- Prostate Center
- Prostate Cancer and Treatment
- Treatment Methods
After prostate cancer is detected, the treatment is planned based on the disease-related factors (stage, spread status) and patient-related factors (general status, age, comorbidities).
The Nanoknife method has started to be used for the treatment of low-volume, low-risk prostate cancers called clinically non-significant tumor.
Used for some liver and pancreas tumors, this method is safely used for the focal treatment of prostate cancer.
For NanoKnife ablation, 3-4 special electrodes are placed around the tumor in prostate with the aid of ultrasonography, and very high but short-term electrical current (e.g., 3000 volt-50 ampere) is given to these electrodes one by one. An electromagnetic field is formed in this area, and cell wall permeability temporarily increases In this way, tumor cells lose their viability.
As this method does not cause temperature change in tissues, it can be applied for tumors close to the nerves and urethra.
Patients who will be treated using this method should be selected carefully. In general, it is a treatment method which can be applied for a patient group which can be actively monitored.
As only cancerous cells in the prostate are destroyed after this procedure, there is a risk for development of cancer from another region of prostate tissue in the future. If this happens, curative (surgery, radiotherapy) treatment is planned for the patient. That is to say, this method allows delaying of curative treatment as long as possible in patients who need it. Using this way, the intent is to delay the potential side effects of curative treatments.
Surgical Therapy for Prostate Cancer - Radical Prostatectomy
It is the surgical removal for the treatment of localized prostate cancer. This surgery is called radical prostatectomy operation. 10-year disease-specific survival rates are over 90% in patients with low-grade tumor undergoing radical prostatectomy.
For conventional open surgical method, approximately 15-cm incision is made below the patient’s umbilicus.
Open surgery poses many challenges both for the patient and surgical team. Challenges for the patient include delayed recovery period after the operation, long hospitalization period, the risk of wound infection and a large scar. Challenges for the surgical team include insufficient manipulations due to narrow surgical site, and long operation durations and increased rates of complications due to being unable to provide a good field of view.
Robotic surgery is performed by appropriate placement of a robot called Da Vinci, and steering the arms of this robot from the control unit called console by the console surgeon. General principles are similar to laparoscopic surgery.
Thanks to fine structure, movement capability and anti-vibration working principle of the operative arms used in robotic surgery, and advanced imaging systems of the robotic system made the structures adjacent to prostate more easily preserved during the prostate operation. Thereby, "bladder preservation technique"the possibility of complications is minimized, the blood loss is decreased and operation duration is shortened.
After the operation, decrease in pain, shorter recovery period, and decrease in health problems greatly affecting the social life such as continuous urinary incontinence and loss of sexual functions in the future are observed.
Independent from the technique, there are also steps in which caution is warranted in prostate cancer operation using robotic surgery. The main objective of this is removal of the prostate without leaving any cancerous tissue behind, preserving the nerves maintaining the continuity of sexual functions, and avoiding damage to the structures ensuring incontinence during prostate removal.
With the revealing of the anatomic plane between bladder and prostate, a novel technique has been developed in robotic prostate operations. With this method known as "bladder preservation technique" in the literature, early and late period incontinence rates are very low.
Radiotherapy is the treatment of cancer disease using ionized radiation. The purpose of radiotherapy is destroying the cancerous cells or preventing their growth by division while bringing minimum damage to normal tissue.
Radiotherapy is a local method of treatment similar to surgical methods exerting its effect and side effects on its application site. While radiotherapy is used as a curative treatment method for localized prostate cancer, it can also be used as a palliative (to relieve complaints such as pain) or tumor-burden reducing therapy in patients with spread to organs adjacent to prostate (locally advanced) and distant organs (metastatic).
What Are The Side Effects of Radiotherapy?
The side effects of radiotherapy usually do not start in the first days, but in the forthcoming days with the increasing dose. They may not occur in every patient and vary between patients.
General side effects include skin irritation (discomfort) and fatigue. Radiation therapy used for prostate cancer may cause erectile dysfunction and incontinence. Other than these, feeling of frequent urination and blood in urine may also occur.
In the advanced stages of prostate cancer, the disease may not be prostate-limited anymore, and be detected as already spread to adjacent tissues and distant organs. This is called the advanced prostate disease. In this stage of the disease, as surgical methods will not suffice, medical therapy is preferred.
As prostate tissue is sensitive to male hormone, testosterone, medications inhibiting the effect of testosterone (anti-androgen) are used in this stage of the disease. This treatment is called hormonotherapy.
For the patients resistant or not responding to this treatment, chemotherapy is planned. Scientific studies have demonstrated that lifespan can be prolonged for these patients with advanced prostate cancer.