TürkçeProstate cancer doctors are so widely preferred in Türkiye on a global scale because the latest medical technologies in the world are seamlessly combined with unique surgical expertise gained from treating a very high volume of patients. Advanced medical centers with international accreditation bring together modern surgical techniques and intelligent imaging systems with the practical skills of expert teams, offering patients a reliable oncology ecosystem that meets global standards. This strong healthcare infrastructure places multidisciplinary teamwork at its core, making Türkiye one of the safest and most preferred medical destinations not only for individuals from neighboring regions but also for patients seeking treatment from all around the world.
What Is the Incidence of Prostate Cancer in Türkiye?
From an anatomical perspective, the prostate is a walnut-sized gland that functions as a highly important part of the male reproductive system. It is located just below the urinary bladder and surrounds the urethra much like a ring. The primary function of this gland is to produce and support certain fluids involved in reproduction. Prostate cancer develops when the cells forming the prostate tissue begin to multiply uncontrollably over time as a result of abnormal genetic changes. According to global health statistics, it is generally the second most common cancer affecting men over the age of fifty. Epidemiological data within the country show a trend very similar to the global picture, and the disease continues to be widespread. It is estimated that tens of thousands of men in Türkiye encounter this disease at some point in their lives each year. However, because public awareness and the habit of undergoing regular health screenings before symptoms appear have not yet reached the desired level, unfortunately only a certain proportion of existing cases are diagnosed early and at the most appropriate stage. In the remaining group, the disease is generally detected only after it has reached advanced stages.
What Are the Early and Advanced Symptoms of Prostate Cancer?
One of the most distinctive characteristics of this disease is that it usually progresses very quietly and insidiously during its early stages. The tumor generally begins to grow in the outer parts of the prostate gland, away from the urethra. At this early stage, because it does not place any physical pressure on the urethra or cause any obstruction, individuals often feel no abnormalities in their daily lives for a long period. However, as time gradually passes, the tumor increases in size, spreads toward the inner parts of the prostate tissue, and narrows the urethra running through the center, causing various physical difficulties to emerge. Once the disease extends beyond the prostate capsule and spreads to the bones or surrounding tissues, much more serious complaints that significantly reduce daily quality of life may develop.
The complaints reported by patients at different stages of the disease include:
- Difficulty initiating urination
- Interrupted urination
- Weak urinary stream
- Frequent nighttime urination that interrupts sleep
- Blood in the urine
- Blood in the semen
- Erectile dysfunction
- Persistent bone pain
What Is the Role of Family History in the Development of Prostate Cancer?
In the development of diseases within the human body, an individual’s inherited genetic background has an undeniable influence alongside environmental factors. Scientific studies clearly demonstrate that genetic inheritance plays a direct role to a certain extent in the development of this disease. In particular, alterations in certain specific genes passed down through generations within a family may predispose cells to damage more easily. When evaluating an individual’s personal risk, examining the family tree of blood relatives provides valuable guidance for physicians. If the person’s father, uncle, grandfather, brother, or other first- or second-degree male relatives have previously been diagnosed with this disease, the individual’s risk increases significantly compared with the general population. As the number of affected family members increases or if the disease develops at a young age, this genetic risk rises even further. Although aging is a natural process for everyone, individuals with a genetic predisposition must be much more vigilant regarding these unchangeable risk factors. People in this group are advised to begin regular blood testing earlier than the standard screening age.
How Do Dietary Habits Affect the Risk of Prostate Cancer?
Although individuals cannot change the genetic code they are born with, it is largely possible to support cellular health through daily choices and lifestyle habits. Excess body weight, or obesity, not only impairs general health but may also create a chronic inflammatory state within the body at the cellular level, providing a favorable environment for the development of cancer cells. Increased fat tissue not only stores energy but may also alter the body’s chemistry by sending signals that encourage cells to multiply more rapidly and irregularly. In particular, high consumption of saturated animal fats and frequent intake of processed meat products may increase cellular stress. In contrast, many naturally occurring foods support cellular repair mechanisms through their antioxidant properties and provide protective functions within the body. Adding certain foods believed to protect cells to the daily diet in balanced portions is considered highly beneficial for health.
