Prof. from Memorial Bahçelievler Hospital, Department of Urology. Dr. Yılmaz Aslan gave information about prostate cancer and its diagnosis methods on the occasion of "September 1-30 Prostate Cancer Awareness Month".
prof. Dr. Yılmaz Aslan talked about prostate cancer as follows:
“The prostate is a gland that exists in men and grows with age. It can cause some urinary complaints such as frequent urination, difficulty urinating, bifurcation, feeling of not being able to empty the bladder completely, waiting while urinating, dripping at the end of urination. Urinary problems can be seen in almost 50-20 percent of patients over the age of 30, 60 percent in their 50s and nearly 70 percent in their 80s and 100s. Both benign enlargement and cancer can occur in the prostate at the same time. The patient may consult a doctor with urinary complaints. However, prostate cancer can be detected as a result of tests performed due to benign growth.
If the patient consults a doctor with urinary complaints and PSA elevation is detected in routine examinations, the presence of cancer other than benign growth should be investigated in this patient. PSA alone is not decisive in the diagnosis. Because PSA can be affected by urinary infections, interventions or sexual intercourse. For this reason, it is not very healthy to subject the patient to an intervention based on PSA only. PSA value varies from person to person. While a 40-year-old patient may have a high PSA value of 3.0 ng/ml, a 70 ng/ml PSA value may be normal in a 3.0-year-old patient. Assessment should be done on a patient basis. It is important to individualize sensitive balances such as the patient's examination findings, complaints and family history for the patient. While trying to protect the patient from unnecessary examinations, it is necessary not to miss an insidious disease that will threaten life. There are a number of artificial intelligence applications and algorithms used by urologists to avoid unnecessary biopsy. However, none alone is sufficient. A personalized assessment should be made for the patient. ”
In prostate diseases, rectal examination is very important and should not be neglected, said Dr. Yılmaz Aslan continued his words as follows:
“Because, in the rectal examination of a patient with a normal PSA, cancer can be detected. If this cancer is advanced enough to be palpable in rectal examination, it should be taken seriously and evaluated accordingly. Anesthesia is a subject that patients usually shy away from, but it is of vital importance. PSA and rectal examination are the basic applications used together. The sensitivity of rectal examination is 60 percent. The rectal examination alone has the ability to detect cancer in 100 of 18 patients, regardless of PSA. It is a fast, easy and inexpensive method that takes 30 seconds on average.
The line determined as the PSA limit is not very clear, but for an adult over the age of 50, over 2.5-3 on a patient basis can be considered high. However, prostate cancer can also occur with a PSA below 1. The important thing here is to detect prostate cancer that is “threatening the life of the patient”. This is called “clinically significant prostate cancer”. If it is palpable on digital examination, it is usually clinically significant prostate cancer. A man has a 17 percent lifetime risk of developing prostate cancer. 3-4% of men die from prostate cancer. However, 13-14% of men can live with cancer and the cancer does not threaten their life. However, it is important to identify that 3-4 percent.
If PSA is high, some imaging methods such as Transrectal ultrasonography and Multiparametric prostate MR are needed. If a lesion is detected in MRI, scoring is checked. While the probability of having cancer is 3% in people with a PIRADS score of 60 and above, this rate is 1% in those with PIRADS 2-30. Therefore, if PIRADS 3, 4 and 5 lesions are detected in multiparametric prostate MRI, fusion biopsy is recommended. If the patient's PSA is high but no lesion is detected in multiparametric prostate MRI, standard biopsy should be performed. If the patient does not have cancer according to the pathology result, the patient can continue his life, provided that he continues with periodic follow-ups. If there is cancer, it is checked whether the person is in the low, medium or high risk group. If this situation does not threaten the life of the person, the patient is followed up without any treatment. However, if it carries a medium or high risk, the algorithms are examined along with the other characteristics of the patient and the appropriate treatment scheme is selected.
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