Prostate Cancer

Prostate cancer is generally a slow-progressing disease. The 10-year survival rate for localized prostate cancer treated in the early stages is over 95%. Even in metastatic disease, survival times have significantly increased in recent years thanks to advances in treatment.

When nerve-sparing surgical techniques are applied, particularly in cases where both nerve bundles are preserved, it is possible to largely preserve erectile function. However, nerve preservation is not always possible depending on the characteristics of the tumor. Patients experiencing erectile dysfunction have options such as PDE-5 inhibitors, intracavernous injections, vacuum devices, and penile prostheses.

Active surveillance is a strategy for close monitoring of low-risk prostate cancers, avoiding immediate treatment. The cancer is monitored with regular PSA tests, MRIs, and biopsies; active treatment is initiated if signs of progression are detected. With appropriate patient selection, the oncological safety of active surveillance has been proven in long-term studies. However, this option is not suitable for every patient, and the decision is made on an individual basis.

In localized prostate cancer, radical prostatectomy and radiotherapy have similar long-term survival outcomes. The decision is made by considering the patient's age, comorbidities, priorities for urinary and sexual function, tumor characteristics, and patient preference.

Robotic radical prostatectomy (RALP) offers advantages over open and laparoscopic methods in terms of less blood loss, shorter hospital stay, and precise nerve-sparing surgery. However, in terms of oncological outcomes (cancer control), the three methods are considered similar. In robotic surgery, the surgeon's experience is the most critical factor.

After radical prostatectomy, PSA levels should drop below 0.1 ng/mL within 6-8 weeks. Following radiotherapy, PSA levels gradually decrease to their lowest point (a rare occurrence). A decrease in PSA indicates a treatment response; however, regular follow-up is essential. If PSA levels rise again, a biochemical recurrence may be present, and additional treatment should be considered.

BRCA1 and especially BRCA2 mutations increase the risk of prostate cancer and are associated with more aggressive disease. Individuals with this condition should undergo PSA screening starting at age 40-45, and BRCA testing should be considered in patients diagnosed with cancer. PARP inhibitors (olaparib, rucaparib) are an effective treatment option for metastatic prostate cancer with BRCA mutations.

Most cases develop sporadically (non-familial). However, approximately 10-15% of cases have a family history, and in 5-10% specific inherited mutations (BRCA1/2, HOXB13, Lynch syndrome) can be detected. It is recommended that individuals with a family history begin screening at an earlier age.

A diet rich in vegetables, tomatoes (lycopene), green tea, and omega-3 fatty acids may have a positive effect on prostate health. Excessive consumption of red meat, processed meat, and saturated fats is thought to increase the risk. However, the effect of diet should be evaluated in moderation and within the context of overall health; it should not be considered a sole preventative measure.

Lifelong follow-up is recommended after both surgery and radiotherapy. PSA tests should be performed every 3-6 months for the first two years, and every 6-12 months in subsequent years. Imaging is performed as needed. The follow-up protocol is more frequent and comprehensive in active surveillance.