Prof. Dr. Faruk Yencilek, Yeditepe University Kozyatağı Hospital Chief Physician and Urology Specialist, explained the things you should know about prostate and prostate cancer and the developments in the treatment process. 

What Motivated You to Study Medicine?

As an Adana tradition, my family was engaged in farming. One day in my secondary school years, while I was working in the fields, I read an article in a newspaper praising Prof. Dr. Gazi Yaşargil. That article affected me very much and the passion for studying medicine got into my heart that day. I am very happy that I had the opportunity to work with my dear professor Gazi, who sow this passion into my heart, in the same hospital after many years, and being Yaşargil's urology physician has been one of the most honorable coincidences that life has given me.

How Did You End Up at Yeditepe University?

After graduating from Marmara University Faculty of Medicine in 1996, I won the Istanbul University Cerrahpaşa Faculty of Medicine, which was my first choice in the medical specialty exam in the same year. Urology was a branch I wanted very much. In 2001, after graduating from Cerrahpaşa Medical Faculty Urology Department, I wanted to work at a university with a vision for my academic career. At that time, the foundations of Yeditepe University Hospital had just been laid. During my meeting with Mr. Bedrettin Dalan at that time, he drew such a beautiful vision that I said, "I should work at such a university." At that time, I was about to start at another state university. But I was so impressed by the vision drawn by Mr. Bedrettin Dalan that I believed that I could really do this job at Yeditepe and show my talent here. For this reason, I joined the staff even before the hospital was opened and I have been here for 17 years.

Let's Talk About Your Specialty. Could You Briefly Inform Us About the Prostate, the "Troublemaker" of Men?

When men hear the name prostate, they always associate it with bad things and perceive it as equivalent to a disease. However, the prostate is an organ that every man has and is very necessary for reproduction. Because the fluid produced by the prostate provides the appropriate nutrients and environment for sperm to live and this organ starts to gain its full function with puberty. With the increase in testosterone with puberty, the prostate takes that testosterone and converts it into a much stronger male hormone and uses it to fully function. In this way, the prostate also produces the nutrients needed for sperm and the substance to keep that nutrient in a liquid state. With such intense hormone exposure, the organ (prostate) starts to change over time. However, hormonal factors alone are not enough to initiate these changes. Studies show that genetic, hormonal, environmental factors, advanced age, ethnicity, and dietary habits play an important role in both benign prostate enlargement and cancer development. In general, men begin to experience prostate enlargement after their 40s. Symptoms related to prostate enlargement begin to appear over the age of 40. Under the age of 40, difficulties related to urination can mostly be due to infection of the prostate or stenosis of the urinary tract.

Is it Possible to Prevent Prostate Enlargement? What Precautions Can Be Taken?

There cannot be a complete stop. Because there is no single factor in the growth of the prostate. It is not possible to master and change all genetic, hormonal, and environmental factors. You cannot know and change them all. But of course, some points can be taken into consideration in order to take precautions. For example, the prostate does not like a high-calorie diet. High-calorie foods are not suitable for both benign growth and prostate cancer. In addition, infections that develop due to unprotected sexual intercourse, especially in those with multiple sexual partners at a young age, may lead to the early appearance of prostate symptoms, and there is scientific data that it is also related to the development of prostate cancer in the future. Therefore, especially those with multiple partners should pay attention to protection. Apart from that, red meat is not good for the prostate. Saturated or unsaturated fatty acids should also be avoided. However, regular sports and exercise as well as a diet that is suitable for our general health are also suitable for prostate health. In summary; red meat, fatty foods, high-calorie diets, and obesity are not suitable for the prostate. However, we should not forget that diet alone is not enough to control cancer. But it can have an effect on the course of cancer that has already started.

Recently, We Have Heard A Lot About Prostate Cancer. What Are the Changes in This Incidence Over the Years?

