Late diagnosis is an important problem in prostate cancer.
Not paying attention to the diagnosis of prostate cancer
Stating that 4,500 new prostate cancer cases can be detected every year in Turkey, VKV American Hospital Urology Department Head Prof. Dr. Tarık Esen stated that the real figure is much higher than this. Expressing that 250 thousand people are diagnosed with prostate cancer annually in the United States, Prof. Dr. Esen stated that sufficient care is not shown in the diagnosis of the disease in Turkey. prof. Dr. Esen answered the questions of the Medical Academy about the current developments in prostate cancer treatment.
What is the incidence of prostate cancer in our country?
When you look at the frequency of prostate cancer in the USA, we see that there is a significant numerical difference. In our country, 4500 new prostate cancer cases are detected annually. There is a big difference when compared to the population. It means that there are problems with diagnosis. We know that not all patients who were decided to have surgery were operated on.
So we stay in a low number. Let’s look at who has surgery and from that aspect, everyone who has been diagnosed with prostate cancer? Of course no. Surgery is only a very valuable weapon in the curative treatment of early diagnosis. Early diagnosis is not enough either. The patient must be a suitable candidate for surgery in many respects. For this reason, patients over the age of 75 are still hesitant and require a decision process in which we consider other options.
Prostate cancer symptoms, early diagnosis and new treatment options
Can you give information about the diagnosis process in our country?
With the increase of early diagnosis mechanism and awareness in the society, prostate cancer can be diagnosed at an earlier stage. This allows us to reach patients at an earlier stage and younger. However, it is not possible to say for Turkey in general. In societies where this early diagnosis program, consisting of PSA and finger examination, is implemented, the stage in which prostate cancer is recognized has been seriously reduced. While we used to encounter advanced disease frequently, now we are in a better situation.
What is the transition time from early to metastatic stage?
This process can take several decades because the disease actually has a slowly progressive character. For example, if you take the first cell as a basis, a 55-year-old patient may have a history going back 15-20 years. In other words, when we diagnose the patient, it can take an average of 10 years. This long process is a great chance for the diagnosis of the disease. This slow growth creates a situation where the disease still does not advance its stage, even though it leaves behind a long period of time. Of course there are exceptions who are very quick and aggressive; but they are a smaller group within the general prostate cancer population.
What problems does late diagnosis create? What is the mortality of the disease?
One of the features of prostate cancer is; We don’t have to catch every prostate cancer case. Because some patients probably end their lives for other reasons without ever being diagnosed with prostate cancer. Already, the increased diagnosis rate with the frequent use of PSA has started a new discussion. ‘I wonder if this situation causes people who do not need to be diagnosed to be diagnosed as well? Is there an unnecessary patient group that is treated when treatment is not needed? This debate still continues in the urology community. However, we know that in our country, this is only a matter for a very small group. Because the main problem for us is the low diagnosis rates.
The problem of every man after the age of forty! Early diagnosis is very important in prostate cancer.
Could the number of physicians be a factor in the low diagnosis rates?
There are over 1700 urologist physicians in our country. We think this number is a good figure for Turkey. Compared to other branches, this is a good number. There is a urologist in almost every district state hospital in our country. Therefore, we do not think that there is a significant problem regarding the number of physicians.
But there is an awareness problem about the seriousness of the issue. On the other hand, the male patient, who has no complaints, associates the prostate problem with urination problems as a whole. Therefore, he thinks that those who do not have a urination problem cannot have prostate cancer. But there is no correlation between prostate cancer and urination problem.
What are the treatment rates?
The cure rates for prostate cancer are extremely high. Today, the 15-year survival of patients who can undergo radical prostatectomy is 95%. This is a very high rate for a cancer surgery field. The key answer here is early diagnosis. Early diagnosis is equivalent to cure.
Prostate cancer process and early diagnosis
It is difficult to enumerate enormous clear findings in the etiology of prostate cancer. As in all types of cancer, we can blame environmental factors and hereditary factors. If one of their relatives has prostate cancer, the risk may increase 2-3 times, and if two family members have the disease, this rate may increase up to 5-7 times. Meanwhile, if the index prostate cancer patient is under the age of 65, but his father was diagnosed with prostate cancer under the age of 65, the risk increases even more.
The test every man should have after 45…
Therefore, the age of the index person is also a very important factor. Apart from that, diet and race can play a role as a factor. There is only one indisputable need for prostate cancer, being aging. If men are biopsied for prostate cancer after age 80, most will likely find cancer. But the question is whether this cancer has clinical significance. This may be one of the blocking factors in Turkey, in fact, I don’t want to attribute too much importance to this.
Unfortunately, prostate examination is unpleasant, this is a problem in our total subconscious. However, finger examination is an examination that closes the gaps of the very valuable PSA. Having a low PSA becomes valuable with a clean finger examination.
Is there a template for operation criteria?
The operating criteria are well defined, and we even solve this by dividing the disease into risk groups. We rarely operate on high-risk patients unless they are very young. Therefore, the surgical group consists of low-risk and well-selected intermediate-risk patients. We can define a good patient description for the operation as follows. Patients who are not disabled for surgery, are younger than 70 years old, have a life expectancy of at least 10 years, not restricted for other reasons, and have a PSA below 10 can be counted. The patient should be well-informed in all aspects and should consider alternatives in solutions.