Prostate Cancer

Prostate cancer is the most common cancer in men and is the third leading cause of cancer-related mortality after lung and colorectal cancers in Europe.

According to the most recent data, prostate cancer is the most common cancer diagnosed in men in the UK, representing 26% of all new diagnoses in 2017. 1 in 9 men in the UK is diagnosed with prostate cancer. For males aged 45 years and over, prostate cancer was the most common cancer, peaking at 32.8% of all cancers in the 65-74 age group.

The etiology of prostate cancer is multifactorial.

Incidence of prostate cancer increases with age. Prostate cancer is rare below the age of 40.

Prostate cancer has an increased heritability. Men with a brother or father diagnosed with prostate cancer have a two to four-fold risk of developing prostate cancer.

A man's risk of developing prostate cancer is thought to be higher if: If you have a father or sibling who is 60 years of age or younger with prostate cancer. If one or more men from the same family have prostate cancer. If these apply to your family, this may indicate the presence of a faulty gene.

Smoking has been shown to have an association with prostate cancer incidence and mortality.

Obesity and increased body mass index have been associated with numerous cancers including prostate cancer.

Numerous studies have shown that there is an inverse relationship between physical activity and risk of progression and mortality from prostate cancer.

Diet and nutrition have been implicated in many cancers including prostate cancer. Consumption of highly processed foods can increase the risk of prostate cancer and conversely, intake of unprocessed/limited processed foods was associated with lower risk of prostate cancer as shown by PROtEuS study.

Every man over 50 should have a prostate control annually.

Even if he does not have any complaints, every man over the age of 50 should have a prostate examination once a year.

Familial transmission has an important place among the causes of prostate cancer, and it is recommended that men with a family history of prostate cancer should be checked after the age of 45.

What complaints should the patient consult a doctor?

• Difficulty in erection or pain,
• Blood in semen or urine,
• Inability to urinate,
• Difficulty in starting or stopping urination,
• Frequent urination,
• Urination at night,
• Weakening in the urine stream,
• Intermittent urination,
• Pain and burning during urination.

In addition, low back, hip and back pain should arouse suspicion as a symptom of advanced disease. It should also be noted that there may be no symptoms for prostate cancer.

Prostate cancer is most often confused with the disease called benign prostatic hyperplasia (BPH). Apart from this, it can also be confused with chronic prostatitis, which is more common.

Definitive diagnosis is made by biopsy.

Digital rectal examination is very important in the diagnosis of prostate cancer.

PSA is checked in the blood as a screening method for prostate cancer. However, a high PSA does not make a definitive diagnosis of cancer. Benign diseases with high PSA should be differentiated.

A definitive diagnosis of prostate cancer can be made by taking a biopsy with transrectal ultrasound guidance.

In the MR Fusion Biopsy method, the exact location of the tumor can be determined by transferring the previously taken multiparametric MR images of the patient to the ultrasound device that underwent prostate biopsy.

Thus, in the MR Fusion Biopsy method, instead of taking a "random" piece as in classical biopsies, a "target" biopsy is performed directly from the suspicious focus. Since the exact location of the tumor or suspicious focus can be found, it may be sufficient to take fewer samples with this method instead of taking a large number of pieces.

Treatment options for early-stage prostate cancer:

• Active Monitoring,
• Wait and see,
• Operation,
• Beam radiotherapy (external beam radiotherapy),
• Brachytherapy.

Sometimes, older men for whom other treatments are not suitable may be given hormone therapy before or after radiotherapy, or hormone therapy alone.

Local prostate cancer in the early stage that has not spread to other organs is usually treated surgically. It can be combined with hormone therapy or radiotherapy in necessary patients.

Robotic Prostate Surgery in Prostate Treatment (Closed Surgery)

The method in which laparoscopic radical prostatectomy is performed with the help of a machine is called Robotic Prostate Cancer Surgery.

Nowadays, robotic surgery is usually used for the treatment of prostate cancer.

The surgeon performs the surgery using robotic arms. Robotic arms move gracefully, steadily and flawlessly.

The machine used in robotic laparoscopic radical prostatectomy is called "Da Vinci Robot". For this reason, this surgery is sometimes called a da Vinci prostatectomy.

However, the experience and training of the surgeon in this type of surgery is very effective on the results of the surgery.

Your specialist will tell you whether Robotic Surgery is suitable for you and its feasibility.

Advantages of robotic prostate surgery:

Most studies show that laparoscopic surgery and robotic laparoscopic surgery are as successful as open surgery in the treatment of cancer. Studies also show that most men who have robotic surgery recover more quickly and have less hospital stays. In addition, one of the biggest problems, urinary incontinence is minimized.

Disadvantages of robotic prostate surgery:

Must be performed by surgeons trained in robotic surgery.

The Da Vinci robotic system

The Da Vinci robotic system houses an imaging system with advanced technology. The system is made up of two high-resolution fiber optic cameras. This provides the operating surgeon with a 3D view having a sense of depth. Furthermore, the camera magnifies the operation field up to 10-12 times.

Besides the camera system, the surgical instruments used are also multifunctional. The instruments connected to the arms of da Vinci have a capacity to mimic the movements of human wrist and fingers even with a wider angle of maneuvering capacity without any vibrations.

The main principles for surgeries performed by robotic systems are similar to those of laparoscopic surgery. Small incisions of 1 cm are performed on the abdomen in varying numbers and positions according to the type of surgery. The camera and the instruments are placed inside the abdomen through those incisions with connections to the robot. The operating surgeon directs both the hand instruments and the camera from the console.

The advanced imaging system and thin arms, high movement capacity and anti-vibration working principle all enable the surgeon to reach and dissect the target tissues during surgery while protecting the other structures that should not get harmed. This is a great advantage for surgeries concerning the organs in a narrow and closed anatomic space. A great vision and maneuvering capacity in robotic surgery has overcome those difficulties with minimal complication risks and bleeding as well as shorter operation times. This is the reason why robotic surgery is preferred for the surgical treatment of prostate cancer in the world.

Smaller laparoscopic incisions during robotic surgery lead to less pain in patients. Patients need a smaller amount of analgesics; furthermore, incision wounds heal faster and patients are discharged earlier with less infection risk. As a result, patients return to normal life more easily and rapidly.

In terms of possible side effects, some technical points are of great importance in the perioperative and postoperative period. These important technical points are similar in every surgical technique: Protection of nerves is important for sexual function, protection of sphincters is important for continence mechanism and it is important not to leave cancer tissue behind. With its advanced imaging system and thin arms, high motion capacity and anti-vibration working principle, high success rates are provided at important points of the operation during robotic radical prostatectomy.

In meta-analyses with large series, the results showed that preserving the bladder neck and ensuring a sufficient urethral length would minimize incontinence. Prof. Dr. Tunc who first described ‘’Bladder neck preserving technique in robotic prostate surgery’’. The technique describes the avascular fatty tissue area around the bladder neck and prostate border to give a chance to reach the correct anatomy during the dissection of prostate. This resulted in the preservation of the bladder neck and minimized incontinence risks and negative surgical margins.

https://www.liebertpub.com/doi/abs/10.1089/end.2014.0459

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