Prostate cancer is the second most common cancer in men after lung cancer. The same ranking is also valid for our country. In the USA, where prostate cancer is the most common cancer in the world, approximately 650-700 thousand new prostate cancers are diagnosed every year. In Europe, this number is around 350 thousand. Unfortunately, it has started to be seen with increasing frequency in our country. The reason why we hear about prostate cancer more frequently is the awareness of people and the development of screening methods. The aim of the treatment of prostate cancer is to diagnose the disease before it becomes symptomatic. In order to achieve this, we commonly use two screening methods. The first of these is the blood analysis we call PSA, and the other is rectal examination. With these two screening tests, we can detect 70 to 80 percent of clinically significant tumors. Therefore, regular health checks are very important in this sense. Thanks to both screening and regular health checks, more prostate cancer can now be detected. However, nowadays we can catch prostate cancer at an earlier stage. In the 1980s, most prostate cancers could be detected as metastatic, that is when they had spread to other organs, whereas today, although more men are diagnosed with prostate cancer, it can be detected at an early stage.

Has This Resulted in a Reduction in Mortality Rates?

Yes, there has been a significant reduction in loss of life. We aim to detect the tumor in prostate cancer while it is still confined to the organ (before it grows outside the prostate). Because when it is detected at this stage, it is possible to completely disable the disease with current treatment methods. Prostate cancer is an insidious type of cancer. PSA and regular urological controls have increased the detection rate of prostate cancer. In addition, it has reduced the loss of life due to the disease by about 60 percent worldwide. Today, patients should know these things. In other words, patients should not just say 'I have cancer, what should I do', the awareness should reach such a level that the patient should ask his physician 'is my cancer limited to the organ (inside the prostate?) or is it outside the organ?

Are There Any New Technological Advances in the Fight Against Prostate Today?

There have been innovations in every stage of the disease related to the prostate. Because the prostate is one of the most researched cancers in the world. Surgical techniques have also changed in recent years. The recipe for success in the treatment of prostate cancer caught at an early stage is not limited to oncologic results. We look at three important outcomes called "trifecta". The first is the oncologic control of cancer, the second is the patient's ability to maintain an erection after treatment, and the third is the patient's ability to continue his life without incontinence. Serious success has been achieved in this regard. When we detect prostate cancer while it is inside the prostate (limited to the organ), we divide it into three subgroups "low, medium, and high-risk" according to its potential to spread outside the organ. This distinction also determines our treatment approach.

Today, with the introduction of the "Multi-parametric Prostate MRI" diagnostic method, the rate of unnecessary prostate biopsy has decreased, and the accuracy of the biopsy has increased. Thus, this technique can help us detect cancer at an early stage. According to the results of Multi-parametric Prostate MRI, it is possible to diagnose cancer only by biopsy from the target. If the cancer is limited to the organ and is in the low or medium-risk group, it is also possible to apply focal treatment as a treatment method. In other words, only the cancerous area is burned with special energy without removing the patient's prostate. In other words, we can cure "local disease with focal treatment". In focal treatment, which has been widely used in recent years, only the cancerous tissue is burned, and the prostate is not damaged. Thus, possible complications are prevented, and the patient can recover quickly. However, in patients in the high-risk group, surgical treatment gains priority.

What Would You Recommend for Protection?

Prostate cancer has multiple causes. Genetic predisposition, advanced age, and ethnicity are the most important determinants. These are not factors that can be controlled today. However, some important dietary and lifestyle changes can help both in the prevention and treatment of prostate cancer. General health measures such as a monogamous life or protected sexual intercourse against sexually transmitted diseases, regular exercise, and a healthy diet are also important for prostate health. Linoleic acid in red meat increases the rate of spread of prostate cancer that has already started. For this reason, red meat consumption should be carefully monitored. The second important point is overweight. The protein called leptin and insulin-like growth factor found in adipose tissue contribute to the development and progression of prostate cancer. Therefore, precautions should be taken against being overweight. In addition, fat-rich and high-calorie foods should be avoided. On the other hand, tomatoes, green tea, and soy group are foods that reduce the growth of prostate cancer cells due to their lycopene content. It is important to include more of these in our diet.