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Prostate Cancer Surgery

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Overview

Prostate; is a small gland resembling a walnut, which is found as part of the male reproductive system (pelvic). It is located under the bladder and just in front of the rectum or large bowel.


Prostate gland surrounding the beginning of the urinary tract secrets the a part of fluid that form semen and so plays a role in the delivery of the semen.


Generally in the men above 40, hormonal changes occur related to age and advancing age may cause benign prostate growth. In these benign prostate growths, genetic factors as well as hormones play a role.


Prostate cancer is the most common type of cancer in men. Due to its slow development, does not give a significant sign and at the beginning it is limited to prostate gland. While some prostate cancers develop slowly, some develops rapidly and can spread other organs of the body. If the prostate cancer can be diagnosed at an early stage without spreading outside the prostate gland, the chance of success becomes rather high.


Risk Factors:

Although the causes of prostate cancer are not completely known, some risk factors such as genetic predisposition, race, age and obesity can cause to the development of prostate cancer.


However, there is no accurately proven factor that causes prostate cancer, or, in other words, it is not known exactly what causes prostate cancer.


With the effects of risk factors, mutations occur in the cells of the prostate gland causing abnormal cells to appear. These cells are reproduces faster than normal cells and survive when the other cells die. So, abnormal cells  increasing in number rapidly forms a bulk called tumor. These abnormal cells can spread to neighbor and distant tissues and organs using lymph nodes and blood circulation.


Since prostate cancer is at the top of the most common types of cancer among men, it is important for men routinely to be examined and checked, especially at middle ages.


Symptoms:

The amount of growth in the gland determines the symptoms of prostate cancer at a large extend. In the early stage, patients do not have any signs. Or its symptoms can be confused with “benign prostate growth”. When the growth of the gland progresses and the advanced stages of the disease are reached, signs and symptoms appear that cause distress in the daily life.


Among the most common causes of prostate cancer are;

  • Blood in urine or semen
  • Difficulty voiding, weak urine stream
  • Urinary incontinence
  • Difficulty in urinating and pain.
  • Anemia, fatigue
  • Erectile dysfunctions,
  • Bone pains.


Prevention:

As in all other cancer types, prevention of prostate cancer is also to remove manageable risks or to reduce to minimum.


Since there is no a known factor that causes prostate cancer, to prevent prostate cancer you should live a healthy life from all perspectives. For this purpose, to protect ideal body weight, vegetable and fruit rich healthy diet, to exercise regularly, to avoid from the sedentary life and to visit your doctor with regular intervals to manage risks apply to you are among to do.


Your doctor may ask you to visit him/her regularly with the purpose of screening. In prostate cancer examination of the prostate gland by finger at regular intervals and analysis of a substance called prostate specific antigen in your blood that shows the risk of prostate cancer, helps to diagnose prostate cancer in early stage. As in all other cancer types, also in prostate cancer early diagnose and treatment increases chance of life.


Diagnosis:

If a finding that may lead cancer suspect is determined in the examination of the prostate gland by finger or in PSA test, your doctor may require advanced tests.


First, information about the prostate gland is collected by using imaging methods such as ultrasound and multiparametric MR. If the prostate cancer suspect cannot be eliminated, a biopsy specimen from the prostate gland is removed in order to establish a definite diagnosis. With this purpose, a thin needle is inserted into the prostate gland and tissue and cell samples of the gland are collected and analyzed. Biopsy specimen, if there is prostate cancer, provides to make definite diagnose and to determine the growth and spread tendency of cancer cells. With this purpose, pathologists use Gleason Scoring System. With this scoring system, tumor is given a score between 2 to 10. While 2 shows low aggressiveness,10 is the highest aggressiveness level.


Treatment:

The most appropriate treatment method is determined after the collection of all information related with patient and tumor. In the assessment of the alternative treatments, not only benefits, but also the side effects and risks are considered.


The identification stage and extent of the prostate cancer, plays a major role in determining the treatment method to be applied.


Generally cancer phases are symbolized with Roman numbers I to IV . The phase IV is the last phase and the most severe cancer. Treatment is planned specific to person regarding the phase, age, general health condition and personal preferences.


Your doctor defines treatment level according to the progression level of the disease, your general health condition and severity of the symptoms. Active follow-up may be recommended, if the growth in the prostate gland is thought to be low risk for prostate cancer. There will be no intervention and healthy lifestyle recommendations will be advised (healthy nutrition, reaching and maintaining ideal body weight, regular exercise, avoid alcohol and special recommendations for you).


