Yeditepe University Koşuyolu Hospital Chief Physician and Urologist Prof. Dr. Faruk Yencilek stated that prostate examination and PSA Test can save lives during the prostate cancer process. 

Does Benign Prostate Enlargement Develop into Cancer?

No, it does not. Scientifically, the prostate has 4 anatomical regions. But for practical purposes, there are 2 regions: The inner region and the shell region. Think of the prostate like an orange, the fruit inside, and the peel. Benign prostate enlargement develops from the inner part of the prostate and cancer develops from the outer part. It is important to know this: People who have undergone surgery for benign prostate enlargement say, "I had my prostate removed, there is no need for follow-up anymore". This is extremely wrong. Because in all surgeries for benign prostate enlargement, the shell part of the prostate is left in place and the inner part is drained. Therefore, it should be kept in mind that the risk of cancer development in the shell part continues, and routine annual prostate examinations should be continued.

Why is Prostate Examination Important?

Many men hesitate to go to a urologist because of finger examination. However, the examination gives us very valuable information, especially in terms of cancer. Thanks to finger examination, we can determine the weight of the prostate, whether its surface is regular, whether it grows symmetrically or asymmetrically, and the presence of a hard spot in the prostate. This information gives us serious clues about cancer. Just as a breast examination is important for tumor detection in women, a prostate examination is just as valuable in men. Because you have the chance to touch an organ that may be diseased. In short, there is no point in hesitating, a 1-minute examination and PSA test can save lives.

What is the Importance of the PSA Test?

The prostate gland produces PSA to make semen fluid. Thus, during sexual intercourse, semen flows like water, and sperm is carried into the vagina. Sperm are stored in a waiting room at the back of the prostate and move freely in the prostatic fluid. PSA does not only indicate cancer, but anything that disrupts the integrity of the prostate increases PSA, such as infections (inflammation), benign prostate enlargement, and advancing age.

Is There an Average Value for the PSA Test?

The PSA normally measured inside the prostate is hundreds of times higher than the PSA we measure in the blood. Only a small amount of PSA gets into the blood. The PSA measured in the blood should be below 2.5. It would be better if it is a little lower at a young age.

Are Other Tests Needed for Diagnosis?

We perform a urination test called uroflowmetry. With this test, we understand how blocked the patient's prostate tract is. We measure the amount of urine left behind by ultrasound. We also perform a urinary tract ultrasound to reveal the condition of the kidneys, urinary tract, bladder, and prostate. We always do a urinalysis and try to rule out a possible infection. We look at creatine values in the blood and evaluate kidney function.

Which Treatment Is Available in the First Stage?

The first step in benign prostate enlargement is medication. Of course, if the function of the kidneys has started to deteriorate, if there is a potential for prostate-induced kidney disease, if there are recurrent infections, if there is bleeding in the urinary tract, if there are stones or small pockets called diverticula in the bladder, we skip the medication and proceed directly to surgery. But if there are no such problems, we try to understand the patient's distress with a test called 'symptom scoring'. If the complaints are mild, only follow-up is sufficient. In moderate and severe symptoms, we start treatment with medication. In cases where we cannot get a response with medication, we recommend surgery.

For How Long Are Medications Used in Prostate Enlargement?

Think of prostate medication as blood pressure medication, the patient needs to take it every day, otherwise, the problem starts again. Medication can last for years. Sometimes drugs to shrink the prostate are added to this treatment, and these are used for at least 6 months. According to some studies, these drugs can shrink the prostate by up to 30 percent. Some studies indicate that drugs that shrink the prostate reduce sexual desire by 15-20 percent. But none of the prostate-related drugs reduce erection capacity. In addition, prostate medications can sometimes cause side effects such as regurgitation of semen, dizziness, and weakness.

Can Prostate Medication Lose Its Efficacy After a While?

It can... Even if it is useful in the first years, it may start to lose its effect after 5-10 years. In some patients, the medication may not work at all. In such cases, we switch to surgery.

Can Prostate Enlargement Cause Kidney Damage?

Unfortunately, it can. The basic logic in all the procedures we perform in urology is to protect the kidneys. Of course, the patient needs to urinate comfortably, but what is more vital is to secure the kidneys. Our kidneys are not only dialysis machines, but also provide the excess water balance of our body. They also contribute greatly to acid-base and electrolyte balance. They also secrete hormones. Any condition that prevents normal urine flow is a threat to the kidneys. The philosophy of urology is to provide a urine pattern that is as suitable as possible for human creation so that we can protect the kidneys. The inability to urinate well due to the prostate first impairs the bladder and then the kidneys.