-T (therapeutic vaccine)
- PARP inhibitors (olaparib, rucaparib) - in those with BRCA mutations
- Lutetium-PSMA therapy (new, metastatic)
7. Focal therapies:
- HIFU (high-intensity focused ultrasound)
- Cryotherapy
- Laser ablation
Prevention and Lifestyle
Prevention:
- Healthy, balanced nutrition
- Limit red meat consumption
- Vegetables (especially tomato - lycopene), fruits
- Green tea, fish (omega-3)
- Maintain a healthy weight
- Regular exercise
- Quit smoking
- Limit alcohol
- Do not take excessive calcium (>1500 mg/day)
Screening:
- Discuss risk-benefit with a doctor starting at age 50
- Earlier in high-risk men (family history) at age 40-45
- Earlier in those with BRCA mutation
After diagnosis:
- Regular follow-up (PSA, examination)
- Exercise (very important)
- Healthy eating
- Manage stress
- Talk openly about sexual life issues
- Pelvic floor exercises for urinary incontinence
- Family and psychological support
- Join prostate cancer support groups