The prostate is a secretion-producing organ found in men that sits below the bladder and above the rectum. The prostate is found only in men PSA.
(Prostate Specific Antigen), on the other hand, is an enzyme released from the prostate that ensures the liquefaction of sperm. PSA is secreted from the ducts and epithelium of the prostate. In cases where the structure of the ducts and epithelium of the prostate is impaired, the PSA passes into the blood at a higher rate than normal, creating a high PSA level. These conditions are usually benign prostatic enlargement and prostate cancer.
The normal value of PSA is considered to be 4 ng/ml. However, not all increases in PSA mean cancer. The PSA test is a screening test, not a diagnostic test. Increase in PSA may also occur in non-cancerous conditions. For example, urinary catheterization, rectal examination of the prostate with finger, cystoscopy. While these conditions create a short-term PSA increase, prostate massage, ejaculation, transrectal ultrasound, prostatitis can cause a longer-term PSA increase.
When should PSA level measurement and prostate cancer investigation be done?
There is not an exact answer to this question because prostate cancer does not show any symptoms in the early stages, but after many years of experience and clinical studies have shown that every man without a family history of prostate cancer should get an examination after the age of 45-50, and if there is a family history of prostate cancer, PSA measurement and prostate cancer research are recommended after the age of 40 every year. The risk of prostate cancer increases with age in men. However, the most important risk factor is a family history of prostate cancer. If there is a history of prostate cancer diagnosed in the father or siblings, the risk of developing cancer increases 2-3 times compared to other men.
The importance of PSA measurements and prostate cancer investigation at an early age, even if the man has no complaints, is that the success of treatment in prostate cancers detected at an early stage is quite high and it provides the opportunity to completely get rid of the tumour with only surgical treatment. Under normal conditions, prostate cancer does not show symptoms in the early stages and progresses silently. If it is not detected at an early stage, the cancer may spread first to the regional lymph nodes, bones, and then to the liver, lungs and other organs of the body. In this case, an advanced prostate cancer develops and its treatment becomes more difficult with oncological support.
What are the procedures to be done when increase in PSA is detected?
When PSA elevation is detected, transrectal prostate needle biopsy is performed under ultrasound guidance and pathological evaluation is performed. If prostate cancer is diagnosed as a result of pathological evalua-tion, staging of the cancer is done.
Today, surgical (radical prostatectomy) is the first treatment method accepted worldwide in cases of prostate cancer that has not spread anywhere and is limited to the prostate gland. In this surgery, the pros-tate gland and the sperm sacs named vesiculasem-inalis, which are located on the right and left side of the lower back of the bladder, are completely removed and the urinary bladder and urethra are reconnected to each other. It can be done in 2 ways, open and closed. Thanks to laparoscopy and especially robotic surgery, which developed in parallel with the develop-ment of today's technology, these operations are now performed closed laparoscopically or robotically in good centres like our hospital. Thanks to laparoscopic and robotic surgery, problems such as bleeding, erec-tile dysfunction and urinary incontinence, which can be seen especially after radical prostatectomy with open method, are minimized.
In laparoscopic and robotic surgery, surgery is per-formed not with a large abdominal incision, as in open surgery to the patient's prostate, but with instruments placed in ports (tubes) placed by making 5-6 small in-cisions (0.5-1 cm) in various regions on the abdomen.
It has many advantages over open surgery. These advantages are as follows:
- The surgical field is seen 10-15 times larger than normal by the surgeon (thanks to the high-resolu-tion telescope and camera system used)
- Thanks to the magnified view, the surgeon can see and separate the nerve that provides erection and the muscles that provide urine retention, and min-imizes the risk of unwanted erection problem and urinary incontinence, thanks to a more detailed dissection.
- Less bleeding
- Having 5-6 small incisions instead of a large ab-dominal incision cosmetically
- Less post-operative pain and discomfort with lap-aroscopic and robotic surgery
- Hospitalization and recovery times are shorter in laparoscopic and robotic surgery than in open surgery
- Patients' return to their daily activities and social life in a shorter time.
Is there a way to protect from prostate cancer?
There is no known active method of protection from prostate cancer, but it has been reported that diet and regular lifestyle reduce the risk of developing prostate cancer somewhat. E.g; Obesity is the biggest envi-ronmental risk factor for the development of prostate cancer. In a study of American origin and large partic-ipation, it was reported that the cancer was more ad-vanced and more fatal in patients with prostate cancer with a body mass index above 30 kg/m2. In a similar study, it was emphasized that the incidence of prostate cancer decreased in patients who lost 5 or more weight in 10 years in a controlled manner. Large-scale studies conducted in Western Europe and America have deter-mined that there is a serious relationship between fatty diet and the incidence of prostate cancer. In studies, it has been argued that the risk of developing prostate cancer increases in men who eat foods high in saturat-ed fat, not all dietary fat.
It has been stated that alpha-linoleic acid, which con-sumes high amounts of animal fat and is partially found in red meat, is an important risk factor for the develop-ment of not only prostate cancer but also many cancers. As a result, there is a serious relationship between the incidence of prostate cancer in men fed with high ani-mal fats and saturated fats. The effects of fatty acids on prostate cancer were investigated in a study by Ritch et al. It has been determined that the development of prostate cancer is more common in men fed with foods containing omega-6 fatty acids, and the incidence of prostate cancer development is less in men fed with omega-3 fatty acids. Omega-3 fatty acids are mostly found in the fatty tissue of fish such as salmon, sardines, mackerel and tuna grown in cold climates, while Ome-ga-6 is more abundant in vegetable oils. Apart from these, it has been observed that uncontrolled diabetes, high cholesterol and irregular stressful life increase the risk of developing prostate cancer.