Diagnosis options

Digital rectal examination

A physician inserts a gloved finger into the patient’s anus to examine the prostate gland. A hard nodule is felt if there is prostate cancer. If prostate cancer is suspected, a core needle biopsy will be required to diagnose the disease.

Transrectal ultrasonography

A core needle biopsy is performed for hard nodules suspicious for prostate cancer, usually found during a digital rectal examination. However, tumors located within the prostate gland and are less than 0.5 mm in size are hard to detect; in this case, transrectal ultrasonography may be beneficial. Biopsies are usually completed on 12 sites. If there is a suspicious region, an additional biopsy is performed.

PSA (prostate specific antigen) blood test

PSA is an enzyme produced in the epithelial cells of the prostate gland. This enzyme exists only in the prostate gland. Therefore it is used as an important indicator for diagnosing or monitoring prostate cancer. The PSA level in the blood increases when a patient has prostate cancer or prostatic hypertrophy.

 

Differentiation from prostatic hypertrophy

There is no difference in urination-related symptoms between prostate cancer and prostatic hypertrophy until the prostate cancer advances. The reason is that the prostate gland enlarges in both cases and presses against the urethra causing related symptoms. Prostate hypertrophy and prostate cancer are diagnosed through biopsy and observation under a microscope.

 

Other tests

To determine the extent of cancer in the prostate itself or surrounding areas, computerized imaging such as an abdominal and pelvic CT or MRI may be used aside from the transrectal ultrasound. To examine bone metastasis, bone scans and X-rays are used. During a bone scan, every bone of the body is scanned after injecting a radioactive material that accumulates in the bone. If the cancer invades the bone, alkaline phosphatase in the blood will increase as the bone deteriorates. If such is the case, remote metastasis of the lymph nodes, lungs, and liver can be identified with the CT or MRI.

 

Treatment options

Prostate cancer can be treated with four methods including hormone therapy, surgical therapy, radiotherapy, and chemotherapy. A physician will develop a treatment plan based on the location and stage of the cancer as well as the age, medical history, and general conditions of the patient.

• Hormone therapy

  Hormone therapy is the most effective and basic treatment for prostate cancer. This therapy suppresses the production of male hormones or inhibits the hormone from working properly in the prostate gland. Methods include ingestion of estrogen or anti-androgen pills several times a day or monthly drug injections that interact with the pituitary gland, inhibiting the secretion of male hormones.

• Surgery

  Prostate glands that are localized within the glands are removed through surgery. An incision in the lower abdomen is made to remove the prostate gland behind the pubic bone and to anastomose the bladder and the urethra. At this point in surgery, the presence of lymph node metastasis is investigated. If there is no metastasis and the cancer has spread slightly beyond the prostate capsule, operation in conjunction with hormone therapy is possible. Recently, robot-assisted surgery has been introduced, decreasing side effects and complications.

  Da Vinci robotic surgery

  Radical prostatectomy is an operation that involves removing the entire prostate gland, seminal vesicles, seminal duct, surrounding tissues, and pelvic lymph nodes all together. This surgical method is typical for cancers confined to the prostate gland.

  The prostate gland is located deep inside the pelvis in the lower abdomen. Prostate cancer removal is performed intricately as the operation requires not only getting rid of cancer but also connecting the bladder and the urethra while leaving nerves and important structures around them intact. Surgery done with the human hand, offers some limitations due to the natural movement of our joints while the robotic arm can move more easily and freely during the operation. The 3D camera provides a sense of depth and a clear view of the nervi erigentes and micronerves, which are nearly invisible to the naked eye. The camera helps to preserve these vital nerves during open surgery. Robotic surgery is also better than open surgery concerning postoperative results because it leaves the patient with a smaller surgical scar, less pain, fast recovery, and a short hospital stay.

• Radiotherapy

  Radiotherapy is a procedure that destroys cancer cells using high-dose radiation. In the case of prostate cancer, high-dose radiation is focused on the tumor from the outside of the body.

• Chemotherapy

  Chemotherapy is used when hormone therapy is not applicable or effective. Like hormone therapy, it works throughout the whole body but its effects do not last long.

AMC’s performance

• Began the use of Da Vinci robotic surgery on prostate cancer in 2007
• Performs more than 600 Da Vinci robotic surgeries a year
• Implements more than 1,500 prostate biopsies a year