Except this, prior to applying surgical methods, hormone therapy, chemotherapy, radiotherapy etc. are applied according to the condition of the disease. 


Treatment methods of the prostate cancer include chemotherapy, target-oriented therapy, radiotherapy and surgery. While these treatments used to cure tumor, in advanced stages can be used to increase quality of life and to ease the severity of the symptoms.. Moreover, the treatment options can be used together or alone.


Chemotherapy

Chemotherapy uses drugs to cure cancer. The active ingredients in these drugs kill cancer cells. Chemotherapy drugs can be administered intravenously or via the oral route. If the drug is administrated through vein, a thin tube, called a catheter, is inserted into a large vein and chemotherapy drug is delivered from this catheter throughout the course of the treatment.


One or more chemotherapy medicines may be administered according to the response of the cancer to the treatment and type of cancer. After chemotherapy was given for a certain period, treatment break is given. After the completion of this defined “break” period, treatment resumes. Each of these periods is called cycle.


In early stage cancers, both to develop surgical results and to increase survival rate, chemotherapy can be started before the surgery or with surgery.


Side effects of chemotherapy are secondary to the chemotherapeutic agent and dose. Most common side effects seen in chemotherapy drugs include; malaise, nausea, vomiting, mouth sores, hair loss and inflammation in the digestive system. Side effects caused by chemotherapy will also be treated by your doctor. In case of the side effects become severe to threaten your health, your doctor may advise to suspend the treatment or to take another chemotherapy medicine.


Hormone therapy

Since testosterone hormone plays a major role in the growth of prostate cells, drugs may stop testosterone production of the body or to decrease the testosterone level testicles can be removed (orchiectomy).


Radiotherapy

Radiation therapy aims to kill cancer cells by using high-powered energy beams.


If the radiation source is out of the body and beams are directed to cancer, this treatment is called external radiotherapy.  On the other hand, if the radioactive agent is put into the area that cancer is present by a needle or catheter, method is called internal radiotherapy (brachytheraphy).


Although radiation therapy can also be used as first order therapy of cancer, generally it is used to kill cells that are not removed by surgery. In first order treatment, mostly radiotherapy and chemotherapy are administered together and this treatment is also known as chemoradiotheraphy.


The side effects of radiotherapy take place in a very wide range depending on the body region where the radioactive rays are transmitted. Urological symptoms such as pain while urinating, needing to urinate more often and needing to rush to the toilet, as well as sexual dysfunctions such as erectile dysfunction, and rectal problems such as pain or soft stools during evacuating the bowel may also be encountered. The risks apply to you will be explained by your doctor.


Surgery:

In stages where cancer is limited to prostate gland, the most appropriate treatment is surgical removal of the prostate gland and surrounding tissue and lymph nodes. In this surgery called radical prostatectomy, open method, laparoscopy or robotic method can be used.


Open radical prostatectomy: your doctor to remove the prostate gland, will make an incision between the scrotum and the anus on the anterior wall of the abdomen in the light of the pre-operative examinations. Additionally, neighboring lymph nodes to the prostate gland is also removed. Depending on the findings monitored during surgery, the same incision may be used or a separate incision may be required to remove the lymph nodes.


Laparoscopic prostatectomy: Small incisions are made on the skin of the abdomen. From one of these incisions, a tube with a camera on the tip and with a light source and is inserted, while from the other incision laparoscopic surgical instruments to be used during surgery are inserted into the abdomen. Prostate gland and lymph nodes are removed.


Robotic Surgery: After the small incisions made on the skin of the abdomen, the camera and the surgical instruments were inserted into the abdomen, surgeon performs the surgery by using robotic arms.


Pelvic lymphadenectomy: In the prostate cancer cases, in addition to the prostate gland removal, it is routinely performed. Purpose is to removal of the lymph nodes of pelvic area. By analyzing lymph nodes, spread and aggressiveness of the cancer is examined.


Cryosurgery: With this method which can be applied in some centers, it is aimed to kill some healthy cells and tissues around the prostate gland and cancer cells by cooling and heating the prostate gland rapidly by inserting small needles into the prostate gland with the help of ultrasound.


Your doctor will decide which method is proper for you according to your general health condition, your age and then inform you. Radical prostatectomy surgery carries risks of urinary incontinence and erectile dysfunction. All of your questions regarding the complications you may encounter will be answered by your doctor in detail. Asking your questions about, treatment of the prostate cancer, post-treatment life, rehabilitation, pain management, clinical studies and prostate cancer to your doctor; will help you to take part in treatment with more information and will ease your concerns.