Foods that may be recommended as part of the diet include:
- Cooked tomatoes
- Green tea
- Soybeans
- Broccoli
- Pomegranate
- Pumpkin seeds
Why Does Traditional Biopsy Have Limitations in the Diagnosis of Prostate Cancer?
Looking at medical history and previous practices, for many years the definitive diagnosis of the disease relied on taking random tissue samples from the prostate under ultrasound guidance. In this traditional method, an ultrasound probe inserted through the rectum displays the anatomical structure of the prostate as a basic black-and-white image on the screen, and tissue samples are collected from predetermined standard locations in an organized pattern. However, this older method has several important limitations. Standard ultrasound imaging cannot always clearly distinguish cancerous areas from healthy tissue. Therefore, the procedure is performed blindly based on a general statistical mapping assumption rather than by directly visualizing the tumor. Small tumors located particularly in the anterior parts of the prostate or in hard-to-reach areas may frequently be missed because of the needle’s orientation and the inability to visualize the exact target. Patients with suspicious blood test results whose tumors are not detected during traditional biopsy may have to undergo this uncomfortable procedure repeatedly at intervals of several months until a diagnosis is finally established. This repetitive process not only causes physical discomfort but may also increase the risk of infection.
How Has Intelligent MRI Technology Changed the Diagnosis of Prostate Cancer?
Technological advances in medical imaging systems have greatly helped reduce the uncertainties associated with older diagnostic methods. In today’s modern medical approach, when prostate-related blood test values are elevated or a suspicious firmness is detected during a digital rectal examination, detailed radiological imaging is preferred before obtaining tissue samples. This technology, known as multiparametric magnetic resonance imaging, examines the prostate gland layer by layer at the cellular level. The density of water molecules within the tissue, cellular density, and abnormalities in the vascular structure of the area can all be clearly identified using these advanced imaging systems. Radiologists evaluate these images using a specialized international scoring system. Within this system, suspicious areas of the prostate tissue are assigned specific risk scores. The regions identified as high risk in the report clearly define the target for the next surgical procedure, allowing physicians to proceed based on an illuminated map rather than navigating in the dark.
How Is the Fusion Biopsy Method Applied in the Diagnosis of Prostate Cancer?
The greatest practical benefit of increased clarity and precision in imaging technology during the diagnostic process is achieved through intelligent software that simultaneously combines MRI images with ultrasound imaging. In this advanced technique, called fusion biopsy, the patient’s previously obtained MRI scans, in which suspicious regions have been marked by a radiologist, are uploaded into a specialized computer system. During the procedure, the real-time live ultrasound images are digitally superimposed onto the detailed MRI images stored in the system. In other words, the images from two different technologies are merged and integrated.
The technological infrastructures used by these intelligent systems include:
- Sensor-based systems
- Organ-based systems
- Elastic registration methods
- Rigid registration methods
Thanks to this integration, the physician can clearly visualize the suspicious tissue that cannot be distinguished on conventional ultrasound as a virtual target area on the screen. Guided by the software and the display, the biopsy needle is directed precisely toward this specific area considered suspicious. Because the procedure is target-oriented, the number of unnecessary tissue samples is reduced, lowering risks such as pain and bleeding while significantly increasing the likelihood of obtaining an accurate diagnosis on the first attempt.
How Does the Robotic Surgery Process Work in the Treatment of Prostate Cancer?
When the disease remains confined to the prostate gland and has not yet spread to distant organs, complete surgical removal of the cancerous tissue has long been one of the primary treatment methods. Robot-assisted surgical systems were developed to overcome the disadvantages of traditional open surgery, such as the large abdominal incision and prolonged recovery period, allowing operations to be performed using minimally invasive techniques. The procedure is carried out through several small openings made in the patient’s abdomen, using slender instruments and high-resolution cameras. The surgeon sits at a console beside the patient and views the internal tissues in three dimensions with significant magnification. The natural finger movements made by the surgeon are filtered and interpreted by the computer system, then transmitted instantly and without tremor to the robotic arms inside the patient’s abdomen. These specialized robotic arms can move through a much wider range of motion than the human wrist. This technology allows the surgeon to work with exceptional precision and gently separate tissues even in deep pelvic regions that are difficult to access by hand.
