Prostate cancer is the most common male cancer, but it also has a relatively good prognosis, especially if diagnosed early. In fact, 95% of cases are diagnosed in men aged 45 – 89. Furthermore, if there is a family history, the risk of cancer appearing in first-degree relatives is doubled.
Symptoms & Diagnosis
Prostate cancer can manifest in many ways and progress at different rates. It may present with the typical symptoms of prostate hypertrophy:
- difficulty initiating or interrupting urination
- nocturia
- burning sensation during urination
- erectile dysfunction
- presence of blood in urine or semen
However, given that it is usually asymptomatic, periodic examinations contribute decisively to diagnosis, even from the age of 45.
These examinations include: PSA, prostate ultrasound, and digital rectal examination. These tests will not necessarily establish a diagnosis, but they will indicate if there is a need for a prostate biopsy, as diagnosis is only confirmed by biopsy. During a biopsy, multiple tissue samples are taken from both lobes of the prostate and sent for histological examination. The aggressiveness of the disease is usually determined by the PSA value, the clinical stage of the cancer, and a sum of the malignancy grades of the disease, which is derived from the histological examination of the prostate biopsy.
At the same time, for better localization of a cancerous lesion within the prostate, we now have a special Multiparametric Magnetic Resonance Imaging (MRI) for the prostate. This is a specialized MRI that requires good training and experience on the part of the radiologist and helps locate cancerous lesions within the prostate gland.
More recently, the biopsy technique has also evolved and can now be performed with a fusion technique: while transrectal ultrasound remains the imaging method during biopsy, modern machines also “read” the MRI and superimpose the MRI findings onto the ultrasound image, allowing the physician to precisely guide the biopsy to suspicious areas.
Treatment
Prostate cancer treatment remains primarily surgical. Alternative solutions exist depending on the patient’s age, stage, and overall health condition. Thus, a patient may undergo radiation, hormone therapy, or combinations of the above, depending on the case.
Radical prostatectomy, which is the removal of the prostate, seminal vesicles, and, if necessary, lymph nodes, is usually the best solution.
Robotic radical prostatectomy is an evolution of laparoscopic radical prostatectomy with several benefits: less blood loss and potentially better rates of continence and preservation of erectile function. A significant prerequisite for good postoperative erectile function is the preservation of the neurovascular bundles.
Source: borousas.gr – Dimitrios Borousas – Urologist, Andrologist Naxos Medical
