What is prostate cancer?
Prostate cancer is a type of cancer that develops when cells in the prostate gland grow uncontrollably. The vast majority are adenocarcinomas. It is one of the most common cancers in men, and its incidence increases with age.
A large proportion of prostate cancers grow slowly and may cause no symptoms for many years. Others tend to progress more quickly. This is why, after diagnosis, the most important step is to determine correctly which risk group the disease belongs to. When prostate cancer is detected at an early stage, there are more treatment options, and long-term outcomes are generally good.
Risk factors
- Age: The risk increases particularly after the age of 50.
- Family history: The risk is higher in men whose father or brother has had prostate cancer.
- Genetic predisposition: The risk is increased in carriers of certain gene mutations, such as BRCA2.
- Ethnic background: It is more common in men of African descent.
Symptoms of prostate cancer
Early-stage prostate cancer usually causes no symptoms at all and is generally detected through a PSA test or a digital rectal examination. Symptoms such as frequent urination or a weak stream are usually due to an enlarged prostate; however, because both occur at similar ages, they need to be distinguished by examination.
In advanced disease, blood in the urine or semen, bone pain (especially in the lower back and hips), unexplained weight loss and fatigue may occur. These symptoms are often due to other causes; even so, it is important to be assessed by a urologist if they occur.
Early diagnosis and diagnostic methods
PSA test and digital rectal examination
PSA (prostate-specific antigen) is measured with a blood test. PSA is specific to the prostate but not to cancer; an enlarged prostate, prostate inflammation and urinary tract infection can also raise it. This is why there is no single “normal” PSA limit that applies to everyone; the result is interpreted according to age, prostate volume, previous values and the medications you take.
According to the European Association of Urology (EAU) guidelines, early detection with PSA can be offered to well-informed men from age 50, to men with a family history of prostate cancer from age 45, and to BRCA2 carriers from age 40. A digital rectal examination assesses whether there is any hardness or irregularity in the prostate and is used together with PSA.
Multiparametric prostate MRI
For patients with a raised PSA or suspicious findings on examination, current guidelines recommend a multiparametric prostate MRI before biopsy. MRI findings are scored from 1 to 5 using the PI-RADS system. MRI helps target suspicious areas and, in some patients, can reduce the need for a biopsy.
MRI fusion biopsy
The diagnosis is made by pathological examination of tissue taken from the prostate. In an MRI fusion biopsy, MRI images are combined with the ultrasound image so that targeted samples can be taken from the suspicious area; these samples are usually assessed together with a systematic biopsy. The biopsy can be taken through the rectum (transrectal) or through the skin between the anus and the scrotum (transperineal). Current guidelines recommend the transperineal route whenever possible because of its lower risk of infection.
Gleason score and ISUP grade group
The pathologist assigns a Gleason score based on how the cancer cells look. Today, this score is reported together with the easier-to-understand ISUP grade group (1–5). Grade group 1 represents the slowest-growing form and grade group 5 the most aggressive. PSA, grade group and examination findings are assessed together to classify the disease as low, intermediate or high risk. For intermediate- and high-risk disease, imaging such as PSMA PET/CT, a bone scan or a CT scan may be requested to check for spread.
Prostate cancer treatment options
Treatment is decided by considering the risk group and stage of the disease together with the patient’s age, general health and preferences. There is no single right treatment for every patient.
Active surveillance
For low-risk, slow-growing prostate cancers, the disease is not treated immediately but is closely monitored with regular PSA tests, MRI and, when needed, repeat biopsies. If the disease progresses, treatment is started. The aim is to protect the patient from the side effects of treatment that is not needed. In some older patients or those with serious other illnesses, a watchful waiting approach, in which treatment is planned only when symptoms develop, may be preferred.
Radical prostatectomy
This is an operation in which the prostate and seminal vesicles are completely removed; in some patients, the lymph nodes are removed as well. It is an option for organ-confined disease in suitable patients with a long life expectancy. The operation can be performed open, laparoscopically or with robotic assistance; for cancer control, what matters most is not the approach but the characteristics of the disease and the correct application of the surgical technique. Temporary urinary incontinence and erectile problems may occur after surgery; in suitable patients, the aim is to preserve the nerves responsible for erections.
Radiotherapy
Radiation therapy is an alternative to surgery for organ-confined and locally advanced disease. External beam radiotherapy (intensity-modulated and image-guided techniques) is the most commonly used method; for intermediate- and high-risk disease, it is usually combined with hormone therapy. In selected patients, placing radioactive sources inside the prostate (brachytherapy) may also be an option. Radiotherapy is planned by a radiation oncologist.
Hormone therapy and systemic treatments
Prostate cancer cells need the male hormone testosterone to grow. Androgen deprivation therapy lowers testosterone levels and slows the progression of the disease. Hormone therapy is used together with radiotherapy or, in disease that has spread, on its own or combined with other treatments such as newer hormonal agents and chemotherapy. Systemic treatments are planned together with medical oncology.
Multidisciplinary approach
Prostate cancer treatment requires a multidisciplinary approach in which specialists in urology, radiation oncology, medical oncology, radiology, nuclear medicine and pathology assess the case together. Informing the patient about all the options, their possible benefits and side effects is an important part of the decision-making process.
Follow-up after treatment
After treatment, patients are followed up with regular PSA measurements. How often depends on the treatment received and the risk group. After surgery, PSA is expected to fall to undetectable levels; if it rises again during follow-up, further assessment may be needed. Treating side effects such as urinary incontinence or erectile dysfunction is also part of follow-up.
Can prostate cancer be prevented?
The main risk factors, such as age, family history and genetic predisposition, cannot be changed; for this reason, there is no proven way to prevent prostate cancer. Nevertheless, maintaining a healthy weight, regular physical activity, stopping smoking and a balanced diet are recommended for general health. What matters most is to speak with a urologist at the age appropriate to your risk and make an informed decision about early detection.
Prostate cancer assessment in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He is a member of the Eurasian Uro-Oncology Association and has a scientific study on testicular metastasis of prostate adenocarcinoma published in an international peer-reviewed journal. He sees patients with a raised PSA and suspected prostate cancer in Bursa (Nilüfer) at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00).
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your appointment in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share your PSA results, MRI and biopsy reports beforehand via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