How Are the Functions Surrounding the Prostate Preserved During Robotic Surgery?
One of the most delicate balances in prostate surgery is ensuring the safe removal of the diseased tissue while preserving the integrity of the anatomical structures that directly affect the patient’s postoperative quality of life. In male anatomy, the muscles responsible for urinary continence and the fine networks of nerves and blood vessels involved in sexual function are located extremely close to, and in some areas directly attached to, the prostate gland. During surgery, the high magnification provided by the robotic camera system helps distinguish these delicate structures with millimetric precision. Using the precision of robotic instruments, the surgeon gradually separates the prostate tissue from these vital nerve networks almost as though peeling away a membrane. The use of high-energy devices that could cause thermal injury is limited in these regions to help prevent electrical burns to the surrounding tissues. Since each patient’s anatomy and the extent of tumor spread differ, the success of nerve-sparing procedures varies from case to case. Nevertheless, thanks to the advantages offered by modern technology, the likelihood of patients regaining postoperative function has increased considerably.
What Differences Does Retzius-Sparing Surgery Create in Prostate Cancer Operations?
As robotic surgery continues to evolve worldwide, innovative techniques have also emerged in surgeons’ approaches to tissue preservation. In conventional robotic prostate surgery, the prostate is reached by approaching from the front of the abdomen and passing through certain connective tissues that support the bladder. Because these anatomical structures are partially disrupted during the procedure, patients may require a period of adaptation before regaining urinary continence after surgery. In the alternative technique known as Retzius-sparing surgery, the surgeon approaches the prostate not from the front but through the posterior space between the bladder and the intestines.
The main potential advantages of this posterior approach include:
- Preservation of the anterior supporting ligaments in their original form
- Maintenance of pelvic muscle integrity
- Earlier recovery of urinary control
- Faster restoration of postoperative anatomical balance
Thanks to this technique, because the structures that directly support the urinary continence mechanism are largely left untouched in their natural positions, the goal is for patients to return to their daily lives more quickly and with less anxiety after their urinary catheters are removed following surgery.
Why Is Pathological Examination Critical After Prostate Cancer Surgery?
The completion of surgery and the patient’s transfer to the recovery room do not signify the end of the medical process. On the contrary, one of the most important stages begins at this point, confirming the success of treatment and guiding future follow-up. The entire tissue specimen removed from the body is sent intact to the pathology laboratory. There, specialists examine the tissue in extremely thin sections using special solutions and stains to determine the tumor’s cellular structure, size, and microscopic aggressiveness. One of the most closely evaluated aspects is the status of the surgical margin. The outer surface of the removed tissue is marked with ink, and under the microscope it is determined whether cancer cells extend to this stained boundary. If cancer cells are found to reach the outer margin, it raises the possibility that microscopic disease may remain in the patient’s body. When such a finding is identified, the patient’s blood values are monitored much more closely than during routine follow-up. When considered necessary, additional radiation therapy or medical treatments may be incorporated into the treatment plan to minimize the risk of recurrence years later.
How Does HIFU, a Nonsurgical Method for Prostate Cancer, Work?
Not every patient’s clinical condition is suitable for a major surgical procedure lasting several hours, and some patients whose disease is detected at a very early stage may wish to consider organ-preserving alternatives. High-intensity focused ultrasound (HIFU) technology, developed in recent years, offers an incision-free treatment option for carefully selected patients who meet specific criteria. After appropriate anesthesia is administered, the procedure is performed using a specialized ultrasound probe gently inserted into the rectum. This device works much like focusing sunlight onto a single point through a magnifying glass to generate heat. High-frequency sound waves are directed under computer guidance precisely toward the diseased tissue within the prostate. Within seconds, very high temperatures develop at the focal point, and this intense heat destroys only the targeted cancer cells by disrupting their structure. The healthy tissues surrounding the target are protected as much as possible through the device’s cooling mechanisms. Overall, the procedure is an incision-free thermal ablation technique.
