- May 31, 2020
- Posted by: Prof Dr Coşkun Şahin
- Category: Prostate Diseases
What is Prostate?
The prostate is a walnut-sized organ under the bladder. The urinary tract passes through it. It has dice like a tangerine peel on the outside. As seen in the ﬁgure, cancers develop from this place soon.
What is Prostate Tumor?
It is the cancer in the prostate organ found only in men. It is the most common cancer type in men. It is generally seen over the age of 50.
What are the Symptoms of Prostate Tumor?
It is difﬁcult to differentiate the symptoms of prostate cancer from the symptoms of benign prostatic enlargement. Differential diagnosis is made by a urology physician as it appears with the same symptoms. But every man should be examined by the urologist after the age of 50, if the family has prostate cancer after the age of 40, and continue the examination for 6-12 months for life.
What Causes Prostate Tumor?
The biggest reason is natural aging. Because it is not seen in young people. The male hormone we call androgen is the main factor. Prostate cancer does not develop in corner types. Oily nutrition, smoking and exposure to carcinogens are among the accused factors.
What are the Risk Factors of Prostate Tumors?
Familial predisposition, radiation exposure, aging, nutritional habits, hormones are the accused cancer causes. Prostate cancer was detected in autopsies of almost all those who died at the age of 100.
What are the methods of examination of the prostate tumor?
The diagnosis requires breech ﬁnger examination, Total and Free PSA, ultrasography, pelvic MR and most importantly prostate biopsy. If metastasis is suspected, bone scintigraphy, whole body Pet-Ct is performed.
How Is Prostate Biopsy Performed?
Usually, a biopsy decision is made based on the patient’s age, breech examination ﬁndings and PSA value. It is not necessary to empty the bowel with an enema. It is necessary to be on an empty stomach. Aspirin should be discontinued 5 days ago. If other blood thinning treatments are being taken, they will be discontinued under the control of a doctor. Antibiotics are deﬁnitely taken before the procedure. The procedure should be performed without any pain by sleeping lightly, which we call sedation, accompanied by ultrasound. 12 pieces of biopsy are taken. It is a 15 minute procedure. After the procedure, he can rest for half an hour and go home. Procedural fever may be rectal and / or bleeding from the urinary tract. If there is high fever, chills, severe breeding bleeding, the doctor should be informed and the nearest health institution should be consulted. Diabetics, obese patients, patients with collapsed defenses are at risk.
Prostate biopsy is performed with a needle accompanied by an ultrasound probe inserted through the anus under sedation. The procedure is painless.
Treatment Methods of Prostate Tumor
Radical Prostatectomy (Cancer surgery of the prostate): It is the operation of removing the prostate together with the male glands, semen and reconnecting the bladder to the urinary canal. It is the most effective treatment method. The surgery takes 2 hours. Stay in the hospital for 2 days. The probe is withdrawn after 2-3 weeks.
After removing the prostate from the radical surgery of prostate cancer, as discussed in this scheme, the urinary tube is sutured to the bladder neck at the level of the outer shrinkage and the continuity of the canal is maintained.
It was removed along with the prostate capsule. Semen storage bags (seminal canal excision) and semen delivery channels were also removed together. Cancer is in the tissue
Canal Tour Surgery
It is performed if the enlarged prostate closes due to cancer and a non-radical prostatectomy treatment is planned for the patient. The aim is to open the way. It does not cure cancer.
It is made from outside or inside. External radiotherapy takes up to 2 months. While the disease may have a chance to cure completely, are there still active questions? The method made from the inside and called brachytherapy is not used frequently. Its side effects are less than those made from the outside.
Which Treatment Method Should I Prefer For Prostate Cancer?
If the goal is to get rid of cancer, Radical Prostatectomy is the best form of treatment. Young patients (under 70 years of age), tumors with aggressive tumors (patients with gleason score of 7 and above) should undergo surgery. Radiotherapy may be considered in elderly patients. If the cancer is non-aggressive type (gleason score is 6 and below, if psa is less than 10, if the patient is sexually active) then it may be an approach to follow.
