Prostate cancer is striking more and more men at a younger age. According to data from the National Center for Public He alth and Analyzes (NCPHA), in 2015 the number of Bulgarians affected by prostate cancer was 438 per 100,000 men, and in 2016 they increased to 470 per 100,000. Newly discovered cases of prostate cancer gland in 2015 were 68 per 100,000, and in 2016 - 73 per 100,000 men
Prostate cancer death rate reported 26.4 men per 100,000 (2016 data). The main reason for the high mortality from this disease, which is absolutely curable in the early phase, is the late diagnosis. In the advanced stages, the treatment is insufficiently effective.
On the occasion of the MOVEMBER global campaign for the prevention of prostate cancer in November at the capital hospital "Hill Clinic" on Blvd."Pushkin" 71 will conduct free examinations for a second opinion for patients diagnosed with prostate cancer. At the start of the campaign, an innovative prostate cancer diagnosis system was presented at Hill Clinic. Especially for "Doctor", the urologist Dr. Georgi Georgiev explained the meaning of prevention and modern methods of diagnosis and treatment of this disease.
Dr. Georgiev, why should men go for prophylactic examinations for prostate cancer without having symptoms?
- Prostate cancer is currently the most common cancer in men and the second leading cause of death after lung cancer. And since there are no symptoms in the first years of its development, the only way of prevention is for men after the age of 50 to come for examinations every year. Younger men whose father, grandfather, uncle or brother had prostate cancer also need to come for examinations. When there are already symptoms, the cancer is in an advanced stage and treatment is very difficult. It is unacceptable for men aged 45-50 years to come with complaints, with advanced prostate cancer. Men should understand that the only option to be diagnosed in time is to go for preventive examinations.
What does a prostate exam consist of, because most men are worried about it?
- There is nothing terrible about the preventive examination. In addition to the conversation we have with the patient, we do a blood test for a tumor marker. This is actually one of the main studies that can lead us to think about the existence of prostate cancer in an early stage. The preventive examination may also include a rectal douching, which is why many patients do not go to the examination at all.
Rectal douching is optional
We will not force anyone. But it should be known that even with normal values of the tumor marker in a rectal smear, we could feel a suspicious area for cancer, because 80% of prostate carcinoma is located on the periphery - that is, that part of the prostate that is located near the rectum. For this reason, cancer can be felt when douching. This is an option that is better for the patient, but it is not mandatory and is not done if the patient does not want it.
And what is the role of the ultrasound examination during the examination?
- Ultrasound examination gives more information about the size of the prostate gland than whether there is a risk of cancer. Prostate cancer is found to be undetectable by ultrasound because malignant tissue looks no different from he althy prostate gland tissue.
Things are different when, in case of suspicion of cancer, we send the patient for a multiparametric nuclear magnetic resonance examination. Imaging equipment is developing more and more. Currently, multiparametric MRI is the best means of diagnosing prostate cancer. This test very precisely directs us to where in the prostate gland there is a suspicious area in order to use this information to perform a fusion biopsy.
What is fusion biopsy?
- This is a type of targeted biopsy where we use MRI to guide where to take tissue for testing. With a special device, we precisely direct the biopsy needle to the most suspicious area for cancer, shoot it and take tissue from the prostate.
If we have to figuratively explain what it was like to take a biopsy the old way, we can compare it to looking for a needle in a haystack. In the modern way, we are still looking for a needle in a haystack, but with a large metal detector.
The advantages of fusion biopsy are enormous. It increases the accuracy of diagnosis three times compared to other methods.
Previously over 50% of biopsies were false negative
Therefore, many patients underwent second and third biopsies. I also had a patient come to me with four false negative biopsies.
With the new type of fusion biopsy, the probability of a false negative result is minimized. Naturally, there is no diagnosis that is 100% accurate. If until now the accuracy of biopsies was 30%, with fusion biopsies the reliability is over 90%. This is a huge leap in the diagnosis of prostate cancer.
How effective is the treatment of prostate carcinoma?
- When the patient is diagnosed in time, the cancer is still within the prostate and there are no metastases, no growth in neighboring organs, the best treatment option is radical prostatectomy. This is a surgical intervention in which the prostate gland with the seminal vesicles is removed. This operation is performed laparoscopically at Hill Clinic through five holes in the abdomen. This is a micro-invasive procedure. A huge advantage of laparoscopy is that by entering the abdominal cavity with a camera, we have a fivefold increase in the image. This is a high-resolution HD image, which macroscopically gives us a great advantage - to be as precise as possible in cutting out the prostate gland. At the same time, we can preserve the special group of nerves responsible for erection, especially in younger men who are sexually active. Thus, we give them the opportunity to restore their sex life, which is part of a man's quality of life.
Risks of urine leakage after laparoscopic surgery are reduced to less than 1%, while in open surgeries the risk is very high.
Is laparoscopic surgery used for advanced cancer?
- Laparoscopically we can also operate on much more advanced cancer. More and more hospitals report achieved results when operating on patients in advanced stages of the oncological process. Several large clinical trials are currently underway in Germany. They prove that if the main core of the tumor is removed, it slows down the development of metastases. So
laparoscopic surgery is the best option
to treat the patient diagnosed with prostate cancer. Expected survival has been shown to exceed 10 years if the patient does not have severe co-morbidities.
If the patient is 80 years old, he does not need surgery, because in the elderly, the cancer process develops much more slowly due to the slowing down of metabolism, delayed cell development and hormonal imbalance. Hormonal therapy is started in these patients, radiotherapy may also be included. This treatment will ensure a normal length and quality of life.
Dr. Goran Derimachkovski: We discharge patients 2-4 days after tumor excision
Once we have already diagnosed prostate cancer with a positive fusion biopsy, effective treatment follows. The main type of treatment is surgery, which we carry out in our clinic and for which we have many years of experience. We perform laparoscopic prostatectomy - radical removal of the entire prostate gland. The intervention is performed through five openings in the abdominal cavity, through which we reach the prostate gland and the surrounding structures and tissues. The main advantage of laparoscopic prostatectomy is that it spares the patient, which allows us to discharge him on the second, third or fourth day of the operation, so that he can return to work very quickly.
Another advantage is that through the laparoscopy equipment we have the opportunity to enlarge the image several times, which enables us to be precise when cutting the gland. This allows us to reduce the risks of postoperative complications - erectile dysfunction and urine leakage.