Which Prostate Cancer Patients Are Better Candidates for HIFU?
Although focused ultrasound treatment offers an innovative and comfortable solution, it should be recognized that it is not a universal remedy suitable for every prostate condition. The success of this treatment depends on carefully matching the appropriate method to the appropriate stage of disease. Cases in which the tumor is relatively small, confined to a single region of the gland, and demonstrates nonaggressive biological behavior under microscopic examination are evaluated by a medical board for suitability.
Some patient profiles that may be considered appropriate for the procedure include:
- Patients diagnosed at an early stage
- Patients whose tumors are confined to a limited area
- Patients at high risk for general anesthesia
- Elderly patients
- Patients concerned about the potential side effects of major surgery
However, the procedure may not be appropriate in cases where the prostate volume is very large or where extensive calcifications or small stones are present within the gland, as these conditions may interfere with the transmission of sound waves. Whether the patient’s anatomy is suitable for this method is determined jointly with the physician after careful evaluation of detailed MRI images.
Is It Always Necessary to Start Treatment Immediately When Prostate Cancer Is Detected?
An important approach that has gained increasing acceptance in modern medicine in recent years and has been shown to benefit patients is the principle of avoiding overtreatment and unnecessary interventions. Thanks to advances in and wider availability of screening methods, very slowly progressing cellular changes that are highly unlikely to spread or threaten life during the patient’s natural lifespan are now frequently detected. Directing patients with these low-risk conditions immediately toward major surgery or weeks of radiation therapy may unnecessarily reduce their quality of life because of treatment-related fatigue and anatomical changes. The active surveillance approach refers not to leaving the patient untreated, but rather to placing the patient into a carefully planned, controlled, and highly safe observation program. During this process, the disease is not ignored; instead, it is monitored very closely under strict protocols, with active treatment reserved only if there is evidence of progression.
What Are the Criteria for Enrollment in an Active Surveillance Protocol for Prostate Cancer?
The decision to pursue active surveillance is based not on the physician’s personal preference but on well-defined internationally accepted medical parameters and test results. The primary goal is to safely monitor a truly indolent, low-volume disease without causing harm to the patient. Once enrolled in this protocol, the patient undergoes blood tests at regular intervals, attends routine examinations, and undergoes repeat tissue sampling or radiological imaging according to the physician’s schedule. If there is even the slightest suspicion that the disease is progressing, the observation period is immediately ended and active treatment, such as surgery, is initiated.
Some of the basic criteria required for a patient to be included in an active surveillance program include:
- Blood test values remaining below a specified level
- Disease being detected in only a very small number of tissue samples
- Cellular characteristics belonging to the lowest-risk group
- A tumor too small to be detected by physical examination
- No evidence on imaging suggesting a risk of spread beyond the prostate
Why Is Shared Decision-Making Critical in the Management of Prostate Cancer?
In modern medicine, the management of oncological diseases has evolved beyond the initiative of a single physician or the limits of a single specialty into a multidisciplinary team effort. The medical records of a patient diagnosed with prostate cancer are discussed in detail not only by the evaluating specialist but also in medical board meetings attended by medical oncologists, radiation oncologists, radiologists, and pathologists. The patient’s overall health, chronic diseases, age, and the molecular characteristics of the tumor are assessed from the perspectives of all these different specialties to create the most appropriate treatment plan. However, the most important factor in treatment planning is always the patient and the patient’s own preferences and experiences. Receiving this diagnosis creates not only a physical challenge but also considerable uncertainty and psychological stress. Since stress-related environmental factors are known to burden the immune system, providing emotional support to the patient together with family members throughout the treatment process contributes positively to treatment success.
Frequently Asked Questions