What are the side effects due to the surgery in the prostate tumor?
Bleeding, clot discharge, urinary tract stenosis, urinary incontinence, and erection problems are the most common side effects. Some of them develop depending on the patient, some on the surgeon, and some on the method. Urinary incontinence; it is closely related to the surgical technique and the surgeon’s experience. The patient’s age is advanced and bladder problems can also be effective. There is no permanent urinary incontinence in any of our patients. Most patients retained their urine from the moment it was drawn. Others remained dry within 3 months. The erection problem occurs especially in elderly patients when the nerve is not protected. If the disease is permanent in these patients, the result is achieved with appropriate treatment.
Surgery in Prostate Tumor But With Which Method? Robot or Open Surgery or Laparoscopic Surgery?
If the patient does not have a special preference, which method is the best, that method is the best for that patient. The complication rate may be high in a clinic that has recently started robotic treatment. We operate with the best open surgery method. In open surgery, the patient has a 10 cm midline surgical wound under the navel. There are 5 1 cm surgical wounds in robotic surgery. The same procedure is performed inside, both in open surgery and robotic surgery. The length of hospital stay and probe withdrawal are similar. In both cases, the surgeon is the surgeon, not the robot. Therefore, trust your surgeon ﬁrst.
Do I Miss Urine After The Operation In Prostate Tumor?
The chief responsible for urinary incontinence after surgery is the surgeon who performs the surgery. The male has two urinary sphincter ( valves ). Of these, the bladder side is already removed as part of the surgery. The main valve is where the prostate ends. Here, a harm done by the surgeon may cause urinary leakage. In addition, the age of the patient and high bladder pressures may be risk factors for incontinence.
Is there any treatment if I miss urine after surgery?
90% of our patients hold their urine the moment we pull the catheter. In very few of them, urinary incontinence occurs in the case of coughing, sneezing, standing up, lifting weights, which continue for the ﬁrst 2-3 months. In this way, all of the patients who leak urine will recover within 3 months. We wait at least 6 months in patients who completely miss their urine. If there is still serious urinary incontinence, we perform an artiﬁcial sphincter surgery. We did a lot of sphincter surgeries in patients who did not operate on our own, but in another center and who missed total urine. Patients hold their urine with this surgery.
Will My Sexual Functions Disrupt After Surgery? Is there any treatment if it is broken?
The main purpose of performing radical prostate surgery due to prostate cancer is to get rid of cancer. Of course, while doing this, the patient’s urine should be fully indispensable, in part, to maintain sexual functions and to establish a urinary tract without stenosis. While maintaining the nerves, 30-50% of patients also have erection problems. As a ﬁrst treatment, we recommend oral or erectile medication. If ineffective, we recommend injections before self-intercourse. Patient satisfaction is very high with this injection.
If needle therapy is not effective or if the patient wants other options, the most effective treatment method is penile prosthesis (happiness stick) surgery. Patient and spouse satisfaction is very high with this surgery.
Eğer iğne tedavisi etkili olmaz ise ya da hasta başka seçenekler ister ise en etkili tedavi şekli penis protezi ( mutluluk çubuğu ) ameliyatıdır. Bu ameliyatla hasta ve eş memnuniyeti çok yüksektir.
What happens if prostate cancer is not treated?
Prostate cancers develop slowly and insidiously. If it is caught early, that is, the cancer has not spread within the prostate and distant organs, its treatment is possible. But if the disease has metastasized, unfortunately there is no effective treatment for the disease. These patients receive hormonal therapy only.
What should be done before the doctor’s appointment?
If available, the examination and radiological imaging methods should be accompanied. Surgery expectations should be clearly demonstrated. Patient-doctor conﬁdence must be ensured.